Department of Health Care Policy, Harvard Medical School, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Health Aff (Millwood). 2011 Sep;30(9):1786-94. doi: 10.1377/hlthaff.2011.0132. Epub 2011 Aug 18.
The proliferation of Medicare Advantage plans has given Medicare enrollees more choices, but these could be overwhelming for some, especially for those with impaired decision-making capabilities. We analyzed national survey data and linked Medicare enrollment data for the period 2004-07 to examine the effects on enrollment of expanded choices and benefits in the Medicare Advantage program. The availability of more plan options was associated with increased enrollment in Medicare Advantage when elderly Medicare beneficiaries chose from a limited number of plans-for example, fewer than fifteen plans. Enrollment was unchanged or decreased in Medicare Advantage when beneficiaries chose from larger numbers of plans-for example, fifteen to thirty, or more than thirty. Elderly adults with low cognitive function were less responsive to the generosity of available benefits than those with high cognitive function when choosing between traditional Medicare and Medicare Advantage. Simplifying choices in Medicare Advantage could improve beneficiaries' enrollment decisions, strengthen value-based competition among plans, and extend the benefits of choice to seniors with impaired cognition. It could also lower their out-of-pocket costs.
医疗保险优势计划的激增为医疗保险参保人提供了更多的选择，但对于一些人来说，这些选择可能会让人不知所措，尤其是对于那些决策能力受损的人。我们分析了 2004 年至 2007 年期间的全国调查数据，并将医疗保险参保数据进行了关联，以研究医疗保险优势计划中扩大选择和福利对参保的影响。当老年医疗保险受益人从有限数量的计划中选择时，例如选择少于十五个计划，更多的计划选择与医疗保险优势计划的参保人数增加有关。当受益人从更多的计划中选择时，例如十五到三十个，或者三十个以上，医疗保险优势计划的参保人数保持不变或减少。在选择传统医疗保险和医疗保险优势计划时，认知功能较低的老年人对可用福利的慷慨程度反应不如认知功能较高的老年人敏感。在医疗保险优势计划中简化选择可以改善受益人的参保决策，加强计划之间基于价值的竞争，并将选择的好处扩展到认知能力受损的老年人。这也可以降低他们的自付费用。
