HEALTH PLAN RESPONSES TO MEDICARE HMO PREMIUM PAYMENTS

健康计划对 Medicare HMO 保费付款的回应

• 批准号: 6232564
• 负责人: RANDALL P. ELLIS
• 金额: $ 14.56万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-01 至 2002-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6232564
• 关键词: Medicare /Medicaid; health care cost /financing; health insurance; health science research analysis /evaluation; health services research tag; managed care

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.

该项目将检查医疗健康维护组织（HMOs）如何对1998年和1999年用于确定HMO人均费率的新的医疗保险公式作出反应。1998年，45家hmo取消了他们的医疗保险合同，另外54家减少了他们提供服务的市场领域。同时，30多个新规划申请入驻；许多计划降低了保费并改变了福利；总体医疗保险HMO注册人数增长了8%。本研究将利用这一背景来研究HMO的行为及其对医疗保险支付政策的差异反应。实证规范将基于HMO和消费者行为的分析模型。三种类型的HMO决定将被检查：HMO选择县招收医疗保险受益人；投保人保费的选择；以及HMO提供的超出最低要求水平的可选福利选择。一个消费者的选择将是模型化的，汇总的和计划级别的医疗卫生组织注册，以响应计划保费和福利特征。该项目将使用来自卫生保健财务管理局、地区资源文件和Interstudy的丰富信息。一系列关于HMO行为和消费者登记决策的统计模型确定了解释医疗保险市场发生的巨大变化的计划和市场因素。将探讨商业和医疗保险HMO活动之间的关系。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决策者了解最近的医疗保险改革如何改变HMO保费、竞争、福利特征和由此产生的医疗保险登记。