Cost-Sharing, Use, and Outcomes of Post-Acute Care in Medicare Advantage Plans

描述(由申请人提供)：在过去十年中，医疗保险在急诊后护理上的支出呈爆炸式增长，在不损害健康或增加其他卫生服务的抵消性成本的情况下，引发了政策对减少急诊后支出的浓厚兴趣。根据传统的医疗保险福利设计，最初20天的熟练护理设施护理和所有家庭护理都是免费提供的(即没有共同付费)，这引发了人们对患者过度使用这些服务的动机的担忧，即使这些服务几乎没有价值或根本没有价值。为了解决这一担忧，奥巴马总统、医疗保险支付咨询委员会和鲍尔斯-辛普森赤字削减委员会都表示支持对急性后护理的使用实行共同支付。然而，没有经验证据基础来预测这些政策的影响。这项提案的目的是使用准实验研究设计和管理保健计划中的全国医疗保险参与者样本来评估费用分担的变化对急性后护理的使用和结果的影响。这项拟议研究基于一系列广泛的初步研究结果，其中心假设是，共同支付将大幅减少急诊后护理的使用，促使患者转向其他自付费用较低的急诊后服务，将住院受助人从管理保健计划中转移到按服务收费的系统中，并增加住院时间和再次入院的可能性。我们的期望是，该项目将为联邦医疗保险受益人对急性补偿后的反应提供严格的估计，并大大有助于我们理解老年人分担费用的效果，老年人被排除在1970年进行的里程碑式的兰德健康保险试验之外。最后，该研究可以为最优的医疗保险福利政策提供信息，这些政策可以促进更好的健康结果和急性后服务的适当使用，同时将虚弱老年人和联邦医疗保险计划预算的负面意外后果降至最低。

DESCRIPTION (provided by applicant): Medicare spending on post acute care has exploded in the past decade, catalyzing intense policy interest in strategies to reduce post acute expenditures without harming health or increasing the offsetting costs of other health services. Under the traditional Medicare benefit design, the first 20 days of skilled nursing facility care ad all episodes of home care are provided free (i.e. without a copayment), raising concerns about patients' incentives to overuse these services, even when they are of little or no value. To address this concern President Obama, the Medicare Payment Advisory Commission, and the Bowles-Simpson deficit reduction committee have all expressed support for the imposition of a copayment for the use of post acute care. Yet, there is no empirical evidence base to predict the impact of such policies. The objective of this proposal is to evaluate the impact of changes in cost-sharing on the use and outcomes of post acute care using a quasi- experimental research design and a national sample of Medicare enrollees in managed care plans. The central hypotheses of the proposed research, which is based on the results of an extensive series of preliminary studies, are that copayments will sharply reduce the use of post acute care, induce shifts to other post acute services with lower out-of-pocket costs, drive hospitalized beneficiarie out of managed care plans into the fee- for-service system, and increase hospital length of stay and the probability of readmission. Our expectations are that this project will provide rigorous estimates of the response of Medicare beneficiaries to post acute copayments and contribute significantly to our understanding of the effect of cost-sharing among the elderly, who were excluded from the landmark RAND Health Insurance Experiment conducted in the 1970's. Finally, this research can inform optimal Medicare benefit policies that promote better health outcomes and the appropriate use of post acute services while minimizing negative unintended consequences for frail elderly and the Medicare program budget.