Commonwealth Fund in New York City, USA.
Health Aff (Millwood). 2012 Aug;31(8):1866-75. doi: 10.1377/hlthaff.2011.1357. Epub 2012 Jul 18.
The experiences of people covered by Medicare and those with private employer insurance can help inform policy debates over the federal budget deficit, Medicare's affordability, and the expansion of private health insurance under the Affordable Care Act. This article provides evidence that people with employer-sponsored coverage were more likely than Medicare beneficiaries to forgo needed care, experience access problems due to cost, encounter medical bill problems, and be less satisfied with their coverage. Within the subset of beneficiaries who are age sixty-five or older, those enrolled in the private Medicare Advantage program were less likely than those in traditional Medicare to have premiums and out-of-pocket costs exceed 10 percent of their income. But they were also more likely than those in traditional Medicare to rate their insurance poorly and to report cost-related access problems. These results suggest that policy options to shift Medicare beneficiaries into private insurance would need to be attentive to potentially negative insurance experiences, problems obtaining needed care, and difficulties paying medical bills.
医疗保险覆盖人群和私人雇主保险人群的经历可以为联邦预算赤字、医疗保险的负担能力以及平价医疗法案下私人医疗保险的扩张等政策辩论提供信息。本文提供的证据表明，与医疗保险受益人相比，有雇主提供保险的人更有可能放弃必要的医疗服务，因费用而出现获得医疗服务的问题，遭遇医疗账单问题，对其保险的满意度较低。在 65 岁或以上的受益人群体中，参加私人医疗保险优势计划的人比参加传统医疗保险的人保费和自付费用超过其收入的 10%的可能性更小。但与传统医疗保险相比，他们更有可能对自己的保险评价不佳，并报告与费用相关的获得医疗服务的问题。这些结果表明，将医疗保险受益人群转移到私人保险的政策选择需要关注潜在的负面保险体验、获得所需医疗服务的问题以及支付医疗账单的困难。
