Department of Health Policy and Management, the Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA; email:
Annu Rev Public Health. 2020 Apr 2;41:537-549. doi: 10.1146/annurev-publhealth-040119-094345.
Medicaid is integral to public health because it insures one in five Americans and half of the nation's births. Nearly two-thirds of all Medicaid recipients are currently enrolled in a health maintenance organization (HMO). Proponents of HMOs argue that they can lower costs while maintaining access and quality. We critically reviewed 32 studies on Medicaid managed care (2011-2019). Authors reported state-specific cost savings and instances of increased access or quality with implementation or redesign of Medicaid managed-care programs. Studies on high-risk populations (e.g., disabled) found improvements in quality specific to a state or a high-risk population. A unique model of managed care (i.e., the Oregon Health Plan) was associated with reduced costs and improved access and quality, but results varied by comparison state. New trends in the literature focused on analysis of auto-assignment algorithms, provider networks, and plan quality. More analysis of costs jointly with access/quality is needed, as is research on managing long-term care among elderly and disabled Medicaid recipients.
医疗补助是公共卫生的重要组成部分，因为它为五分之一的美国人以及全国一半的新生儿提供了保险。目前，近三分之二的医疗补助受助人参加了健康维护组织（HMO）。HMO 的支持者认为，它们可以在保持可及性和质量的同时降低成本。我们对 32 项关于医疗补助管理式医疗的研究进行了批判性回顾（2011-2019 年）。作者报告了在实施或重新设计医疗补助管理式医疗计划后，各州特定的节省成本以及增加可及性或质量的情况。针对高风险人群（如残疾人）的研究发现，特定于一个州或高风险人群的质量有所提高。一种独特的管理式医疗模式（即俄勒冈健康计划）与降低成本以及改善可及性和质量相关，但结果因比较州而异。文献中的新趋势侧重于自动分配算法、供应商网络和计划质量的分析。需要对成本与可及性/质量进行更多的联合分析，同时还需要研究老年和残疾医疗补助受助人的长期护理管理。
