Department of Finance, Insurance and Real Estate, Virginia Commonwealth University, Snead Hall, 301 W Main St, Ste B4167, Richmond, VA 23284-4000. Email:
Am J Manag Care. 2021 Apr 1;27(4):e123-e129. doi: 10.37765/ajmc.2021.88621.
Proponents of a single-payer or public option health care system often cite the lower administrative expenses in public Medicare compared with those in private Medicare, claiming that this difference represents efficiency. We check the validity of this comparison in terms of accuracy and definitions and suggest expanding its scope to include expanded financial data of the 2 Medicare systems.
Using annual Medicare Boards of Trustees and National Health Expenditure Accounts data from CMS and health insurers' financial statement data, we compare the level and percentage of the administrative expenses of the Medicare systems and show incompatible and not reconcilable definitions of administrative expenses. We expand our analysis to income, benefits, gains and losses, and loss ratios of the programs.
Our methodology is a careful comparison of categories of expenses between public and private insurers using official data sources. The comparison is both qualitative and quantitative.
We validate the low administrative expenses of Medicare parts A, B, and D (1.35% of benefits in 2018) compared with Medicare Part C (10.86% of benefits without loss adjustment expenses [LAE] and 14.84% with LAE for 2018). Expanding the focus, the income and benefits per beneficiary grew faster and larger in Medicare parts A, B, and D than in Medicare Part C-a reversal of earlier trends. The public Medicare program suffered losses in 11 years during 2002-2018, whereas private insurers' Medicare remained solvent with about an 85% loss ratio.
Comparisons of the systems in the United States would benefit from expanding the focus beyond incomparable administrative expenses. For the current period of coronavirus disease 2019, if the trends continue, public Medicare may suffer greater deficits relative to the private Medicare Part C.
单一支付者或公共选择医疗保健系统的支持者经常引用公共医疗保险比私人医疗保险的行政费用低，声称这种差异代表了效率。我们根据准确性和定义来检查这种比较的有效性，并建议扩大其范围，将两个医疗保险系统的扩展财务数据包括在内。
使用来自 CMS 和医疗保险承保人财务报表数据的年度医疗保险理事会和国家卫生支出账户数据，我们比较了医疗保险系统的行政费用水平和百分比，并显示行政费用的定义不兼容且不可调和。我们将分析扩展到该计划的收入、福利、收益和损失率。
我们的方法是使用官方数据源仔细比较公共和私人保险公司之间的费用类别。这种比较既是定性的，也是定量的。
与医疗保险部分 C（2018 年无损失调整费用[LAE]的 10.86%和有 LAE 的 14.84%）相比，我们验证了医疗保险部分 A、B 和 D 的行政费用较低（2018 年福利的 1.35%）。扩大重点，医疗保险部分 A、B 和 D 的每位受益人的收入和福利增长速度和幅度都快于医疗保险部分 C-这是早期趋势的逆转。公共医疗保险计划在 2002 年至 2018 年的 11 年中遭受损失，而私人保险公司的医疗保险仍保持偿付能力，损失比率约为 85%。
如果将重点扩大到无法比较的行政费用之外，对美国系统的比较将受益。对于当前的 2019 年冠状病毒病时期，如果趋势继续下去，公共医疗保险相对于私人医疗保险部分 C 可能会遭受更大的赤字。
