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Medicare Advantage, Medical Loss Ratio, Service Efficiency, and Efficiently Positive Health Outcomes
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MAP20230021965
Medicare Advantage, Medical Loss Ratio, Service Efficiency, and Efficiently Positive Health Outcomes / Patrick Brockett...[et al.]
Sumario: Within the context of Medicare's enunciated triple aims of better health, better care, and lower costs, we examine the effectiveness of medical loss ratio (MLR) on health outcomes of Medicare Advantage insurers. We simultaneously examine the effect of an efficiency measure for the insurer performance: medical service utilization efficiency (an assessment of how efficiently an insurer provides medical services). This research is based upon collection and integration of several data sources: health outcome data, financial data, and medical service utilization data. Our results suggest that to enhance health improvement efficiency, medical service utilization efficiency should be incorporated as a cost-efficient regulatory and monitoring indicator when evaluating Medical Advantage insurers
En: North American actuarial journal. - Schaumburg : Society of Actuaries, 1997- = ISSN 1092-0277. - 06/09/2023 Tomo 27 Número 3 - 2023 , 16 p.
1. Modelos actuariales ‌. 2. Salud ‌. 3. Pérdidas ‌. 4. Empresas de seguros ‌. 5. Asistencia sanitaria ‌. 6. Eficiencia operacional ‌. 7. Sistemas de medición ‌. 8. Medicare ‌. 9. Estados Unidos ‌. I. Brockett, Patrick L. ‌. II. Title.