Health Effects of Managed Care Among the Near-Ederly

描述(由申请人提供)：医疗保健组织使用按人头计算的方式激励提供者降低成本，可能是通过降低提供的服务，而医疗保健组织对参与者的竞争给这些计划提供了增加其提供的服务的动机。理想情况下，这些相互抵消的激励措施将引导人们制定计划，在服务和护理质量方面做出有效选择。经验研究现在清楚地表明，医疗保健组织在降低住院护理成本方面取得了成功，特别是通过降低住院率。Melnick和他的同事(1992)、Gaskin和Hadley(1997)、Rosko(2001)和其他人的工作表明，在市场上存在大规模管理性医疗渗透的情况下，医院价格和平均成本更低。但是，HMO是否对老年人的健康状况有任何可察觉的影响，如果是的话，这种影响的性质在很大程度上仍然是一个悬而未决的问题。 这项拟议研究的目标是分析参加管理性保健计划对近老年成年人健康的影响。候选人将利用1994年、1996年、1998年和2000年健康和退休调查(HRS)浪潮中收集的信息，努力实现这一目标。 这项研究的三个具体目标是：1)使用考虑个人健康计划(即，无论是HMO、PPO还是FFS计划)性质的明确模型，估计几个自我报告的健康衡量标准的健康生产函数；2)在估计这些函数时，控制几个右侧变量的可能内生性，特别是计划类型，这是因为许多近老年人从他们现在或以前的雇主提供的计划菜单中选择他们的保险范围；(3)比较HMOS、PPO和FFS计划对高龄老年人健康的影响。

DESCRIPTION (provided by the applicant): The use of capitation by HMOs gives providers an incentive to reduce costs, possibly by lowering the services provided, while HMO competition for enrollees gives these plans an incentive to increase the services they provide. Ideally, these countervailing incentives lead plans to make efficient choices about services and care quality. Empirical research has now clearly demonstrated the success of HMOs in reducing the cost of inpatient care, especially through lowering hospitalizations. Work by Melnick and colleagues (1992), Gaskin and Hadley (1997), Rosko (2001), and others suggests that hospital prices and average costs are lower in the presence of large managed care penetration in the market. But whether HMOs have any perceivable effects on the health status of older adults and, if so, the nature of such effects, is still largely an open question. The goal of the proposed study is to analyze the effects of enrollment in a managed care plan on the health of near-elderly adults. The candidate will work toward this goal using information gathered in the 1994, 1996, 1998, and 2000 waves of the Health and Retirement Survey (HRS). The three specific aims of the study are to: 1) Estimate health production functions for several self-reported measures of health, using well-specified models that account for the nature of an individual's health plan (i.e., whether it is an HMO, a PPO, or a FFS plan); 2) While estimating these, control for the possible endogeneity of several right-hand-side variables, particularly plan type, which occurs because many near-elders choose their insurance coverage from a menu of plans offered by either their current or former employer; and 3) Compare and contrast the effects of HMOs, PPOs, and FFS plans on the health of near-elders.