Berkeley Center for Health Technology, School of Public Health, University of California, Berkeley, CA, USA.
Health Aff (Millwood). 2013 Aug;32(8):1392-7. doi: 10.1377/hlthaff.2013.0188.
Some employers are implementing reference-pricing benefit designs, which establish limits on the amount they will pay for some procedures covered by employer-sponsored insurance. Employees are required to pay the difference between the employer's contribution limit and the actual price received by the hospital. These initiatives encourage patients to select low-price facilities and indirectly encourage facilities to reduce prices to increase patient volume. We evaluated the impact of reference pricing on the use of and prices paid for knee and hip replacement surgery by members of the California Public Employees' Retirement System (CalPERS) from 2008 to 2012, using enrollees in Anthem Blue Cross as a comparison group. In the first year after implementation, surgical volumes for CalPERS members increased by 21.2 percent at low-price facilities and decreased by 34.3 percent at high-price facilities. Prices charged to CalPERS members declined by 5.6 percent at low-price facilities and by 34.3 percent at high-price facilities. Our analysis indicates that in 2011 reference pricing accounted for $2.8 million in savings for CalPERS and $0.3 million in lower cost sharing for CalPERS members.
一些雇主正在实施参考定价福利设计，为雇主赞助保险所涵盖的某些程序设定支付上限。员工需要支付雇主缴费上限与医院实际收取价格之间的差额。这些举措鼓励患者选择低价医疗机构，并间接地鼓励医疗机构降低价格以增加患者量。我们评估了参考定价对加州公共雇员退休系统（CalPERS）成员在 2008 年至 2012 年期间进行膝关节和髋关节置换手术的使用和支付价格的影响，使用安森蓝十字的参保人员作为对照组。在实施的第一年，低价医疗机构的手术量增加了 21.2%，高价医疗机构的手术量则下降了 34.3%。向 CalPERS 成员收取的价格在低价医疗机构下降了 5.6%，在高价医疗机构下降了 34.3%。我们的分析表明，2011 年参考定价为 CalPERS 节省了 280 万美元，为 CalPERS 成员降低了 30 万美元的自付费用。
