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WHOM DOES MEDICARE BENEFIT

医疗保险对谁有利

基本信息

批准号：
7095130
负责人：
DARIUS N. LAKDAWALLA
金额：
$ 23.54万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-08-15 至 2009-01-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Rapid growth in Medicare claims payments has transferred resources away from younger cohorts to elderly cohorts. Less clear, however, is the way in which Medicare redistributes resources within cohorts. While disadvantaged groups pay fewer Medicare taxes, they also tend to die earlier and receive fewer Medicare benefits. We propose to use several new data sources to investigate whether Medicare redistributes resources towards disadvantaged groups within a cohort, and whether it improves the welfare of any or all these groups. We will compare less educated people to the more educated, non-whites to whites, and smokers to nonsmokers. Our calculations will be based primarily on individual-level data on Medicare benefits from the Medicare Current Beneficiary Survey, and on individual-level longitudinal data on lifetime Medicare taxes paid from the Health and Retirement Study's Earnings History Files. Our approach differs from previous research in its use of individual-level data, which--unlike the previous studies of geographically aggregated Medicare claims data--seem to reveal an extremely high degree of progressivity in Medicare. Our data suggests that disadvantaged people--who are sicker--receive more Medicare benefits, even though average Medicare claims are higher in richer areas. As a result, the cash value of Medicare seems to be higher for poorer groups. We propose at least two reasons for this result: health care price levels are higher in richer areas, so that geographic variation in health care expenditures can be misleading; in addition, richer areas will tend to have better health care facilities and will thus attract sicker people. We propose two distinct methods for calculating welfare effects: the first, less structural approach yields a lower bound on the benefits and progressivity of Medicare; the second, more structural approach yields both upper and lower bounds that are also likely to be tighter. Finally, our data can be used to evaluate the welfare impact of past policy changes-- such as the repeal of the Medicare earnings cap--and proposed policy changes--such as a Medicare prescription drug benefit, changes in the age of Medicare eligibility, or Medicare "buy-in" proposals.

描述（由申请人提供）：医疗保险索赔支付的快速增长已经将资源从年轻群体转移到老年群体。然而，不太清楚的是医疗保险在队列中重新分配资源的方式。虽然弱势群体支付的医疗保险税较少，但他们也往往死得更早，获得的医疗保险福利更少。我们建议使用几个新的数据源，以调查医疗保险是否重新分配资源，对弱势群体内的队列，以及它是否提高了任何或所有这些群体的福利。我们将比较受教育程度较低的人与受教育程度较高的人，非白人与白人，吸烟者与不吸烟者。我们的计算将主要基于来自医疗保险当前福利调查的医疗保险福利的个人层面数据，以及来自健康和退休研究的收入历史文件的终身医疗保险税的个人层面纵向数据。我们的方法与以前的研究不同，它使用的是个人层面的数据，与以前的研究不同，地理上聚集的医疗保险索赔数据似乎揭示了医疗保险中极高的累进性。我们的数据表明，弱势群体--病情更重的人--获得了更多的医疗保险福利，尽管富裕地区的平均医疗保险索赔额更高。因此，医疗保险的现金价值似乎对较贫穷的群体更高。我们提出至少有两个原因，这一结果：医疗保健价格水平较高，在较富裕的地区，因此，医疗保健支出的地理差异可能会产生误导;此外，较富裕的地区往往有更好的医疗保健设施，从而吸引生病的人。我们提出了两种不同的方法来计算福利效应：第一，结构性较弱的方法产生的福利和累进性的医疗保险的下限;第二，结构性较强的方法产生的上限和下限也可能更紧。最后，我们的数据可用于评估过去政策变化的福利影响-例如废除医疗保险收入上限-以及拟议的政策变化-例如医疗保险处方药福利，医疗保险资格年龄的变化或医疗保险“买入”建议。