The Role of Private Plans in Medicare

私人计划在医疗保险中的作用

• 批准号: 8145121
• 负责人: JOSEPH PAUL NEWHOUSE
• 金额: $ 4.92万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-15 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8145121
• 关键词: Role; Private; Plans; Medicare

DESCRIPTION (provided by applicant): The purpose of the proposed Program Project is to undertake a fundamental examination of the theoretical and empirical underpinnings of Medicare Part C, or Medicare Advantage (MA) from a framework grounded in economic theory. The Project is organized around five projects that relate to three levels of a multi-stage game: 1) At the lowest level, beneficiaries choose MA or traditional Medicare (TM) depending on plan offerings; 2) At the middle level, plans decide about entry and choose the overall generosity of benefits, depending upon Medicare policy and accounting for beneficiary reaction; 3) Also at the middle level, plans choose the mix or structure of their benefits, depending upon Medicare policy and in light of possible opportunities for efficiencies from integration and incentives due to imperfect risk adjustment, accounting for beneficiary reaction (selection); 4) Also at the middle level, MA plan choices about entry and practice patterns have consequences for beneficiaries in TM and non-Medicare populations; this empirical project focuses on these spillovers; 5) At the highest level, the fifth project is theoretical, focusing on design optimal policies for Medicare given plan and beneficiary reaction, and potential spillovers investigated in the empirical projects. The significance of the proposed research is premised on four observations. First, the Medicare program is of enormous importance to the elderly in the United States, affecting their health, their financial status, and overall welfare. Second, the Medicare program is of broad importance to the federal government because of its budgetary impact. Third, MA, a critical and growing part of Medicare, is arguably failing to achieve its objective of providing high-quality care with greater efficiency than TM. The June 2007 Report to Congress of the Medicare Payment Advisory Commission (MedPAC) flatly concluded: "The current MA payment policy is inconsistent with MedPAC's principles of payment equity between MA and the traditional FFS program." Fourth, a well-designed MA program has the power to move Medicare into a position of leadership in health policy, while a poorly-designed program will stifle attempts at positive reform.

描述(由申请人提供)：计划项目的目的是从一个以经济理论为基础的框架出发，对联邦医疗保险C部分或联邦医疗保险优势(MA)的理论和经验基础进行根本性的审查。该项目围绕五个项目组织，涉及三个多阶段博弈：1)在最低层，受益人根据计划产品选择MA或传统Medicare(TM)；2)在中间层，计划决定进入并选择总体福利慷慨，取决于联邦医疗保险政策和考虑受益人反应；3)也是在中间层，计划选择其福利的组合或结构，取决于联邦医疗保险政策，并考虑到由于风险调整不完善而可能从整合和激励中获得效率的机会，考虑到受益人反应(选择)；4)同样在中层，MA计划中关于进入和实践模式的选择对TM和非联邦医疗保险人群中的受益者有影响；本实证项目侧重于这些溢出效应；5)在最高层面，第五个项目是理论上的，重点是为给定计划和受益人反应的联邦医疗保险设计最优政策，以及在实证项目中调查的潜在溢出效应。 拟议研究的意义是基于四个观察结果。首先，医疗保险计划对美国的老年人非常重要，影响到他们的健康、经济状况和整体福利。其次，联邦医疗保险计划对联邦政府具有广泛的重要性，因为它对预算有影响。第三，MA作为联邦医疗保险中一个关键且不断增长的部分，可以说未能实现其目标，即以比TM更高的效率提供高质量的医疗服务。2007年6月提交给国会的医疗保险支付咨询委员会(MedPAC)的报告断然得出结论：“目前的MA支付政策与MedPAC关于MA和传统FFS计划之间的支付公平的原则不一致。”第四，设计良好的MA计划有能力将医疗保险推向医疗政策的领导地位，而设计糟糕的计划将扼杀积极改革的尝试。