Feldman R, Wholey D, Christianson J B
Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis 55455-0381, USA.
Inquiry. 1998 Fall;35(3):315-31.
We tested the hypothesis that health maintenance organizations (HMOs) increase their commercial premiums when Medicare pays less. Such a linkage would be taken as evidence of "cost shifting." Other studies have tested the cost-shifting hypothesis among health care providers, but this is the first to examine the HMO industry. Our data consisted of annual observations on all HMOs that operated in the United States between 1990 and 1995 and had a Medicare risk contract. A comparison group of HMOs that had no Medicare contract during that period also was analyzed. The main finding from this study is that HMOs have not shifted costs from Medicare to commercial premiums. This results supports the skeptical consensus that is developing toward the cost-shifting hypothesis. Additional findings include the negative effects of competition and for-profit status on HMOs' commercial premiums.
当医疗保险支付减少时，健康维护组织（HMOs）会提高其商业保险费。这种联系将被视为“成本转嫁”的证据。其他研究已经在医疗服务提供者中检验了成本转嫁假设，但这是首次对HMO行业进行研究。我们的数据包括1990年至1995年间在美国运营且拥有医疗保险风险合同的所有HMO的年度观测数据。同时也分析了同期没有医疗保险合同的HMO组成的对照组。这项研究的主要发现是，HMOs并没有将成本从医疗保险转嫁到商业保险费上。这一结果支持了对成本转嫁假设逐渐形成的怀疑共识。其他发现包括竞争和营利性地位对HMOs商业保险费的负面影响。
