私的メディケア保険プラン販売に新たな規制/米国医療事情

 私的メディケア保険プランに対して、受給者の要請のない訪問や電話を禁止し、代理店へのコミッションを調節し、罰金を増大することで、過度な販売活動を取り締まることをブッシュ政権は提案した。メディケアは無法な販売代理店の蝕まれてはならない。州は私的メディケア計画の販売を調節する権限を持たないとブッシュ政権は見ている。
 プロモーション用の贈り物などは15ドルを限度と定めるだろう。セールスの説明をファミレスで食事を提供しながら行うことなどはできなくなる。現在は罰金が最高25,000ドルだが、それ以上になるだろう。
 4400万人のメディケア受給者のうち少なくとも2500万人は何らかの私的プランに加入し、医療サービスMedicare Advantage planや処方薬プランdrug planを受けている。保険業者は高いコミッションを払うことでより高収益な製品の販売が可能であったので、医療ニーズを考えずに高額プラン販売するインセンティブは止めるべきである。
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Hard Sell to Medicare Insurance Buyers Would Get Softer Under New Rules
http://www.nytimes.com/2008/05/09/washington/09medicare.html?_r=1&ref=health&oref=slogin
By ROBERT PEAR
Published: May 9, 2008

WASHINGTON ― The Bush administration proposed on Thursday to crack down on the aggressive marketing of private Medicare insurance plans by outlawing unsolicited visits and telephone calls to beneficiaries, regulating commissions paid to sales agents and increasing the fines that could be imposed on insurers.

Medicare “should not be undermined by the actions of a limited number of unscrupulous sales agents,” said Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services.

In the last two years, Medicare beneficiaries and state officials have often complained that high-pressure sales tactics led some people to sign up for unsuitable policies.

After reviewing comments from the public, federal officials intend to issue final rules before the marketing of plans for 2009 begins this October.

The proposed rules respond to pleas by consumers, Congress and state officials, but do not go as far as they wanted. In particular, the proposal affirms the Bush administration’s view that “states do not have the authority to regulate the marketing” of private Medicare plans.

Paul Precht, policy director of the Medicare Rights Center, a group that counsels beneficiaries, said: “We need Congress to give the states a greater role in enforcement. The federal government does not have the manpower.”

Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, praised the Bush proposals as a good first step. But Mr. Baucus said, “These protections are so important that they need to be codified in law.” He promised to push for passage of a bill in the next few months.

The Bush proposal would prohibit door-to-door marketing of private Medicare plans. Agents could not accost beneficiaries in the parking lot of a center for the elderly, a clinic or an apartment building. Agents could respond to telephone inquiries, but they could not make “cold calls” to beneficiaries.

Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said she welcomed the proposals, though they go further than the industry had recommended in a few areas like cold calls.

The rules would set a $15 limit on the value of gifts and promotional items offered to potential customers. Insurance companies could offer coffee, soft drinks, snacks, pill dispensers and water bottles worth less than $15. But insurers could not offer free meals, whatever their value.

This proposal would end a common practice. Insurers like Humana have signed up many beneficiaries at family restaurants where the companies provide sales presentations and meals.

“Have Lunch on Us!” said fliers and advertisements inviting Medicare beneficiaries to Humana events last fall.

The proposed rules would also prohibit agents from offering annuities, life insurance and other “non-health care related products” while selling private Medicare plans.

Under current rules, the government can impose a civil fine up to $25,000 for each serious violation. The proposed rule would allow larger fines, up to $25,000 for each beneficiary who was “directly adversely affected.”

The Bush administration also wants to regulate sales commissions, to discourage agents from switching people inappropriately from one Medicare plan to another. Under the proposal, the commission paid for the initial sale and first year of coverage could not exceed the commission paid for renewal of coverage in a subsequent year.

Many carriers now pay higher commissions in the first year. Some pay only for the first year, with no commission in later years. This creates a “financial incentive for agents to encourage beneficiaries to change plans each year,” the administration said.

Of the 44 million Medicare beneficiaries, at least 25 million are in some type of private plan ― either a Medicare Advantage plan, which provides a wide range of health services, or a free-standing prescription drug plan, which covers just medicines.

Under the proposal, an insurer would have to pay the same commission for all its Medicare Advantage plans and a uniform amount for all its drug plans. An insurer could still encourage sales of the more profitable products by paying higher commissions ― $200 a year for sale of a Medicare Advantage plan and $50 a year for a drug plan, for example.

Jessica F. Waltman, a vice president of the National Association of Health Underwriters, which represents agents and brokers, said, “We agree that insurers should eliminate financial incentives for agents to make quick sales and shift beneficiaries from one plan to another without regard to their health care needs.”

But, Ms. Waltman added, small differences in commissions in the first and subsequent years may be justified.

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