Implications of Switching Costs for Medicare Premium Support

医疗保险保费支持转换成本的影响

基本信息

批准号：
8620426
负责人：
ADAM J ATHERLY
金额：
$ 11.6万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-30 至 2015-06-30
项目状态：
已结题

项目摘要

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.

描述（由申请人提供）：该项目的总体目标是评估Medicare健康计划中切换成本的程度，以了解它们是否足够大，以破坏竞争市场在高级支持环境中运作的能力。为此，我们将分析Medicare受益人是否足够响应健康计划保费的变化和“高级支持”样式改革的福利，这是控制医疗保险支出的可行策略。在接下来的几十年中，Medicare计划面临着重大的财务挑战。 Medicare受托人项目，即信托基金将在2025年将无力偿债，并且整个计划都处于不可持续的支出轨迹上。尽管关于如何应对即将到来的支出危机有许多不同的建议，但大多数属于两个群体之一：护理重新设计和高级支持。护理重新设计旨在保留现有费用服务（FFS）模型的基本结构，同时引入激励措施以更有效地提供护理。第二个想法 - 高级支持 - 让健康计划向政府提交“投标”，以获得基本的福利计划。政府使用这些投标来为保费做出贡献。提供更好价值的计划将获得高市场份额的奖励，而那些不会因失去市场份额而受到惩罚的计划。这是医疗保险D处方药覆盖范围的结构背后的重要逻辑，该计划已达到高受益人满意度，并且计划成本基本低于预测。但是，该部分结果是否会转化为包括更广泛覆盖范围的高级支持模型。尽管已经做出了重大努力来评估Medicare重新设计的影响，但CMS目前正在为诸如捆绑的付款计划和负责任的护理组织等众多评估护理评估提供资金 - 尽管它作为可能的改革选择，但努力却相对较少地评估高级支持者模型的可行性。该项目从Medicare当前的受益人调查中汲取了数据，该调查是代表性的纵向数据集。从分析上，我们将使用混合的logit模型估算切换成本的幅度，并随着时间的推移观察计划选择。我们将明确对计划“忠诚度”对计划选择的影响进行建模，并允许“忠诚度”成为一个随机系数。随机系数将使我们不仅可以识别忠诚度的平均值，同时也要确定预测忠诚度的因素。