McCue Michael J, Hall Mark
Virginia Commonwealth University, Richmond, VA, USA
Wake Forest University, Winston-Salem, NC, USA.
Med Care Res Rev. 2015 Feb;72(1):113-22. doi: 10.1177/1077558714563172. Epub 2014 Dec 18.
The Affordable Care Act requires health insurers to rebate any amounts less than 80%-85% of their premiums that they fail to spend on medical claims or quality improvement. This study uses the new comprehensive reporting under this law to examine changes in insurers' financial performance and differences in their quality improvement expenditures. In the ACA's second year (2012), insurers' median medical loss ratios continued to increase and their median administrative cost ratios dropped, producing moderate operating margins in the group markets but a small operating loss in the individual market, at the median. For-profit insurers showed larger changes, in general, than did nonprofits. For quality improvement, insurers reported spending a significantly greater amount per member in their government plans than they did on their self-insured members, with spending on commercial insurance being in between these two extremes. The magnitude and source of these differences varied by corporate ownership.
《平价医疗法案》要求健康保险公司退还其保费中未用于医疗理赔或质量改进的金额，退还比例低于保费的80%-85%。本研究利用该法律下新的综合报告来检验保险公司财务业绩的变化及其质量改进支出的差异。在《平价医疗法案》实施的第二年（2012年），保险公司的医疗损失率中位数持续上升，行政成本率中位数下降，在团体市场产生了适度的运营利润率，但在个人市场中位数水平出现了小额运营亏损。总体而言，营利性保险公司的变化比非营利性保险公司更大。在质量改进方面，保险公司报告称，其政府计划中每位成员的支出明显高于自保成员，商业保险支出则介于这两个极端之间。这些差异的程度和来源因公司所有权而异。
