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Titolo:
RISK ADJUSTMENT AND MEDICARE - TAKING A CLOSER LOOK - THE TIME FOR MEDICARE TO EXPERIMENT WITH NEW PAYMENT METHODS TO MANAGED CARE PLANS ISNOW
Autore:
NEWHOUSE JP; BUNTIN MB; CHAPMAN JD;
Indirizzi:
HARVARD UNIV,HLTH POLICY PROGRAM CAMBRIDGE MA 02138
Titolo Testata:
Health affairs
fascicolo: 5, volume: 16, anno: 1997,
pagine: 26 - 43
SICI:
0278-2715(1997)16:5<26:RAAM-T>2.0.ZU;2-F
Fonte:
ISI
Lingua:
ENG
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Physical, Chemical & Earth Sciences
Citazioni:
23
Recensione:
Indirizzi per estratti:
Citazione:
J.P. Newhouse et al., "RISK ADJUSTMENT AND MEDICARE - TAKING A CLOSER LOOK - THE TIME FOR MEDICARE TO EXPERIMENT WITH NEW PAYMENT METHODS TO MANAGED CARE PLANS ISNOW", Health affairs, 16(5), 1997, pp. 26-43

Abstract

Medicare's method for reimbursing at-risk managed care plans causes potential problems with selection (when beneficiaries with higher-than-expected costs stay in traditional plans) and stinting (the tendency to under-provide health services). Adjusting payment by diagnosis offers substantial improvement. We favor large-scale demonstrations of diagnosis-based reimbursement. Reducing payment, a Clinton administration proposal, would recoup excess payments in the short run but not address the selection problem, which could reemerge. Selection makes currentpayments vulnerable to upward spirals. We propose not using traditional Medicare to update reimbursement. Basing some payment on enrollees'actual use addresses selection and stinting. Rather than reinsurance,we propose blending traditional Medicare and risk-adjusted capitation. Ceding some cases to traditional Medicare in advance appears to be useful for terminally ill patients.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 14/07/20 alle ore 18:22:52