Hall Mark A, McCue Michael J
Wake Forest University School of Law and School of Medicine, USA.
Issue Brief (Commonw Fund). 2013 Mar;14:1-9.
The Affordable Care Act's medical loss ratio (MLR) regulation requires insurers to spend 80 percent or 85 percent of premiums on medical claims and quality improvements. In 2011, insurers falling below this minimum paid more than $1 billion in rebates. This brief examines how insurers spend their premium dollars--particularly their investment in quality improvement activities--focusing on differences among insurers based on corporate traits. In the aggregate, insurers paid less than 1 percent of premiums on either MLR rebates or quality improvement activities in 2011, with amounts varying by insurer type. Publicly traded insurers had significantly lower MLRs in each market segment (individual, small group, and large group), and were more likely to owe a rebate in most segments compared with non-publicly traded insurers. The median quality improvement expenditure per member among nonprofit and provider-sponsored insurers was more than the median among for-profit and non-provider-sponsored insurers.
《平价医疗法案》的医疗损失率（MLR）规定要求保险公司将保费的80%或85%用于医疗理赔和质量改进。2011年，未达到这一最低标准的保险公司支付了超过10亿美元的回扣。本简报探讨了保险公司如何使用保费资金，特别是他们在质量改进活动上的投入，重点关注基于公司特征的保险公司之间的差异。总体而言，2011年保险公司在MLR回扣或质量改进活动上的支出不到保费的1%，支出金额因保险公司类型而异。在每个市场细分领域（个人、小团体和大团体），上市保险公司的MLR显著较低，与非上市保险公司相比，在大多数细分领域更有可能支付回扣。非营利性和提供者赞助的保险公司中，每位成员的质量改进支出中位数高于营利性和非提供者赞助的保险公司。
