Department of Health Policy and Management, Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Health Aff (Millwood). 2013 May;32(5):900-9. doi: 10.1377/hlthaff.2012.1203.
Medicare's core benefit design reflects private insurance as of 1965, with separate coverage for hospital and physician services (and now prescription drugs) and no protection against catastrophic costs. Modernizing Medicare's benefit design to offer comprehensive benefits, financial protection, and incentives to choose high-value care could improve coverage and lower beneficiary costs. We describe a new option we call Medicare Essential, which would combine Medicare's hospital, physician, and prescription drug coverage into an integrated benefit with an annual limit on out-of-pocket expenses for covered benefits. Cost sharing would be reduced for enrollees who seek care from high-quality low-cost providers. Out-of-pocket savings from lower premiums and health care costs for a Medicare Essential enrollee could be $173 per month, compared to what an enrollee would pay with traditional Medicare, prescription drug and private supplemental coverage. Financed by a budget-neutral premium, we estimate that this new plan choice could reduce total health spending relative to current projections by $180 billion and reduce employer retiree spending by $90 billion during 2014-23. Given its potential, such an alternative should be a part of the debate over the future of Medicare.
医疗保险的核心福利设计反映了 1965 年的私人保险，分别涵盖医院和医生服务（现在还有处方药），但没有针对灾难性费用的保障。使医疗保险的福利设计现代化，提供全面的福利、财务保障，并为选择高价值的医疗服务提供激励，可以改善覆盖范围并降低受益人的成本。我们描述了一种新的选择，我们称之为“医疗保险基础”，它将医疗保险的住院、医生和处方药物覆盖范围合并为一个综合福利，为涵盖的福利设定了年度自付费用上限。对于寻求高质量、低成本提供者的参保者，分担费用将会降低。与传统的医疗保险、处方药和私人补充保险相比，医疗保险基础参保者的每月自付节省可能为 173 美元。通过预算中性保费提供资金，我们估计这种新的计划选择可以使相对于当前预测的总医疗支出减少 1800 亿美元，并在 2014-2023 年期间减少雇主退休人员支出 900 亿美元。鉴于其潜力，这种替代方案应该成为医疗保险未来辩论的一部分。
