The Role of Private Plans in Medicare

私人计划在医疗保险中的作用

• 批准号: 7559851
• 负责人: JOSEPH PAUL NEWHOUSE
• 金额: $ 198.53万
• 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/7559851
• 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）：拟议项目的目的是从经济理论的框架中对医疗保险C部分或医疗保险优势（MA）的理论和实证基础进行基本检查。该项目由五个项目组成，涉及三个层次的多阶段博弈：1)在最低层次，受益人根据计划提供选择MA或传统医疗保险（TM）；2)在中层，计划根据Medicare政策和考虑受益人的反应，决定进入和选择总体福利慷慨程度；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产生的整合和激励可能带来的效率机会，考虑到受益人的反应（选择）；4)同样在中等水平，MA计划关于进入和实践模式的选择对TM和非medicare人群的受益人有影响；本实证项目侧重于这些溢出效应；5)在最高层面上，第五个项目是理论性的，侧重于设计医疗保险给定计划和受益人反应的最优政策，并在实证项目中研究了潜在的溢出效应。