Implications of Switching Costs for Medicare Premium Support

描述(由申请人提供)：本项目的首要目标是评估联邦医疗保险健康计划中转换成本的程度，以了解它们是否足够大，从而削弱竞争市场在保费支持背景下发挥作用的能力。为此，我们将分析联邦医疗保险受益人是否对医疗计划保费和福利的变化做出足够的反应，以使“保费支持”式的联邦医疗保险改革成为控制联邦医疗保险支出的可行战略。联邦医疗保险计划在接下来的几十年里面临着巨大的财务挑战。联邦医疗保险受托人预计，A部分信托基金将在2025年之前破产，整个计划将处于不可持续的支出轨道上。尽管对于如何应对迫在眉睫的支出危机有许多不同的建议，但大多数建议分为两类：重新设计医疗保健和保费支持。护理重新设计寻求保留现有按服务收费(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。第二个想法--保费支持--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其保费的贡献。提供更好价值的计划会获得很高的市场份额，而不能提供更高价值的计划则会受到失去市场份额的惩罚。这是Medicare Part D处方药保险结构背后的基本逻辑，该计划实现了很高的受益人满意度，计划成本大大低于预期。然而，这一D部分的结果是否会转化为包括更广泛覆盖范围的高级支持模式尚不清楚。尽管已经做出了大量努力来评估医疗保险中医疗重新设计的影响-CMS目前正在资助许多医疗重新设计的评估，例如捆绑支付倡议和责任医疗组织-但评估保费支持模式的可行性的努力相对较少，尽管它是一个可能的改革选项。该项目从联邦医疗保险当前受益人调查中提取数据，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模型来估计转换成本的大小，观察随着时间的推移而做出的计划选择。我们将明确建模计划“忠诚度”对计划选择的影响，并允许“忠诚度”作为随机系数。随机系数将使我们不仅能够识别 忠诚度的平均值，也是为了识别预测忠诚度的因素。

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.