Effects of changes in Medicaid physician fees on use of preventive care

医疗补助医生费用的变化对预防性护理使用的影响

• 批准号: 8336741
• 负责人: ADAM J ATHERLY
• 金额: $ 22.44万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-24 至 2013-12-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8336741
• 关键词: Adult; Advisory Committees; Caring; Categories; Congresses; Cost Sharing; Data; Elements; Eligibility Determination; Excision; Expenditure; Fees; Funding; Future; Health; Incentives; Insurance; Laws; Low Income Population; Medicaid; Medical; Medical Assistance; Medicare; Modeling; Monitor; National Ambulatory Medical Care Survey; Parents; Patients; Physicians; Policies; Population; Preventive; Primary Care Physician; Primary Health Care; Provider; Research; Services; Structure; Surveys; Techniques; United States Centers for Medicare and Medicaid Services; Variant; beneficiary; copayment; cost; design; financial incentive; geographic difference; payment; programs; safety net; trend

DESCRIPTION (provided by applicant): The purpose of this project is to model the effects of temporary changes in Medicaid physician fees, removal of preventive care copayment rates and Medicaid eligibility expansion in the Patient Protection and Affordable Care Act of 2010 (PPACA) on the use of US Preventive Services Task Force (USPSTF) recommended preventive care among Medicaid enrollees. PPACA appropriates federal dollars to fund increases in physician fees for the Medicaid program to Medicare rates for 2013 and 2014. After 2014, the federal incentive expires and it is up to states to determine if they will continue to fund the payment increase using state funds if Congress does not fund an extension. Traditionally, each state has set its own Medicaid reimbursement rates and has had wide discretion in eligibility rules and copayment structure. Federal Medicaid law does not define preventive services, include these services under a mandatory benefit category or track specific preventive services covered for adults by each Medicaid program. This has led to substantial geographic variation in Medicaid plan design and use of preventive services, with not all USPSTF services covered in all states and substantial differences in provider reimbursement and beneficiary cost sharing. This study will examine the effect of the previous increases in physician fees on the use of USPSTF recommended preventive care services and model the projected impact of additional utilization increases under PPACA. Similarly, we will estimate the effects of the elimination of this financial incentive after 2014. We will also estimate the cost of increases in the use of these preventive services, resulting from the increase in physician fees, the removal of copayments, and the eligibility expansion to parents and childless adults. To answer these questions, we will use data from the Medical Expenditure Panel Survey (MEPS) and the National Ambulatory Medical Care Survey (NAMCS). The project will answer an important research question that will be critical for the next step in health reform. When the federal subsidies for higher Medicaid reimbursement and program expansions expire in 2014, states will make choices about which elements to retain and which to discard. It will be critical that there be scientific evidence regarding the impact of the different policy options. Currently, that evidence is lacking. This study will provide guidance to states about the likely effect of different policy choices on the use of preventive care in low income populations.

描述（由申请人提供）：本项目的目的是模拟医疗补助医生费用的临时变化、2010年《患者保护和平价医疗法案》（PPACA）中预防性护理共付费用率的取消和医疗补助资格扩展对医疗补助参保者使用美国预防服务工作组（USPSTF）建议的预防性护理的影响。PPACA拨款联邦美元，以资助2013年和2014年医疗补助计划的医生费用增加到医疗保险费率。2014年后，联邦激励措施到期，如果国会不为延长提供资金，则由各州决定是否继续使用州资金为支付增加提供资金。传统上，每个州都有自己的医疗补助报销率，并在资格规则和共同支付结构方面有广泛的自由裁量权。联邦医疗补助法没有定义预防服务，将这些服务纳入强制性福利类别，也没有跟踪每个医疗补助计划为成年人提供的特定预防服务。这导致医疗补助计划设计和预防服务使用的地理差异很大，并非所有USPSTF服务都覆盖所有州，并且提供者报销和受益人费用分摊存在重大差异。本研究将研究以前增加医生费用对使用USPSTF推荐的预防保健服务的影响，并模拟PPACA下额外利用率增加的预计影响。同样，我们将估计2014年后取消这一财政激励措施的影响。我们还将估计增加使用这些预防性服务的成本，这是由于医生费用增加、取消共同负担以及将资格扩大到父母和无子女的成年人。为了回答这些问题，我们将使用来自医疗支出小组调查（MEPS）和全国门诊医疗调查（NAMCS）的数据。该项目将回答一个重要的研究问题，这对卫生改革的下一步至关重要。当联邦对更高医疗补助报销和项目扩展的补贴在2014年到期时，各州将做出选择，保留哪些元素，放弃哪些元素。关键是要有关于不同政策选择的影响的科学证据。目前，这方面的证据还很缺乏。这项研究将为各州提供指导，了解不同政策选择对低收入人群使用预防保健的可能影响。