The Effects of Private Health Insurance in Publicly Funded Programs

描述（由申请人提供）：在过去的30年里，医疗保健支出的增长速度超过了通货膨胀，使消费者、患者、雇主、政府项目和纳税人的预算紧张。决策者面临的主要挑战是如何设计有效地控制成本的政策-减少不必要的支出，同时保持或增加高价值服务的支出。确定私营保险在促进有效利用护理方面的适当作用是这一挑战的一个重要部分。本研究的目的是通过研究美国医疗保险计划的经验，为私人医疗保险如何影响公共资助计划中医疗保健的利用、融资和结果提供新的证据。本研究有以下两个具体目的：1)确定补充或替代医疗保险的不同类型保险之间风险选择的程度和来源；2)确定补充或替代医疗保险的私人保险如何影响医疗保险受益人的医疗利用、融资和结果。利用计量经济学方法检验二手数据来源，我们将确定保险补充或替代医疗保险覆盖的市场风险选择的程度和来源，政策在减轻或加剧风险选择方面的作用，以及私人补充和替代保险对医疗保险受益人的利用、融资和护理结果的影响。对于具有特定慢性疾病的受益人子集，我们将检查保险覆盖对护理过程的影响。该项目的主要数据来源将是健康和退休调查、医疗保险当前受益人调查和医疗支出小组调查。该项目将提供证据，证明不同类型的私人保险对受益人和医疗保险计划的影响。这一证据对于确定在何种程度上应将私人保险选择视为加强该计划的一种机制至关重要。反过来，来自医疗保险计划的证据将为决策提供有关私人医疗保险在其他政策背景下的作用的信息，例如促进州医疗补助计划的私人覆盖，建立健康保险交易所，以及在私人计划和公共管理的替代方案之间创造竞争。

DESCRIPTION (provided by applicant): Health care spending has risen more quickly than inflation over the last 30 years, straining the budgets of consumers, patients, employers, government programs, and tax payers. The key challenge facing policy makers is how to design policies that contain costs efficiently - reducing unnecessary expenditures while maintaining or increasing expenditures on high value services. Determining the appropriate role of private insurance in promoting the efficient utilization of care is an important part of that challenge. The objective of this research is to provide new evidence on how private health insurance influences the utilization, financing, and outcomes of health care in publicly funded programs by examining the experience of the U.S. Medicare program. The proposed research has the following two specific aims: 1) To identify the extent and sources of risk selection between different types of insurance that either supplement or replace Medicare coverage, and 2) To determine how private insurance either supplementing or replacing Medicare coverage affects the utilization, financing, and outcomes of care for Medicare beneficiaries. Using econometric methods to examine secondary data sources, we will identify the extent and sources of risk selection in markets for insurance supplementing or replacing Medicare coverage, the role of policies in either attenuating or exacerbating risk selection, and the effects of private supplementary and replacement insurance on the utilization, financing, and outcomes of care for Medicare beneficiaries. For a subset of beneficiaries with particular chronic conditions, we will examine the effects of insurance coverage on process of care. The primary data sources for the project will be the Health and Retirement Survey, The Medicare Current Beneficiary Survey, and The Medical Expenditure Panel Survey. The project will provide evidence on the effects of different types of private coverage on both beneficiaries and the Medicare program. This evidence is essential for determining the extent to which private insurance options should be viewed as a mechanism to enhance the program. Evidence from the Medicare program, in turn, will inform decision-making regarding the role of private health insurance in other policy contexts, such as promoting private coverage in state Medicaid programs, establishing health insurance exchanges, and creating competition between private plans and a publicly administered alternative. PUBLIC HEALTH RELEVANCE: The objective of this research is to provide new evidence on how private health insurance influences the utilization, financing, and outcomes of health care in publicly funded programs by examining the experience of the U.S. Medicare program. We will examine the extent and sources risk selection in these markets as well as how the different types of private coverage enroll affect the utilization, cost, and outcomes of medical care. We anticipate that this research will provide important evidence on the effects of different models of financing health insurance on the Medicare program and its beneficiaries as well as on the potential effects of similar policies in other contexts.