Choice and Consequences in the Medicare Part D Plan

Medicare D 部分计划中的选择和后果

• 批准号: 7586202
• 负责人: JONATHAN GRUBER
• 金额: $ 28.46万
• 依托单位: NATIONAL BUREAU OF ECONOMIC RESEARCH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-15 至 2012-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7586202
• 关键词: Address; Affect; Automobile Driving; Behavioral; Cost Sharing; County; Data; Data Set; Drug Costs; Drug Prescriptions; Drug Utilization; Drug usage; Econometric Models; Economics; Elasticity; Elderly; Evaluation; Expenditure; Individual; Insurance; Knowledge; Left; Medicare; Modeling; Modernization; Names; Nature; Outcome; Patients; Pattern; Pharmaceutical Preparations; Play; Policy Maker; Price; Provider; Research; Risk; Role; Sampling; Statutes and Laws; Structure; Time; beneficiary; cost; novel; prescription drug costs; programs

DESCRIPTION (provided by applicant): The Medicare Modernization Act of 2003, better known as the legislation that added the Part D prescription drug benefit to the Medicare program, represents the single most significant expansion of public insurance programs in the U.S. in the past 40 years. Perhaps the most novel, and controversial, feature of this legislation was the use of multiple private insurance providers to deliver this new public insurance product, with widely varying prices and product features (including the donut hole whereby individuals are covered for initial drug expenditures but not for higher levels of expenditures). I will evaluate the effects of Part D using a unique data set that allows me to follow several million elders over the 2005 to 2009 period, with data on both their prescription drug coverage and their choice of Part D plan. In particular, this project aims to answer six questions. First, what is the financial risk facing elder when choosing their Part D plans; what are the financial consequences of alternative plan choices in their county? Second, are elders choosing the part D plan that minimizes their total cost of prescription drug coverage, and, if not, how much money are they leaving on the table through their choices? Third, what determines choice of Part D plan? I will estimate a comprehensive econometric model of plan choice to assess the role of financial and non-financial factors in driving choices. Fourth, what determines the dynamics of plan choice; do individuals re-optimize if they have chosen an inappropriate plan or is there very strong inertia in plan choice? Fifth, how does the structure of Part D plans affect utilization? These longitudinal data, and the potential econometric identification that is provided by inertia in plan choice, will allow me to develop estimates of utilization elasticity. Finally, how does prescription drug use respond to within-year changes in cost-sharing? Understanding whether individuals anticipate the donut hole, and how they react to this feature, is critical for modeling reforms to the Part D benefit structure. The result of these analyses will be the first comprehensive picture of how Part D choices are made, and how those choices impact beneficiary drug utilization. These findings should be very helpful to policy- makers as they consider ongoing reforms of this major entitlement program. The Medicare Modernization Act of 2003, better known as the legislation that added the Part D prescription drug benefit to the Medicare program, represents the single most significant expansion of public insurance programs in the U.S. in the past 40 years. Perhaps the most novel, and controversial, feature of this legislation was the use of multiple private insurance providers to deliver this new public insurance product, with widely varying prices and product features (including the donut hole whereby individuals are covered for initial drug expenditures but not for higher levels of expenditures). I will provide the first comprehensive picture of how Part D choices are made, and how those choices impact beneficiary drug utilization. These findings should be very helpful to policy-makers as they consider ongoing reforms of this major entitlement program.

描述（由申请人提供）：2003年的医疗保险现代化法案，更好地称为将D部分处方药福利添加到医疗保险计划的立法，代表了美国公共保险计划在过去40年中最重要的一次扩展。这项立法最新颖、最有争议的特点可能是使用多个私人保险提供商来提供这种新的公共保险产品，价格和产品特征差异很大（包括甜甜圈洞，个人可以支付初始药物支出，但不能支付更高水平的支出）。我将使用一个独特的数据集来评估D部分的效果，该数据集允许我在2005年至2009年期间跟踪数百万老年人，其中包括他们的处方药覆盖范围和他们选择D部分计划的数据。本项目旨在回答六个问题。首先，老年人在选择D部分计划时面临的财务风险是什么？在他们的国家选择替代计划的财务后果是什么？第二，老年人是否选择了D部分计划，以最大限度地减少他们的处方药覆盖的总成本，如果不是，他们通过他们的选择留下了多少钱？第三，是什么决定了D部分计划的选择？我将估计一个全面的计划选择的计量经济模型，以评估金融和非金融因素在推动选择中的作用。第四，是什么决定了计划选择的动力;如果个人选择了一个不合适的计划，他们会重新优化吗？还是计划选择中存在很强的惯性？第五，D部分计划的结构如何影响利用？这些纵向数据，以及计划选择惯性所提供的潜在计量经济学识别，将使我能够对利用弹性进行估计。最后，处方药的使用如何应对年内费用分摊的变化？了解个人是否预期甜甜圈洞，以及他们如何对这一特征作出反应，对于D部分福利结构的改革建模至关重要。这些分析的结果将是第一次全面了解如何做出D部分选择，以及这些选择如何影响受益药物的使用。这些发现应该对政策制定者非常有帮助，因为他们考虑正在进行的这一主要权利计划的改革。 2003年的《医疗保险现代化法案》（Medicare Modernization Act of 2003）是美国过去40年来公共保险计划最重要的一次扩张，该法案更为人所知的是将D部分处方药福利纳入医疗保险计划的立法。这项立法最新颖、最有争议的特点可能是使用多个私人保险提供商来提供这种新的公共保险产品，价格和产品特征差异很大（包括甜甜圈洞，个人可以支付初始药物支出，但不能支付更高水平的支出）。我将提供第一个全面的图片如何D部分的选择，以及这些选择如何影响受益人的药物利用。这些研究结果应该是非常有帮助的政策制定者，因为他们考虑正在进行的改革，这一主要的权利计划。