Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.
Health Serv Res. 2012 Dec;47(6):2339-52. doi: 10.1111/j.1475-6773.2012.01426.x. Epub 2012 May 11.
To assess the impact of the Patient Protection and Affordable Care Act's (ACA) changes in Medicare Advantage (MA) payment rates on the availability of and enrollment in MA plans.
Secondary data on MA plan offerings, contract offerings, and enrollment by state and county, in 2010-2011.
We estimated regression models of the change in the number of plans, the number of contracts, and enrollment as a function of quartiles of FFS spending and pre-ACA MA payment generosity. Counties in the lowest quartile of spending are treated most generously by the ACA.
Relative to counties in the highest quartile of spending, the number of plans in counties in the first, second, and third quartiles rose by 12 percent, 7.6 percent, and 5.4 percent, respectively. Counties with more generous MA payment rates before the ACA lost significantly more plans. We did not find a similar impact on the change in contracts or enrollment.
The ACA-induced MA payment changes reduced the number of plan choices available for Medicare beneficiaries, but they have yet affected enrollment patterns.
评估《患者保护与平价医疗法案》（ACA）对医疗保险优势计划（MA）支付率的调整对 MA 计划的供应和参保情况的影响。
2010-2011 年按州和县划分的 MA 计划提供情况、合同提供情况和参保情况的二级数据。
我们估计了计划数量、合同数量和参保情况变化的回归模型，作为 FFS 支出和 ACA 前 MA 支付慷慨程度的四分位数的函数。在支出最低的县，ACA 的待遇最慷慨。
与支出最高的县相比，支出处于第一、第二和第三四分位数的县的计划数量分别增加了 12%、7.6%和 5.4%。在 ACA 之前 MA 支付率较高的县，计划数量显著减少。我们没有发现对合同或参保变化的类似影响。
ACA 引发的 MA 支付变化减少了医疗保险受益人的计划选择数量，但尚未影响参保模式。
