文章： 歐巴馬的全民健保對績優股MCO公司，如UNH、AET、CI等，到底是好事還壞事 ?
連結： http://mikeon88.blogspot.com/2012/07/blog-post.html
--
From: anddi
發表於 2012-7-2 10:32
Marco桑，可以請問一下是否了解美國健保制度的內容，
我周末研究了一下，
對美國的健保制度有了解部分，也有許多疑問。
美國健保制度公家保險目前有Medicare及Medicaid，
前者針對65歲以上，後者針對特殊情形者，如真的貧窮者及低收入戶
而私人健保公司為主流，
這些健保公司一般稱做Managed care 組織(MCO)，型態有HMO等等，
這些MCO公司的概念為先付費制度，就如同我們繳健保費一樣。
不過這些MCO公司為私人公司，
大多是營利性組織，背負著獲利的壓力，
這點跟公家保險保明顯不同，
因此這些MCO公司會監督醫生的作為，
確保不要給予不必要的醫療行為，
才不會影響MCO的獲利。
也因為要監督醫生的行為，因此需要跟醫生簽約，
因此一般來說，參加MCO的保險，
必須要到指定的區域或醫生才可以看診，
(有部分的型態是例外)，
總和來說，這樣的制度，使美國的醫療品質低落，
且這些MCO也會選擇客戶，
(就像台灣投保時一樣，不希望帶病投保，這些病人屬於較貴的病人)，
因此真正有需要的人無法投保私人健保。
也因為種種因素，歐巴馬希望進行全民健保。
我的問題是，這個是產業界的大事，
對這些過去是績優股的MCO公司，如UNH、AET、CI等，到底是好事還壞事。
我看到幾個評論
1. 這些較貴的病人，將使MCO公司的支出上升，利空
2. 因為強制投保，這些私人保險公司仍是市場主流，利多
3. 歐巴馬也打算推平價保險交易市場，對這些大MCO利潤將下滑
4. 這些大MCO成本較低，未來有機會在平價保險市場脫穎而出
先感謝各位高手
「UnitedHealth Group Inc. 提供在生活所有階段幫助人們改善健康和福利的醫療保險和相關的服務。公司的產品和服務反映了一定數量的核心能力，包括體格檢查資訊管理，保健福利管理，關心協調，風險評估和定價，保健福利設計和提供者合同。以這些能力，它能通過組織的健康系統和保險產品提供全面醫療保健管理服務。」...Quote123
「Aetna Inc. 是美國最大的保健福利公司和最大的保險金融服務機構之一。該公司在國内50個州内向雇主和潛在顧客提供保健福利服務，其客戶服務範圍從大的多地點全國帳戶，到對中型市場及小規模業主。它的全方位健康保險服務包括牙齒和醫藥福利, 從綜合醫療保健組織和銷售點系統到PPO 和賠償, 以及團體保險服務如人壽、傷殘和長期醫療保險。」...Quote123
「CIGNA Corporation, a health services organization, through its subsidiaries, provides insurance and related products and services in the United States and internationally. Its Health Care segment offers insured and self-insured medical, dental, behavioral health, vision, and prescription drug benefit plans; health advocacy programs; and other products and services that may be integrated to provide health care benefit programs, as well as operates retail pharmacies. The company’s Disability and Life segment offers various insurance products and related services, including group long-term and short-term disability insurance; group life insurance products comprising group term life and group universal life; and personal accident insurance consisting of accidental death and dismemberment, and travel accident insurance to employers. This segment also provides specialty insurance services that primarily include disability and life, accident, and hospital indemnity products to professional or trade associations, and financial institutions. Its International segment offers supplemental health, life, and accident insurance products, as well as international health care products and services. The company’s Run-off Reinsurance segment manages its run-off reinsurance coverage for risks written by other insurance companies under life and annuity policies and accident policies under guaranteed minimum death benefits and guaranteed minimum income benefits contracts. Its Other Operations segment provides corporate owned life insurance, which are permanent insurance contracts sold to corporations to offer coverage on the lives of certain employees, as well engages in run-off settlement annuity business. CIGNA Corporation distributes its products and services through independent brokers and agents, consultants, and direct sales personnel, as well as through the Internet. The company was founded in 1792 and is headquartered in Bloomfield, Connecticut. 」...Quote123
沒有留言:
張貼留言