首页> 美国政府科技报告 >Medicare Managed Care: Better Risk Adjustment Expected to Reduce Excess Payments211 Overall While Making Them Fairer to Individual Plans. Statement of William J. 211 Scanlon, Director Health Financing and Public Health Issues, Health, Education 211 and Hu

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Medicare Managed Care: Better Risk Adjustment Expected to Reduce Excess Payments211 Overall While Making Them Fairer to Individual Plans. Statement of William J. 211 Scanlon, Director Health Financing and Public Health Issues, Health, Education 211 and Hu

机译：医疗保险管理护理：更好的风险调整预计会减少超额支付211整体，同时使他们更加公平对待个人计划。 William J. 211 scanlon的声明，健康，教育和健康，健康，教育211和胡锦涛主任

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The Balanced Budget Act of 1997 (BBA) changed Medicare payment rules because of211u001eproblems in the way Medicare paid capitated managed care plans in the 211u001eMedicare+Choice program. Managed care plans receive from Medicare a fixed monthly 211u001epayment, called a capitation payment, for each beneficiary they enroll. However, 211u001esince payments are based on health care spending for the average non-enrolled 211u001ebeneficiary, while the plan's enrollees tend to be healthier than average, 211u001eMedicare capitation rates are excessive. To correct these problems, BBA changed 211u001ethe rate-setting formula in 1998 and called for the Health Care Financing 211u001eAdministration (HFCA) to replace the current risk adjuster (a mechanism for 211u001emodifying a plans average capitation rate to better reflect enrollees expected 211u001emedical costs) in 2000.

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年度 1999
页码 1-18
总页数 18
原文格式 PDF
正文语种 eng
中图分类工业技术;
关键词
Health care; Capitation fee; Health related costs; Rate setting; Medicare; 211 Regulation; Physical condition; Health risks; Medical fees; Rates(Costs); Payment; 211 Health plans;

机译：医疗保健;人头费;健康相关费用;费率设定;医疗保险; 211监管;身体状况;健康风险;医疗费用;费率（费用）;支付; 211健康计划;

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1. Trends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina 11This study was supported in part by the Patrick and Catherine Weldon Donaghue Medical Research Foundation Hartford. Dr. Krumholz is a Paul Beeson Faculty Scholar. The analyses on which this publication is based were performed under Contract Number 500-96-P549, entitled “Utilization and Quality Control Peer Review Organization for the State of Connecticut,” sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this Contractor. Ideas and contributions to the authors concerning experience in engaging with the issues presented are welcomed. [O] . Krumholz Harlan M., Philbin Daniel M., Wang Yun, 1998

机译：不稳定型心绞痛住院的医疗保险受益人的护理质量趋势11该研究部分得到了帕特里克和凯瑟琳·韦尔顿·多纳休医疗研究基金会的支持。 Krumholz博士是Paul Beeson系的学者。本出版物所依据的分析是在合同号500-96-P549下进行的，该合同的名称为“康涅狄格州使用和质量控制同行评审组织”，由卫生与公共服务部卫生保健融资管理局赞助。本出版物的内容不一定反映卫生和公共服务部的观点或政策，提及商品名称，商业产品或组织也不一定表示得到美国政府的认可。作者对所提出想法的准确性和完整性承担全部责任。本文是卫生保健筹资管理局发起的“卫生保健质量改善计划”的直接结果，该计划鼓励确定通过对护理模式进行分析而得出的质量改善项目，因此该承包商不需要任何特殊资金。欢迎作者就涉及所提出问题的经验提出想法和贡献。
2. Medicare: Better Information Can Help Ensure That Refinements to BBA Reforms Lead211 to Appropriate Payments. Statement of William J. Scanlon, Director Health 211 Financing and Public Health Issues, Health, Education, and Human Services 211 Division [R] . 1999

机译：医疗保险：更好的信息可以帮助确保对BBa的改进将Lead211改为适当的支付。卫生署署长，卫生，教育及人类服务部211财务及健康问题卫生署署长William J. scanlon致辞

Medicare Managed Care: Better Risk Adjustment Expected to Reduce Excess Payments211 Overall While Making Them Fairer to Individual Plans. Statement of William J. 211 Scanlon, Director Health Financing and Public Health Issues, Health, Education 211 and Hu

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