Dynamics of Plan Choice and Prescription Drug Utilization in Medicare Part D

医疗保险 D 部分中计划选择和处方药使用的动态

• 批准号: 8372015
• 负责人: JONATHAN GRUBER
• 金额: $ 31万
• 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 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8372015
• 关键词: Budgets; Caring; Characteristics; Coinsurance; Consumer Preferences; Consumption; Data; Data Set; Data Sources; Diagnosis; Drug Insurance; Drug Prescriptions; Drug Utilization; Elasticity; Elderly; Enrollment; Expenditure; Face; Government; Health Care Reform; Hospitals; Individual; Insurance; Insurance Benefits; Insurance Carriers; Learning; Link; Marketing; Medical; Medicare; Medicare Part A; Modeling; Pattern; Pharmaceutical Preparations; Physicians; Policies; Price; Privatization; Provider; Research; Risk; Sampling; Schedule; Side; Social Welfare; Statutes and Laws; Structural Models; Time; Uncertainty; United States Centers for Medicare and Medicaid Services; Work; base; beneficiary; cost; design; discounting; experience; improved; innovation; novel; payment; preference; programs

DESCRIPTION (provided by applicant): Dynamics of Plan Choice and Prescription Drug Utilization in Medicare Part D. The Medicare Part D prescription drug benefit pioneered the use of multiple private insurance providers to deliver a public insurance product, and as such raises a host of important policy questions. Are consumers capable of making an informed choice across so many private insurance options? Once enrolled in a plan, do consumers respond appropriately to the non-linear schedule of prices they face throughout the year? The key methodological innovation in our work is to construct models where choices reveal information about consumers' preferences, even when those choices are not necessarily optimal. This builds on our earlier work, which uses an incomplete data set to document evidence of inconsistencies in elders' choice of Part D plans. We will replicate and extend this work using a complete 20% sample of Medicare Part D claims provided by CMS. In particular, we will assess whether consumers tend to improve over time as beneficiaries gain experience in the market or whether consumers tend to remain in sub-optimal plans, either because they attempt to choose a better plan and fail, or because they remain in the same plan through inertia. We will develop a structural model which allows us to decompose the demand and supply side factors which drive changes in plan choices over time. Individuals enrolled in Medicare Part D face a complicated dynamic consumption decision: the prices of drugs today depend on out of pocket payments to date. Forward-looking consumers should consider their entire expected path of spending throughout the year in deciding on drug consumption at each point during the year, while time-inconsistent consumers may not do so. We will build a dynamic model of drug consumption with respect to the nonlinear budget sets facing consumers that incorporates uncertainty as well as potential discounting inconsistencies. Changes in drug consumption around the variance in drug plan pricing schedules allow us to identify both whether choices are consistent over time and how individuals react to price uncertainty. We will also extend our analysis to consider the impacts of prescription drug utilization for downstream physician and hospital spending. Our empirical strategy will allow us to estimate both an overall elasticity of hospital and doctor spending with respect to prescription drug expenditures (and coinsurances), and more particular elasticity's for different types of prescription drugs. We can use the results to provide projections of how changes in the time path of prices under Part D (e.g. filling in the donut hole) will impact annual consumption patterns of both prescription drugs and other types of medical consumption. PUBLIC HEALTH RELEVANCE: The Medicare Part D program pioneered the use of multiple private insurers to deliver a public insurance benefit, an approach which is the centerpiece of the Affordable Care Act. Our project will rigorously analyze the ability of individuals to make appropriate choices of plans within Part D, both upon initial enrollment and as they remain in the program. The results will be directly relevant to the design of Part D and will also apply to the design of exchanges and insurance options under health care reform.

描述（由申请人提供）：Medicare第D部分的计划选择和处方药利用的动态D动态D。医疗保险D处方药福利率先使用了多个私人保险提供商提供公共保险产品，因此提出了许多重要的政策问题。消费者是否有能力在如此众多的私人保险选择中做出明智的选择？一旦加入了计划，消费者是否应对全年面临的非线性价格时间表做出适当响应？我们工作中的关键方法论创新是构建模型，即使这些选择不一定是最佳选择，也可以揭示有关消费者偏好的信息。这是基于我们较早的工作，该工作使用不完整的数据集记录长者选择D部分计划中不一致的证据。我们将使用CMS提供的完全20％的Medicare D部分索赔来复制和扩展这项工作。特别是，随着受益人在市场上获得经验，或者消费者是否倾向于在次优计划中，我们将随着时间的流逝而评估消费者是否倾向于改善，要么是因为他们试图选择一个更好的计划和失败，要么是因为他们通过惯性保留了同一计划。我们将开发一个结构模型，该模型使我们能够分解需求和供应副因素，从而推动计划选择随着时间的推移而变化。参加Medicare D部分的个人面临着一个复杂的动态消费决定：当今的药物价格取决于迄今为止的零用费用。前瞻性消费者应考虑全年的全年支出的整个预期路径，以决定一年中每个点的毒品消费，而时间不足的消费者可能不会。我们将建立一个动态的药物消费模型，该模型相对于消费者面临的非线性预算集，这些预算集合融合了不确定性以及潜在的折现不一致。围绕药品计划定价时间表差异的药物消耗的变化使我们能够确定选择是否随着时间的流逝是一致的，以及个人如何对价格不确定性做出反应。我们还将扩展分析，以考虑处方药利用对下游医师和医院支出的影响。我们的经验策略将使我们能够估计医院的总体弹性和有关处方药支出（以及共同保险）的医生支出，以及针对不同类型的处方药的更特殊弹性。我们可以使用结果来提供有关D部分下价格时间的变化（例如，填充甜甜圈孔）如何影响处方药和其他类型的医疗消费的年度消费模式。 公共卫生相关性：Medicare D部分计划开创了使用多个私人保险公司提供公共保险福利的率，这是《平价医疗法案》的核心方法。我们的项目将严格分析个人在初次入学后以及在计划中保留的情况下在D部分内做出适当选择的能力。结果将与D部分的设计直接相关，还适用于医疗保健改革下的交易所和保险选择的设计。