Harrington Scott E
Health Care Management Department, Wharton School, University of Pennsylvania, USA.
Inquiry. 2013 Spring;50(1):9-26. doi: 10.5034/inquiryjrnl_50.01.05.
The minimum medical loss ratio (MLR) regulations in the Affordable Care Act guarantee that a specific percentage of health insurance premiums is spent on medical care and specified activities to improve health care quality. This paper analyzes the regulations' potential unintended consequences and incentive effects, including: higher medical costs and premiums for some insurers; less innovation to align consumer, provider, and health plan incentives, less consumer choice and increased market concentration; and the risk that insurers will pay rebates if claim costs are lower than projected when premiums are established, despite the regulations' permitted "credibility adjustments." The paper discusses modifications and alternatives to the MLR regulations to help achieve their stated goals with less potential for adverse effects.
《平价医疗法案》中的最低医疗损失率（MLR）规定确保了一定比例的医疗保险费用于医疗保健及为提高医疗保健质量而开展的特定活动。本文分析了这些规定可能产生的意外后果和激励效应，包括：一些保险公司的医疗成本和保费增加；在调整消费者、医疗服务提供者和健康计划激励措施方面的创新减少，消费者选择减少，市场集中度提高；以及尽管规定允许进行“可信度调整”，但如果在设定保费时索赔成本低于预期，保险公司仍需支付回扣的风险。本文讨论了对MLR规定的修改和替代方案，以帮助在减少负面影响可能性的情况下实现其既定目标。
