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The Science of Medicare Reform

医疗保险改革的科学

基本信息

批准号：
8047224
负责人：
ALAN Michael GARBER
金额：
$ 550.07万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-30 至 2013-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8047224
关键词：
Address Affect Aging American Area Belief California Caring Characteristics Clinical Collaborations Cost Sharing Deductibles Drug Prescriptions Drug usage Economic Policy Elderly Enrollment Ensure Expenditure Federal Government Fee-for-Service Reimbursements Formularies Future Health Health Care Reform Health Insurance Health Services Needs Healthcare Heterogeneity Institution Insurance Insurance Coverage Marketing Medicare Methods Mind Modeling Myopia Outcome Pattern Pharmaceutical Preparations Play Policies Policy Research Population Recovery Research Resources Risk Role Savings Science Science Policy Services Social Welfare Solutions Swelling System United States Universities Variant base beneficiary comparative effectiveness copayment cost design effectiveness research health economics inattention multidisciplinary payment programs simulation success symposium wasting

项目摘要

DESCRIPTION (provided by applicant): This application addresses the thematic area, "Using Science to Enable Health Care Reform." The future of the Medicare program poses one of the greatest policy challenges to the United States. This extraordinarily popular program has brought universal health insurance coverage to the elderly and others who would otherwise lack access to needed health services. The implementation of Medicare Part D to cover prescription drugs is widely viewed as a success; yet in several ways Medicare is an anachronism. First, its fee-for-service reimbursement system has all but vanished from private health insurance. Medicare imposes copayments and deductibles like commercial health insurance plans, but about 80% of beneficiaries have supplemental insurance, which reduces the out-of-pocket payments. Thus most beneficiaries do not fully consider costs-or even Medicare copayments-when making health care decisions. Second, research has demonstrated dramatic variation in per capita Medicare expenditures across regions of the U.S.-variation that cannot be explained by demographic or health characteristics. Yet high resource use regions do not have superior health outcomes. The services covered by Medicare may thus be a poor match to the needs of older Americans in many regions. Third, the program is the largest fiscal liability of the Federal government. The aging of the baby boomers will swell the population of Medicare beneficiaries. Absent program changes, Medicare expenditures will rise from 3% of gross domestic product today to 17% by 2082. This research collaboration will design and conduct Medicare-related research, policy simulation, and welfare analysis to address these issues. A multidisciplinary team spanning four institutions at the forefront of health economics and policy research- Stanford University, University of Southern California, RAND Corporation, and the University of California, Berkeley-will focus on solutions to ensure Medicare continues its legacy of success. The American Recovery and Reinvestment Act of 2009 provided an unprecedented $1.1 billion to explore comparative effectiveness research (CER). Yet specific applications of CER to the Medicare program do not yet exist. With these in mind, our Specific Aims are: 1) Develop intertemporal optimization models of plan choice in the Medicare Part D market; 2) Understand competition in the Medicare Part D marketplace; 3) Examine the consequences of FBD for utilization, health, and spending; 4) Apply comparative effectiveness analysis to identify clinical areas for potential savings in Medicare; and 5) Build a research network to support Medicare-related research and policy. We will promote collaboration and dissemination through various activities, including a national Medicare: Science and Policy Conference that will disseminate research findings and promote science-based Medicare reform. PUBLIC HEALTH RELEVANCE: This application focuses on solutions to ensure that Medicare continues its legacy of success. Our multidisciplinary team spanning four institutions at the forefront of health economics and policy research will design and conduct Medicare-related research, policy simulation, and welfare analysis that will focus on solutions to ensure Medicare continues its legacy of success.

描述（由申请人提供）：本申请涉及的主题领域，“利用科学，使医疗保健改革。“医疗保险计划的未来对美国构成了最大的政策挑战之一。这项非常受欢迎的计划为老年人和其他无法获得所需医疗服务的人带来了全民医疗保险。医疗保险D部分的实施，以涵盖处方药被广泛认为是成功的，但在几个方面，医疗保险是一个时代错误。首先，它的按服务收费的报销制度几乎从私人医疗保险中消失了。医疗保险像商业健康保险计划一样征收共同负担费用和免赔额，但大约80%的受益人有补充保险，这减少了自付费用。因此，大多数受益人在做出医疗保健决策时并没有充分考虑成本，甚至没有考虑医疗保险的共同负担。其次，研究表明，美国各地区的人均医疗保险支出存在巨大差异。无法用人口统计学或健康特征解释的变化。然而，高资源使用地区并没有上级健康成果。因此，在许多地区，医疗保险所覆盖的服务可能与美国老年人的需求不匹配。第三，该计划是联邦政府最大的财政负债。婴儿潮一代的老龄化将扩大医疗保险受益人的人数。如果没有计划的变化，医疗保险支出将从今天占国内生产总值的3%上升到2082年的17%。这项研究合作将设计和进行医疗保险相关的研究，政策模拟和福利分析，以解决这些问题。一个跨学科的团队跨越四个机构在卫生经济学和政策研究的前沿-斯坦福大学，南加州大学，兰德公司和加州大学伯克利分校-将专注于解决方案，以确保医疗保险继续其成功的遗产。2009年的《美国复苏和再投资法案》提供了前所未有的11亿美元，用于探索比较有效性研究。然而，CER在医疗保险计划中的具体应用还不存在。考虑到这些，我们的具体目标是：1）在医疗保险D部分市场中开发计划选择的跨期优化模型; 2）了解医疗保险D部分市场的竞争; 3）检查FBD对利用率，健康和支出的影响; 4）应用比较有效性分析来确定医疗保险中潜在节省的临床领域;（5）建立研究网络，支持医疗保险相关研究和政策。我们将通过各种活动促进合作和传播，包括全国医疗保险：科学与政策会议，该会议将传播研究成果并促进基于科学的医疗保险改革。公共卫生相关性：此应用程序侧重于解决方案，以确保医疗保险继续其成功的遗产。我们的多学科团队跨越卫生经济学和政策研究前沿的四个机构，将设计和进行医疗保险相关的研究，政策模拟和福利分析，重点是解决方案，以确保医疗保险继续其成功的遗产。