Une \u00e9tude publi\u00e9e dans le cadre de la s\u00e9rie de publications externes de RAND analyse des options de r\u00e9forme de Medicare Advantage (MA) aux \u00c9tats-Unis, dans un contexte de pr\u00e9occupations persistantes concernant des surpaiements aux organismes gestionnaires, un contr\u00f4le jug\u00e9 insuffisant des plans et des limitations d\u2019acc\u00e8s aux soins pour les b\u00e9n\u00e9ficiaires. Plus de la moiti\u00e9 des b\u00e9n\u00e9ficiaires de Medicare sont d\u00e9sormais affili\u00e9s \u00e0 un plan MA, ce qui conf\u00e8re un poids structurel important \u00e0 ce segment du syst\u00e8me d\u2019assurance maladie pour personnes \u00e2g\u00e9es et certaines personnes en situation de handicap.<\/p>\n
Les auteurs ont conduit un exercice de type e-Delphi en deux tours aupr\u00e8s de 39 experts : chercheurs, repr\u00e9sentants du secteur, d\u00e9fenseurs des patients et anciens d\u00e9cideurs publics. Quinze options de r\u00e9forme des plans MA ont \u00e9t\u00e9 \u00e9valu\u00e9es selon leurs effets potentiels sur trois cat\u00e9gories d\u2019acteurs : les b\u00e9n\u00e9ficiaires, le gouvernement f\u00e9d\u00e9ral et les plans eux\u2011m\u00eames. Les experts ont converg\u00e9 sur le fait que 6 id\u00e9es de r\u00e9forme seraient globalement favorables aux b\u00e9n\u00e9ficiaires, 3 b\u00e9n\u00e9ficieraient au gouvernement f\u00e9d\u00e9ral et 1 serait plut\u00f4t favorable aux plans MA.<\/p>\n
Les options jug\u00e9es les plus r\u00e9alisables \u00e0 court terme sont : la standardisation des prestations compl\u00e9mentaires propos\u00e9es par les plans MA, la limitation du nombre de plans MA qu\u2019un assureur peut offrir et la r\u00e9forme des commissions vers\u00e9es aux agents commerciaux. Ces mesures, consid\u00e9r\u00e9es comme des r\u00e9formes incr\u00e9mentales, viseraient \u00e0 am\u00e9liorer la capacit\u00e9 des b\u00e9n\u00e9ficiaires \u00e0 comparer les offres, \u00e0 renforcer leurs protections financi\u00e8res et \u00e0 limiter certains risques commerciaux, sans impact n\u00e9gatif identifi\u00e9 sur le gouvernement f\u00e9d\u00e9ral ni sur les plans MA. Selon l\u2019\u00e9tude, ces changements pourraient \u00eatre mis en \u0153uvre par voie administrative par les Centers for Medicare and Medicaid Services (CMS), l\u2019autorit\u00e9 f\u00e9d\u00e9rale de gestion des programmes Medicare et Medicaid.<\/p>\n
Les auteurs soulignent cependant que ces ajustements ne suffiraient pas \u00e0 assurer la soutenabilit\u00e9 financi\u00e8re de Medicare \u00e0 long terme. Les \u00e9conomies significatives jug\u00e9es n\u00e9cessaires impliqueraient des politiques plus ambitieuses, susceptibles de perturber le fonctionnement du march\u00e9 et d\u2019avoir des effets n\u00e9gatifs sur les plans MA. RAND, institution de recherche \u00e0 but non lucratif, pr\u00e9cise que ses publications ne refl\u00e8tent pas n\u00e9cessairement les positions de ses commanditaires ou clients, ce qui souligne le caract\u00e8re analytique et non prescriptif de ces travaux. Ce cas am\u00e9ricain illustre les enjeux de r\u00e9gulation des assurances maladie g\u00e9r\u00e9es par des acteurs priv\u00e9s, ainsi que les arbitrages entre protection des b\u00e9n\u00e9ficiaires, soutenabilit\u00e9 budg\u00e9taire et stabilit\u00e9 des op\u00e9rateurs.(contenu r\u00e9sum\u00e9 en fran\u00e7ais par l’IA)\u00a0Lire la Suite<\/a><\/p>","protected":false},"excerpt":{"rendered":" Une \u00e9tude publi\u00e9e dans le cadre de la s\u00e9rie de publications externes de RAND analyse des options de r\u00e9forme de Medicare Advantage (MA) aux \u00c9tats-Unis, dans un contexte de pr\u00e9occupations […]<\/p>\n","protected":false},"author":1,"featured_media":10675,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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