RTI International, Research Triangle Park, NC, USA.
University of Virginia, Charlottesville, VA, USA.
Med Care Res Rev. 2020 Apr;77(2):176-186. doi: 10.1177/1077558718785559. Epub 2018 Jul 12.
To combat risk selection, it is becoming increasingly common for payments to insurers (and providers) to adjust for patients' chronic conditions. A possible unintended negative consequence is to reduce insurers' (and providers') incentives to prevent chronic conditions. This study examined the effect of Medicare's risk adjustment for payments to Medicare Advantage plans, first introduced in 2004, on pneumonia and influenza vaccination for the elderly. The analysis used the 2000 through 2010 waves of the Medicare Current Beneficiary Survey and a difference-in-differences approach. Presumably by decreasing Medicare Advantage plans' positive influence on vaccination, Medicare's risk adjustment policy was estimated to have reduced pneumonia vaccination rates by 2.9 percentage points (4%, = .039) and to have possibly reduced influenza vaccination rates by 2.2 percentage points (3%, = .096). The results clarify an argument against including vaccine-preventable conditions, like pneumonia, in a risk adjustment model.
为了应对风险选择，支付给保险公司（和供应商）的款项越来越多地根据患者的慢性病情况进行调整。一个可能的意外负面后果是降低保险公司（和供应商）预防慢性病的积极性。本研究考察了 2004 年首次引入的医疗保险向医疗保险优势计划支付的风险调整对老年人肺炎和流感疫苗接种的影响。该分析使用了 2000 年至 2010 年的医疗保险当前受益人调查数据和差异中的差异方法。据推测，通过降低医疗保险优势计划对疫苗接种的积极影响，医疗保险的风险调整政策估计使肺炎疫苗接种率降低了 2.9 个百分点（4%，p=.039），并可能使流感疫苗接种率降低了 2.2 个百分点（3%，p=.096）。结果澄清了反对在风险调整模型中纳入可通过疫苗预防的疾病（如肺炎）的论点。
