Greenwald L M, Esposito A, Ingber M J, Levy J M
Division of Payment Research, Research and Evaluation Group, Baltimore, MD 21244, USA.
Inquiry. 1998 Summer;35(2):193-209.
The Balanced Budget Act (BBA) of 1997 requires numerous changes in Medicare. Medicare's managed care program has been reinvented as "Medicare + Choice," offering an expanded range of delivery system options for beneficiaries and a schedule of payment changes that will dramatically affect managed care plans. Preceding some of these BBA-legislated changes to Medicare were years of research and demonstrations. Risk-adjusted payment in the Medicare + Choice program, which is mandated for implementation in 2000, is one example of a longstanding developmental initiative. This paper provides a brief overview of risk adjustment-related research and demonstration activities carried out by the Health Care Financing Administration (HCFA) since the 1980s, and describes a possible technical approach for the implementation of risk-adjusted Medicare managed care payments in 2000.
1997年的《平衡预算法案》（BBA）要求对医疗保险进行多项改革。医疗保险的管理式医疗计划已被重新塑造为“医疗保险+选择”，为受益人提供了更广泛的医疗服务提供系统选择，以及一系列将对管理式医疗计划产生重大影响的支付方式变化。在这些由BBA立法的医疗保险改革之前，进行了多年的研究和示范。医疗保险+选择计划中的风险调整支付（该计划于2000年强制实施）就是一项长期发展举措的例子。本文简要概述了自20世纪80年代以来医疗保健财务管理局（HCFA）开展的与风险调整相关的研究和示范活动，并描述了2000年实施风险调整后的医疗保险管理式医疗支付的一种可能的技术方法。
