商学 ６１‐４・５／４．長谷川
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1 CDHP : Consumer-Directed Health Plan or Consumer-Driven Health Plan Employer-Sponsored Health Insurance 1980 Managed Care Plan HDHP : High-Deductible Health PlanHRA : Health Reimbursement Arrangement HSA : Health Saving Account 2007
2 HMO Health Maintenance Organization, POS Point-of-Service, PPO Preferred Provider Organization 1 HMO PPO POS
3 CDHP : Consumer-Directed or Consumer-Driven Health Plan HDHP : High-Deductible Health Plan deductible HSA : Health Saving Account HRA : Health Reimbursement Arrangement 5 coinsurance or copayment Kaiser/HRET HSA 24HRA GAO2006 b2006 c. deductible coinsurance or copayment
4 272 6 HSA Section 223 HSA HSA HSA ,100 2,200 5,600 11, HRA HSA HRA 2001 HSA 2003 FSA : Flexible Saving Account 1 HSA GAO2006 b2006 c $1,000 $2, $1,050 $2, $1,100 $2, $1,100 $2, $1,150 $2, $1,200 $2, $5,100 $10, $5,250 $10, $5,500 $11, $5,600 $11, $5,800 $11, $5,950 $11,900 U.S. Department of the Treasury, Internal Revenue Service
5 273 HRA, HSA FSA Section 125 FSA Healthcare Reimbursement Account13 Dependent care Reimbursement Account 2 Setion 125 HRA, HSA HRA HSA HSA HRA, HSA Internal Revenue Service HP http : // 969 /ar 02.html#en_US_publink
6 274 HRA HRA fringe benefit HRA HRA HRA HSA HSA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P. L Section 1201 Section 223 HSA HRA HSA HSA HSA HSA eligibility HSA HSA 12 HSA HAS ,650 5, ,000 5, HSA
7 275 3 HSA 2005 $2,650 $5, $2,700 $5, $2,850 $5, $2,900 $5, $3,000 $5, $3,050 $6,150 U.S. Department of the Treasury, Internal Revenue Service HSA HSA catch-upcontribution U.S. Department of the Treasury HP http : // affairs/hsa/faq_contributing.shtml#hsa Regopoulos et al2006
8 Musco and Thompson2002pp
9 GDP GDP GDP U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services2008
10 U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services National Health Expenditure1Health Services and Supplies2Investments2
11 General Motors HMO PPO POS HMO Kaiser/HRET2007U.S. Bureau of Labos StatisticsConsumer Price Index for All Urban Consumers ; U.S. city average GM Darling1991
12 Kaiser/HRET Mercer Miller and Luft
13 Tricare/CHAMPVA Tricare/CHAMPVA TRICARECHAMPUS 3CHAMPVAthe Civilian Health and Medical Program for the Department of Veterans Affairs Fronstin
14 282 FEHB : Federal Employees Health Benefits HSA Medicare fringe benefit business 20 reason U.S. Government Accountability OfficeGAO2006 a Fronstin Fronstin1998p. 9 ; Christensen et al2002p WorldatWork/EBRI Value of Benefits Survey !
15 HSA HSA HRA 5 Kaiser/HRET2008HRA HSA! Defined Benefits 6401k Defined Contribution 21WorldatWork /EBRI2000; Salisbury and Ostuw2000 Federal Poverty Line U.S. Census Bureau 2008 Federal Poverty Threshold ,834 FPL Fronstin,
16 284 5 HDHP HRA/HDHP HSA/HDHP HDHP HRA/HDHP HSA/HDHP HDHP $4,468 $3,527 $4,769 $11,571 $9,101 $12,892 $533 $420 $742 $3,455 $2,332 $3,397 $3,935 $3,107 $4,027 $8,117 $6,769 $9, HRA/HSA $1,249 $838 NA $2,073 $1,522 NA $5,184 $3,945 $4,027 $10,190 $8,291 $9,495 HRA/HSA HSA HSA HSA $1,139$2,067 Kaiser/HRET2008 4,769 12,892 HRA 4,468 11,571 HSA 3,527 9,101 HSA HRA HSA 5 HRA/HDHP 3, , HSA/HDHP 3, , HRA/HDHP, HSA/HDHP 4, , HRA/HDHP HRA HSA HRA HSA HRA 1,249 2,073 HSA 838 1,522 HSA HRA HSA HSA HSA 1,139 2,067 HRA
17 285 HSA/HDHP 4,027 9,495 HRA/HDHP 5,184 10,190 HRA/HDHP HSA/HDHP 3,945 8,291 Mercer PPO HMO PPO 7,029 HMO 7,004 HRA 6,214 HSA 5, HSA Mercer 2006 HSA HSA HSA HSA 28 HSA HSA HRA 6 Kaiser/HRET2008HRA 1,522 3,057 HSA 2,010 3,911 HSA Mercer2006 Mercer2006. Mercer HSA GAO2008 a2008 b Kaiser/HERT2007 Mercer2006
18 286 6 HRA/HDHP HSA/HDHP HRA/HDHP HSA/HDHP $1,522 $2,010 $3,057 $3,911 HRA/HSA $1,249 $838 $2,073 $1,522 $2,543 $3,292 $5,331 $6, HSA 1,100 2,200 Kaiser/HRET2008 1,100 2, HRA 2,543 5,331 HSA 3,292 6,280 2 GAO HSA America s Health Insurance Plans GAO2008 a2008 b
19 Kaiser/HRET HMO PPO POS PPO HDHP/SOHigh Deductible Health Plan with a savings option Kaiser/HRET2008 America s Health Insurance Plans U.S. Census Bureau Current Population Survey 2006 GAO2008 a2008 b HMO POS McDonnell and Fronstin1999.
20 288 HDHP/SO HRA/HDHP 3HSA/HDHP HDHP Kaiser/HRET HDHP Kaiser/HRET2008
21 289 Kaiser/HRET HRA, HSA HSA Watson Wyatt Worldwide and the National Group on Health HDHP Kaiser/HRET HDHP Kaiser/HRET2008
22 290 9 Watson Wyatt Worldwide HSA 4249HSA 2024HSA HSA HSA HSA HSA 35 National Center for Health StatisticsNCHS1993Agency for Healthcare Research and Quality AHRQ Ibid Blue Cross Blue Shield Association CDHP Member Experience Surveys GAO2008 a2008 b
23 291 3Wal-Mart Wal-Mart WM WM WM General Motors UAW WM WM WM WM WM 37 WM GM UAW UFCW, United Food and Commercial Workers Wake-Up Wal-MartSEIU, Service Employees International Union Wal-Mart Watch Businessweek, April 19, 2006.
24 292 WM Value Plan HSA HSA Qualified plan 2 39 WM Performance Performance ER HSA HSA Performance Performance Performance Performance HSA 2 12 WM WM 2400 HSA Wal-Mart2006Human Right Watch2007 New York Times, October 24, 2005.
25 WM WM 2007 WM 43 HSA Wal-Mart2006 Wal-Mart2007 UFCW Wake Up Wal-Mart Chris Kofinis WM WM PR WM Businessweek, April 19, 2006
26 294 HSA 1 2 3
27 Agency for Healthcare Research and QualityAHRQ , Medical Expenditure Panel Survey- Insurance ComponentMEPS-IC. Christensen, R., P. Fronstin, K.Polzer,andR.Werntz2002,Employer Attitudes and Practices Affecting Health Benefits and the Uninsured,EBRI Issue Brief, 250. Darling H.1991,Employers and Managed Care : What are the Early Returns, Health Affairs, 104, pp Fronstin, P.1998,Features of Employment-Based Health Plansin The Future of Medical Benefits, ed. by Salisbury D. L., Employee Benefit Research Institute Education and Research Fund. Fronstin, P.2003,Sources of Health Insurance and Characteristics of the Uninsured : Analysis of the March 2003 Current Population Survey,EBRI Issue Brief, 264. Fronstin, P.2007,Sources of Health Insurance and Characteristics of the Uninsured : Analysis of the March 2007 Current Population Survey,EBRI Issue Brief, 310. Fronstin, P.2008,Sources of Health Insurance and Characteristics of the Uninsured : Analysis of the March 2008 Current Population Survey,EBRI Issue Brief, 321. Hendrix, T. J. and K. Kaufman2003,Medical Savings Accounts : Theory, Politics, Pros, and Cons, Policy, Politics, & Nursing Practice, 41, pp Human Right Watch2007, Discounting Rights : Wal-Mart s Violation of US Workers Right to Freedom of Association, 192. Kaiser Family Foundation/Health Research and Educational TrustKaiser/HRET , Employer Health Benefits Annual Survey. Mercer2006, National Survey of Employer-Sponsored Health Plans. McDonnell, K., and P. Fronstin1999, EBRI Health Benefits Databook, 1 st ed., eds. by Homes, D., S. Blakely,
28 296 Employee Benefit Research Institute. Miller, R. H., and H. S. Luft1997,Does Managed Care Lead to Better or Worse Quality of Care?, Health Affairs, 165, pp Musco, T., B. Thompson2002, Source Book of Health Insurance Data 2002, Health Insurance Association of America. National Center for Health StatisticsNCHS1993, National Employer Health Insurance SurveyNEHIS. Regopoulos, L., J. B. Christianson, G. Claxton, and S. Trude2006,Consumer-Directed Health Insurance Products : Local-Market Perspectives, Health Affairs, 253, pp Robinson, J. C.2005,Health Savings Accounts-The Ownership Society in Health Care, New England Journal of Medicine, 35312, pp Robinson, J. C. and P. B. Ginsburg2009,Consumer-Driven Health Care : Promise and Performance, Health Affairs-Web Exclusive, 27 January, pp Salisbury, D. L. and P. Ostuw2000,Value of Benefits Constant in a Changing Job Environment : Findings from the 1999 ACA/EBRI Value of Benefits Survey,EBRI Notes, 6. Tynan, A and J. B. Christianson2008,Consumer-Directed Health Plans : Mixed Employer Signals, Complex Market Dynamics, Center for Studying Health System Change Issue Brief, 119, March. U.S. Department of Health and Human Services, Center for Medicare & Medicaid Services2008, Sponsors of Health Care Costs : Businesses, Households, and Governments, http : // 07.pdf U.S. Department of Labor, Bureau of Labor Statistics , National Compensation Survey. U.S. Government Accountability Office2006 a,federal Employees Health Benefits Program : First-Year Experience with High-Deductible Health Plans and Health Savings Accounts, GAO U.S. Government Accountability OfficeGAO2006 b,consumer-directed Health Plans : Small but Growing Enrollment Fueled by Rising CostofHealth Care Coverage, GAO U.S. Government Accountability OfficeGAO2006 c,consumer-directed Health Plans : Early Enrollee Experiences with Health Savings Accounts and Eligible Health Plans, GAO U.S. Government Accountability OfficeGAO2008 a,health Savings Accounts : Participation Increased and Was More Common among Individuals with Higher Incomes, GAO R. U.S. Government Accountability OfficeGAO2008 b,health Savings Accounts : Participation Grew, and Many HSA-Eligible Plan Enrollees Did Not Open HSAs while Individuals Who Did Had Higher Incomes, GAO T. Wal-Mart2006, Wal-Mart OE Magazine, January. Wal-Mart2007, Open Enrollment Survey Report.http : // Watson Wyatt Worldwide2007,More Companies Offering Consumer-Directed Health Plans, Watson Wyatt / National Business Group on Health Survey Finds, Watson Wyatt Press Release, March 15. Watson Wyatt Worldwide2008,More Companies, Workers Adopt Consumer-Directed Health Plans, Watson Wyatt Press Release, March 13. WorldatWork/EBRI2000, WorldatWork/EBRI Value of Benefits Survey HSA GM
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