医疗保险中的竞标：竞争能使谁受益？
Competitive bidding in Medicare: who benefits from competition?
机构信息
Department of Health Care Policy, Harvard Medical School, National Bureau of Economic Research, Boston, MA 02115, USA.
出版信息
Am J Manag Care. 2012 Sep;18(9):546-52.
OBJECTIVES
To conduct the first empirical study of competitive bidding in Medicare.
STUDY DESIGN AND METHODS
We analyzed 2006-2010 Medicare Advantage data from the Centers for Medicare and Medicaid Services using longitudinal models adjusted for market and plan characteristics.
RESULTS
A $1 increase in Medicare's payment to health maintenance organization (HMO) plans led to a $0.49 (P <.001) increase in plan bids, with $0.34 (P <.001) going to beneficiaries in the form of extra benefits or lower cost sharing. With preferred provider organization and private fee-for-service plans included, higher Medicare payments increased bids less ($0.33 per dollar), suggesting more competition among these latter plans.
CONCLUSIONS
As a market-based alternative to cost control through administrative pricing, competitive bidding relies on private insurance plans proposing prices they are willing to accept for insuring a beneficiary. However, competition is imperfect in the Medicare bidding market. As much as half of every dollar in increased plan payment went to higher bids rather than to beneficiaries. While having more insurers in a market lowered bids, the design of any bidding system for Medicare should recognize this shortcoming of competition.
目的
对医疗保险中的竞标进行首次实证研究。
研究设计与方法
我们使用纵向模型，根据市场和计划特征对 2006 年至 2010 年医疗保险优势数据进行了分析。
结果
医疗保险向健康维护组织（HMO）计划支付的款项增加 1 美元，导致计划竞标增加 0.49 美元（P <.001），其中 0.34 美元（P <.001）以额外福利或更低的自付额形式支付给受益人。如果包括首选提供商组织和私人按服务收费计划，医疗保险支付额越高，竞标增加的幅度越小（每美元增加 0.33 美元），这表明这些计划之间的竞争更为激烈。
结论
作为通过行政定价进行成本控制的一种基于市场的替代方案，竞标依赖于私营保险公司提出他们愿意接受的价格，为受益人提供保险。然而，医疗保险竞标市场的竞争并不完美。每增加一美元的计划支付中，有多达一半的金额用于提高竞标价格，而不是支付给受益人。虽然市场上有更多的保险公司会降低竞标价格，但任何医疗保险竞标系统的设计都应认识到竞争的这一缺陷。
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