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The Role of Private Plans in Medicare

私人计划在医疗保险中的作用

基本信息

批准号：
8432039
负责人：
JOSEPH PAUL NEWHOUSE
金额：
$ 186.29万
依托单位：
HARVARD MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-04-15 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8432039
关键词：
Accounting Address Affect Attention Behavior Behavioral Budgets Characteristics Congresses County Data Sources Economic Policy Economics Elderly Empirical Research Enrollment Equilibrium Federal Government Feeds Funding Future Game Theory Growth Health Health Care Costs Health Insurance Health Planning Health Policy Healthcare Incentives Individual Leadership Light Logic Marketing Medicaid Medicare Medicare Part C Methodology Modernization Names Nature Pattern Persons Pharmaceutical Preparations Policies Population Positioning Attribute Principal Investigator Quality of Care Reaction Reporting Research Research Personnel Research Project Grants Risk Adjustment Role Savings Services Social Welfare Staging Structure System Theoretical model Time United States Update Work base beneficiary cost design feeding flexibility improved innovation payment programs response social theories

项目摘要

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）：拟议计划项目的目的是从经济理论基础的框架中对Medicare Part C或Medicare Advantage（MA）的理论和经验基础进行基本检查。该项目是围绕五个项目，涉及三个层次的多阶段游戏：1）在最低层次，受益人选择MA或传统的医疗保险（TM）取决于计划产品; 2）在中间层次，计划决定进入和选择整体慷慨的好处，取决于医疗保险政策和会计受益人的反应; 3）同样在中层，计划选择其福利的组合或结构，这取决于医疗保险政策，并考虑到由于不完善的风险调整而导致的整合和激励可能带来的效率机会，并考虑到受益人的反应（选择）; 4）同样在中级，MA计划关于进入和实践模式的选择对TM和非医疗保险人群的受益人有影响;本实证项目侧重于这些溢出效应; 5）在最高层次上，第五个项目是理论性的，重点是为给定的计划和受益人反应设计最优的医疗保险政策，以及在实证项目中研究的潜在溢出效应。提出的研究的意义是由四个观察。首先，医疗保险计划对美国老年人非常重要，影响他们的健康，财务状况和整体福利。第二，由于医疗保险计划对预算的影响，它对联邦政府具有广泛的重要性。第三，医疗保险的一个关键和不断增长的部分，可以说是未能实现其目标，提供高质量的护理比TM更有效。2007年6月，医疗保险支付咨询委员会（MedPAC）向国会提交的报告断然得出结论：“目前的MA支付政策与MedPAC的MA和传统FFS计划之间的支付公平原则不一致。“第四，一个设计良好的硕士项目有能力将医疗保险推向卫生政策的领导地位，而一个设计不良的项目将扼杀积极的改革尝试。