HEALTH PLAN RESPONSES TO MEDICARE HMO PREMIUM PAYMENTS

这个项目将考察医疗健康维护组织(HMOS)如何对1998年和1999年用于设定HMO资产率的新的医疗保险公式做出反应。1998年，45家医疗保健组织取消了医疗保险合同，另有54家减少了提供服务的市场区域。与此同时，30多个新计划申请加入；许多计划降低了保费并改变了福利；联邦医疗保险HMO的总体登记人数增长了8%。本研究将利用这一背景来研究医疗保险组织的行为及其对医疗保险支付政策的不同反应。经验性规范将基于HMO和消费者行为的分析模型。将审查三种类型的HMO决定：HMO选择将联邦医疗保险受益人登记到的县；选择参保人保费；以及HMO选择提供超出最低要求水平的可选福利。消费者的一个选择将是建模、聚合和计划级别的联邦医疗保险HMO登记，以响应计划保费和福利功能。该项目将使用来自卫生保健财务管理局、区域资源文件和InterStudy的丰富信息。HMO行为和消费者投保决策的一系列统计模型确定了解释联邦医疗保险市场发生戏剧性变化的计划和市场因素。将探索商业和医疗保险HMO活动之间的关系。这些结果将有助于最近关于健康计划如何竞争的学术研究。研究结果也将有助于政策制定者了解最近的医疗保险改革如何改变医疗保险保费、竞争、福利特征以及由此产生的医疗保险参保人数。

This project will examine how Medical Health Maintenance Organizations (HMOs) have reacted to the new Medicare formula being used to set HMO capitation rates in 1998 and 1999. In 1998, 45 HMOs canceled their Medicare contracts, while 54 others reduced the market areas in which they offer services. At the same time, more than 30 new plans applied to enter; many plans lowered premiums and changed benefits; and overall Medicare HMO enrollment grew by eight percent. This study will take advantage of this setting to study HMO behavior and its differential response to Medicare payment policy. Empirical specifications will be based on an analytical model of HMO and consumer behavior. Three types of HMO decisions will be examined: HMO selection of counties to enroll Medicare beneficiaries in; the choice of the enrollee premiums; and HMO selection of optional benefits to offer beyond the minimum required levels. One consumer choice will be modeled, aggregate and plan-level Medicare HMO enrollment, in response to plan premiums and benefit features. The project will use rich information from the Health Care Finance Administration, the Area Resource File, and Interstudy. A series of statistical models of HMO behavior and consumer enrollment decisions identify the plan and market factors that explain the dramatic changes that have occurred in Medicare markets. The relationship between commercial and Medicare HMO activities will be explored. Results will contribute to the recent academic research about how health plans compete. Results will also be useful to policy makers in understanding how recent Medicare reforms have altered HMO premiums, competition, benefit features and the resulting Medicare enrollments.