New Evidence on the Persistence of High Health Spending

描述（由申请人提供）：在一定程度上，随着时间的推移，高医疗保健支出持续存在，逆向选择问题将在基于年度合同的私人保险市场上加剧，加剧了对负担得起的保险的可用性的担忧。尽管了解医疗支出的持续性很重要，但令人惊讶的是，人们对此知之甚少。有几项研究是基于医疗保险的数据，限制了对65岁以下人群的普遍性。代表年轻人的研究有其局限性，包括缺乏最新数据、后续行动时间短、雇主或保险公司样本单一，以及缺乏对雇主保险的自然减员的关注。关于支出持续性的新知识可以改善许多政策选择的证据基础，包括补贴再保险市场，医疗保险买入， 鼓励扩大个人保险合同和消费者驱动的健康计划的作用。我们将使用2002-2007年汤姆森医疗保健市场扫描数据库，其中包括通过100多家大公司投保的个人索赔数据，以及2001-2006年MEPS浪潮，评估医疗保健成本的持续性。支出类别将基于年度支出的削减点 分布（例如，前5%）。主要分析将侧重于65岁以下的个人。将按年龄/性别组以及选定的临床状况和符合Medicare资格的退休人员进行亚组分析。成本模式的预测因素包括人口统计学、健康计划设计和合并症。由于MEPS的样本量有限，并且仅跟踪家庭两年，因此主要分析将使用MarketScan数据来提供更长的大样本面板。超过300万人可以被跟踪至少5年。MEPS将用于评估MarketScan调查结果的普遍性，以及雇主保险对基于私人保险公司索赔的支出持续性估计的影响。分析方法是通过1）描述成本分布、转移概率和随时间推移跨类别的支出相关性（例如，从前50%到前5%），和2）建模的预测因素之间的过渡分布类别作为一个功能的雇员和家庭的特点，和预测的流失从MarketScan数据库。 由此产生的估计可以为解决再保险成本等问题的政策模拟提供信息 根据不同的止损阈值，以及在扩大的个人保险市场或医疗保险买入的逆向选择的潜在规模。我们将提供一个例子，说明这种估计如何可以告知风险调整和再保险的评估机制，以改善小型团体健康保险市场的运作。

DESCRIPTION (provided by the applicant): To the extent that high health care spending persists over time, problems of adverse selection would be accentuated in private insurance markets based on annual contracts, exacerbating concerns about the availability of affordable coverage. Despite the importance of understanding the persistence of medical spending, surprisingly little is known. Several studies are based on Medicare data, limiting generalizability to the under 65 population. Studies representing younger persons have limitations, including the lack of recent data, short follow-up, single employer or insurer samples, and lack of attention to attrition from employer-based coverage. New knowledge regarding spending persistence can improve the evidence base underlying many policy options for covering the uninsured, including subsidized reinsurance markets, Medicare buy-ins, and incentives to expand the role of individual insurance contracts and consumer-driven health plans. We will assess the persistence of health care costs using the 2002-2007 Thomson Healthcare MarketScan Database, which includes claims data for individuals insured through over 100 large firms, and the 2001-2006 waves of the MEPS. Spending categories will be based on cut points in the annual spending distribution (e.g., top 5%). The primary analyses will focus on individuals under age 65. Subanalyses will be done by age/gender group and for selected clinical conditions and Medicare-eligible retirees. Predictors of cost patterns will include demographics, health plan design, and comorbid conditions. Because the MEPS has a limited sample size and follows households for only two years, the primary analyses will use MarketScan data to provide a longer panel on a large sample. Over 3 million people can be followed for at least 5 years. The MEPS will be used to assess the generalizability of the MarketScan findings and the effects of attrition from employer coverage on estimates of spending persistence based on private insurer claims. The analytic approach is to characterize the run-up to high spending periods and the persistence of high spending over time by 1) describing the cost distribution, transition probabilities, and spending correlations across categories over time (e.g., from top 50% to top 5%), and 2) modeling the predictors of transitioning between distributional categories as a function of employee and household characteristics, and the predictors of attrition from the MarketScan database. The resulting estimates can inform policy simulations addressing issues such as the cost of reinsurance under different stop-loss thresholds, and the potential magnitude of adverse selection in expanded individual insurance markets or Medicare buy-ins. We will provide an example of how such estimates can inform the evaluation of risk-adjustment and reinsurance as mechanisms to improve the functioning of small group health insurance markets.