Jones S B
Health Insurance Reform Project, George Washington University, Washington, D.C., USA.
Hosp J. 1998;13(1-2):101-15. doi: 10.1080/0742-969x.1998.11882891.
Premium adjustors to neutralize risk selection among health plans are the weakest component in the technology for assuring competitive markets. It will be many years before we have adjustors adequate to free health plans to invest in and market improved managed care to predictably high-cost chronically ill persons. For want of a fair premium, health plans are driven by risk selection to underinvest in and otherwise "demarket" care to these very employees and beneficiaries whose costs and care most need to be managed. To achieve best value for the chronically ill, large employer coalitions, Medicare, and Medicaid should consider radical new approaches, such as establishing separate prices for care to people with specific chronic conditions and purchasing such care both from health plans and directly from provider systems.
用于抵消健康计划之间风险选择的保费调整机制是确保竞争性市场的技术中最薄弱的环节。在我们拥有足够的调整机制，使健康计划能够放心地投资并向可预测的高成本慢性病患者推销改进的管理式医疗之前，还需要很多年。由于缺乏公平的保费，健康计划受风险选择驱动，对这些成本和护理最需要管理的员工和受益人投资不足，并在其他方面减少对他们的护理服务。为了让慢性病患者获得最佳价值，大型雇主联盟、医疗保险和医疗补助计划应考虑激进的新方法，例如为患有特定慢性病的人制定单独的护理价格，并从健康计划和直接从医疗服务提供系统购买此类护理。
