Welch W P
Urban Institute, Washington, DC 20037.
Inquiry. 1989 Fall;26(3):321-34.
The Federal Employees Health Benefits Program (FEHBP) needs to contain its costs. This paper recommends reforms of FEHBP that would substantially lower costs. As a first step, FEHBP should offer each employee a high and low option from a single conventional carrier, plus several HMO alternatives. FEHBP's practice of offering employees a choice of conventional carriers is virtually unheard of in the private sector. Cost control is more likely when carriers compete for employment groups rather than for individual employees. In addition, my analysis suggests that FEHBP should self-insure, competitively select third-party administrators (TPAs), one for each region of the country, aggressively manage program costs through preadmission certification and DRGs, and allow Medicare-eligible annuitants to enroll in Medicare HMOs and receive the government contribution. All of these reforms have been successfully implemented elsewhere, either by private employers or state or federal governments. These reforms would yield savings of at least $500 million annually for taxpayers and additional savings for federal employees.
联邦雇员健康福利计划（FEHBP）需要控制其成本。本文建议对FEHBP进行改革，以大幅降低成本。第一步，FEHBP应从单一传统承保公司为每位员工提供一个高成本和低成本选项，再加上几个健康维护组织（HMO）的替代方案。FEHBP让员工选择传统承保公司的做法在私营部门几乎闻所未闻。当承保公司争夺就业群体而非单个员工时，成本控制更有可能实现。此外，我的分析表明，FEHBP应进行自我保险，竞争性地选择第三方管理机构（TPA），为美国每个地区各选一家，通过入院前认证和诊断相关分组（DRG）积极管理项目成本，并允许符合医疗保险资格的年金领取者加入医疗保险HMO并领取政府补贴。所有这些改革在其他地方都已由私人雇主或州或联邦政府成功实施。这些改革每年将为纳税人节省至少5亿美元，并为联邦雇员带来额外节省。
