Frank Richard G
Department of Health Care Policy, Harvard Medical School.
Issue Brief (Commonw Fund). 2019 Jan 1;2019:1-11.
Republicans and Democrats agree on prioritizing choice in health insurance, but disagree on what it entails and how to achieve it. Choice and competition can create negative consequences, including adverse selection and consumer confusion.
Examine the experiences of the Affordable Care Act’s marketplaces and recommend ways policymakers can harness choice and competition to improve coverage, satisfaction, and affordability.
Review of existing evidence.
There are multiple areas where insurance design could promote efficient competition and consumer choice. Experiences with the ACA have shown that health insurance marketplaces should include an urban area with adjacent rural and suburban communities to promote competition among insurers. Other recommendations include allowing smaller insurance carriers to base medical loss ratio rates on past years’ data; allowing insurers to bid against each other for contracts to serve a population; providing resources to allow consumers to make informed choices; and including features like essential health benefits to counteract adverse selection.
Markets can deliver efficient premiums, access to care, and consumer satisfaction but only when they are carefully designed and actively managed through regulation.
共和党人和民主党人在医疗保险中优先考虑选择这一点上达成一致，但在其内涵以及如何实现这一点上存在分歧。选择和竞争可能会产生负面后果，包括逆向选择和消费者困惑。
审视《平价医疗法案》市场的经验，并为政策制定者提出利用选择和竞争来改善保险覆盖范围、满意度和可承受性的方法。
审查现有证据。
在多个领域，保险设计可以促进有效竞争和消费者选择。《平价医疗法案》的经验表明，医疗保险市场应包括一个与相邻农村和郊区社区相邻的城市地区，以促进保险公司之间的竞争。其他建议包括允许较小的保险公司根据过去几年的数据确定医疗损失率；允许保险公司相互竞标为特定人群提供服务的合同；提供资源使消费者能够做出明智的选择；以及纳入基本健康福利等特征以应对逆向选择。
市场能够提供有效的保费、医疗服务可及性和消费者满意度，但前提是市场经过精心设计并通过监管进行积极管理。
