Implications of Switching Costs for Medicare Premium Support

描述（由申请人提供）：本项目的总体目标是评估医疗保险健康计划中转换成本的程度，以了解它们是否大到足以破坏竞争市场在保费支持环境下运作的能力。为此，我们将分析医疗保险受益人是否对健康计划保费和“保费支持”式医疗保险改革的福利变化做出足够的反应，以成为控制医疗保险支出的可行策略。医疗保险计划在未来几十年将面临巨大的财政挑战。医疗保险受托人预计，到2025年，A部分信托基金将资不抵债，整个计划将处于不可持续的支出轨道上。尽管关于如何应对迫在眉睫的支出危机有许多不同的建议，但大多数建议可归为两类：重新设计医疗保健和额外支持。护理重新设计旨在保留现有的按服务收费（FFS）模式的基本结构，同时引入激励措施，以更有效地提供护理。第二种想法——溢价支持——让医疗计划向政府提交基本福利一揽子计划的“投标”。政府利用这些投标来确定自己对保费的贡献。提供更好价值的计划将获得高市场份额的奖励，而那些不提供更好价值的计划将失去市场份额。这是医疗保险D部分处方药覆盖结构背后的基本逻辑，该计划获得了很高的受益人满意度，计划成本大大低于预期。然而，D部分的结果是否会转化为包括更广泛覆盖的保费支持模型尚不清楚。尽管已经有大量的努力来评估医疗保险中护理重新设计的影响- CMS目前正在资助许多护理重新设计的评估，例如捆绑支付计划和负责任的医疗组织-相对而言，很少有努力来评估保费支持模式的可行性，尽管它作为一个可能的改革选择而突出。该项目的数据来自医疗保险当前受益人调查，这是一个具有代表性的纵向数据集。在分析上，我们将使用混合logit模型来估计切换成本的大小，并随时间观察计划选择。我们将明确地模拟计划“忠诚度”对计划选择的影响，并允许“忠诚度”是一个随机系数。随机系数不仅能让我们确定

DESCRIPTION (provided by applicant): The overarching goal of this project is to evaluate the extent of switching costs in Medicare health plans to understand whether they are large enough to undermine the ability of competitive markets to function in a premium support context. To do this, we will analyze whether Medicare beneficiaries are sufficiently responsive to changes in health plan premiums and benefits for "premium support" style Medicare reforms to be a viable strategy to control Medicare spending. The Medicare program faces substantial financial challenges over the next several decades. The Medicare Trustees project that the Part A trust fund will become insolvent by 2025 and that the entire program is on an unsustainable spending trajectory. Although there are many different proposals for how to deal with the impending spending crisis, most falls into one of two groups: care redesign and premium support. Care redesign seeks to preserve the basic structure of the existing Fee-For-Service (FFS) model while introducing incentives to provide care more efficiently. The second idea - premium support - has health plans submit "bids" to the government for a basic benefit package. The government uses these bids to set its contribution to premiums. Plans that provide better value are rewarded with high market share, while those that do not are penalized by losing market share. This is the essential logic behind the structure of Medicare Part D prescription drug coverage, a program that has achieved high beneficiary satisfaction and program costs substantially below projections. However, whether this Part D result would translate to a premium support model that included broader coverage is unclear. Although there have been substantial efforts to evaluate the impact of care redesign in Medicare - CMS is currently funding numerous evaluations of care redesigns, such as bundled payment initiatives and Accountable Care Organizations - there has been relatively little effort to evaluate the viability of premium suppor models, despite its prominence as a possible reform option. The project draws data from the Medicare Current Beneficiary Survey, a representative longitudinal dataset. Analytically, we will estimate the magnitude of switching costs using a mixed logit model, observing plan choices over time. We will explicitly model the impact of plan "loyalty" on plan choices, and will allow "loyalty" to be a random coefficient. The random coefficient will allow us to identify not only the mean value of loyalty, but also to identify factors which predict loyalty.