Choice and Consequences in the Medicare Part D Plan

Medicare D 部分计划中的选择和后果

• 批准号: 7796560
• 负责人: JONATHAN GRUBER
• 金额: $ 28.47万
• 依托单位: NATIONAL BUREAU OF ECONOMIC RESEARCH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-15 至 2012-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7796560
• 关键词: Address; Affect; Automobile Driving; Behavioral; Cost Sharing; County; Data; Data Set; Drug Costs; Drug Prescriptions; Drug Utilization; Drug usage; Econometric Models; Economics; Elasticity; Elderly; Evaluation; Expenditure; Individual; Insurance; Knowledge; Left; Medicare; Modeling; Modernization; Names; Nature; Outcome; Patients; Pattern; Pharmaceutical Preparations; Play; Policy Maker; Price; Provider; Research; Risk; Role; Sampling; Statutes and Laws; Structure; Time; beneficiary; cost; novel; prescription drug costs; programs

DESCRIPTION (provided by applicant): The Medicare Modernization Act of 2003, better known as the legislation that added the Part D prescription drug benefit to the Medicare program, represents the single most significant expansion of public insurance programs in the U.S. in the past 40 years. Perhaps the most novel, and controversial, feature of this legislation was the use of multiple private insurance providers to deliver this new public insurance product, with widely varying prices and product features (including the donut hole whereby individuals are covered for initial drug expenditures but not for higher levels of expenditures). I will evaluate the effects of Part D using a unique data set that allows me to follow several million elders over the 2005 to 2009 period, with data on both their prescription drug coverage and their choice of Part D plan. In particular, this project aims to answer six questions. First, what is the financial risk facing elder when choosing their Part D plans; what are the financial consequences of alternative plan choices in their county? Second, are elders choosing the part D plan that minimizes their total cost of prescription drug coverage, and, if not, how much money are they leaving on the table through their choices? Third, what determines choice of Part D plan? I will estimate a comprehensive econometric model of plan choice to assess the role of financial and non-financial factors in driving choices. Fourth, what determines the dynamics of plan choice; do individuals re-optimize if they have chosen an inappropriate plan or is there very strong inertia in plan choice? Fifth, how does the structure of Part D plans affect utilization? These longitudinal data, and the potential econometric identification that is provided by inertia in plan choice, will allow me to develop estimates of utilization elasticity. Finally, how does prescription drug use respond to within-year changes in cost-sharing? Understanding whether individuals anticipate the donut hole, and how they react to this feature, is critical for modeling reforms to the Part D benefit structure. The result of these analyses will be the first comprehensive picture of how Part D choices are made, and how those choices impact beneficiary drug utilization. These findings should be very helpful to policy- makers as they consider ongoing reforms of this major entitlement program. The Medicare Modernization Act of 2003, better known as the legislation that added the Part D prescription drug benefit to the Medicare program, represents the single most significant expansion of public insurance programs in the U.S. in the past 40 years. Perhaps the most novel, and controversial, feature of this legislation was the use of multiple private insurance providers to deliver this new public insurance product, with widely varying prices and product features (including the donut hole whereby individuals are covered for initial drug expenditures but not for higher levels of expenditures). I will provide the first comprehensive picture of how Part D choices are made, and how those choices impact beneficiary drug utilization. These findings should be very helpful to policy-makers as they consider ongoing reforms of this major entitlement program.

描述（由申请人提供）：2003年的《医疗保险现代化法》（Medicare Modernization Act），众所周知的立法，为医疗保险计划增加了D部分处方药福利，代表了过去40年美国公共保险计划中最重要的扩展。这项立法的最新颖，最有争议的特征也许是使用多个私人保险提供商提供这种新的公共保险产品，其价格和产品功能差异很大（包括甜甜圈孔，其中个人被覆盖以用于初步的药物支出，但没有用于更高水平的支出）。我将使用独特的数据集评估D部分的效果，该数据集使我可以在2005年至2009年期间关注数百万长者，并提供有关其处方药覆盖范围和选择D部分计划的数据。特别是，该项目旨在回答六个问题。首先，在选择D部分计划时，老人面临的财务风险是什么？他们县的替代计划选择会带来哪些财务后果？其次，长者是否选择了D部分计划，以最大程度地减少他们的总处方药覆盖范围，如果没有，他们通过自己的选择留在桌子上多少钱？第三，是什么决定了D部分计划的选择？我将估计计划选择的全面计量经济学模型，以评估财务和非财务因素在推动选择中的作用。第四，决定了计划选择的动态的原因；个人是否选择了不适当的计划或计划选择中有很强的惯性？第五，D部分计划的结构如何影响利用？这些纵向数据以及计划选择中惯性提供的潜在计量经济学识别将使我能够开发利用弹性的估计值。最后，处方药物使用如何应对成本分担的年度变化？了解个人是否预期甜甜圈漏洞，以及他们对此功能的反应，对于对D部分福利结构进行建模的改革至关重要。这些分析的结果将是第一部分选择的第一局，以及这些选择如何影响受益人的药物利用。这些发现对政策制定者考虑对这一重大权利计划进行的持续改革应该非常有帮助。 2003年的《 Medicare Modernation Act》（Medicare Modernization Act），称为Medicare计划的D部分处方药福利的立法，代表了过去40年中美国最重要的公共保险计划最重要的扩展。这项立法的最新颖，最有争议的特征也许是使用多个私人保险提供商提供这种新的公共保险产品，其价格和产品功能差异很大（包括甜甜圈孔，其中个人被覆盖以用于初步的药物支出，但没有用于更高水平的支出）。我将提供第一个全面的图案，说明如何做出D部分选择以及这些选择如何影响受益人的药物利用。这些发现对决策者考虑对这一重大权利计划进行的持续改革时应该非常有帮助。