The Effects of Medicare Advantage on Healthcare Use and Patient Outcomes

项目摘要/摘要 越来越多的联邦医疗保险受益人参加了联邦医疗保险优势(MA)，而不是传统的费用- For-Service(TM)Medicare，MA份额从2004年的13%增加到2020年的39%。城市发展中心 Medicare和Medicaid Services(CMS)Pay MA计划每月支付几乎所有医疗保健 计划参与者的费用。MA计划将未用于覆盖参保人的付款部分保留为利润 费用。此外，CMS授予MA计划更大的自由来管理参与者的医疗保健使用，例如， 通过狭窄的提供商网络等工具和更广泛的交付创新覆盖范围，例如 远程医疗。支持者认为，这些针对并购计划的财务激励和有效工具可能会使 他们提供的护理比TM更有效率。另一方面，这些影响可以通过金融来抵消。 限制服务提供超出改善短期健康所需范围的激励措施， 从而对长期结果产生不利影响。先前的工作主要估计了横截面 TM和MA参与者的比较，如果MA参与者与TM不同，这可能会导致估计有偏差 以其他与卫生保健使用和健康结果相关的方式登记。我们提议的项目将研究 硕士注册人数的变化来自七个州，这些州最近将公共退休人员的健康福利从 强制性MA计划的补充TM覆盖范围(或在一个州，从强制性MA计划到补充 TM覆盖范围)。我们将使用这些自然实验，以及TM和MA的全面医疗保险数据 参与者，以评估MA注册对医疗保健使用、质量和患者结局的因果影响。 这些结果将为考虑更广泛地扩大医疗保险的政策制定者提供重要证据 优势。

Project Summary/ Abstract A growing share of Medicare beneficiaries are enrolled in Medicare Advantage (MA) rather than traditional fee- for-service (TM) Medicare, with the MA share increasing from 13% in 2004 to 39% in 2020. The Centers for Medicare and Medicaid Services (CMS) pay MA plans a monthly capitated rate to cover nearly all health care expenses for plan enrollees. MA plans keep as profits the portion of payments that are not used to cover enrollee expenses. In addition, CMS grants MA plans greater freedom to manage enrollees’ health care use, for example, through tools such as narrow provider networks and broader coverage of delivery innovations such as telemedicine. Proponents argue that these financial incentives and effective tools for MA plans might enable them to provide care more efficiently than TM. On the other hand, these effects could be offset by financial incentives under capitation to limit service provision beyond what is necessary to improve short term health, resulting in adverse impacts on longer-term outcomes. Prior work has primarily estimated cross-sectional comparisons of TM and MA enrollees, which could lead to biased estimates if MA enrollees differ from TM enrollees in other ways that are related to health care use and health outcomes. Our proposed project will study changes in MA enrollment coming from seven states that recently changed public retiree health benefits from supplemental TM coverage to mandatory MA plans (or in one state, from a mandatory MA plan to supplemental TM coverage). We will use these natural experiments, along with comprehensive Medicare data for TM and MA enrollees, to estimate the causal impact of MA enrollment on health care use, quality, and patient outcomes. These results will provide important evidence to policymakers weighing broader expansions of Medicare Advantage.