Income Effects and Current Law Forecasts of Health Care Spending Growth

医疗保健支出增长的收入影响和现行法律预测

• 批准号: 7907786
• 负责人: MICHAEL E CHERNEW
• 金额: $ 47.58万
• 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: 2009-08-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7907786
• 关键词: Accounting; Address; American; Behavior; Belief; Budgets; Caring; Characteristics; Conflict (Psychology); Cost Sharing; Country; Data Aggregation; Economics; Elderly; Environment; Face; Funding; Future; Growth; Health; Healthcare; Heterogeneity; Income; Individual; Insurance; Intuition; Laws; Marketing; Medicare; Modeling; Patients; Perception; Persons; Policies; Policy Analysis; Relative (related person); Resource Sharing; Risk; Role; Services; Solvents; Taxes; Testing; Time; Trust; United States Centers for Medicare and Medicaid Services; Validation; base; beneficiary; cost; experience; improved; interest; programs; public health relevance; theories; tool; trend

DESCRIPTION (provided by applicant): Each year the Office of the Actuary (OACT) at the Center for Medicare and Medicaid Services (CMS) and the Congressional Budget Office (CBO) assess the fiscal health of the Medicare trust funds. These forecasts are required to assume current law remains in force (no policy changes). Current-law forecasts may produce unsustainable projections if the current policy environment inhibits market mechanisms from slowing cost growth. The challenge for forecasters is that past experience does not clearly indicate any persistent slowing in aggregate health care spending growth, yet forecasters generally believe that spending growth will slow as health care spending consumes a greater share of income. This belief is reflected in both the CBO and OACT models, which assume spending growth will diminish over time, though neither relies on underlying models of behavior to justify the assumptions. Recent CMS advisory panels have called for improved understanding of the mechanisms that, under current law, might slow spending. The effect of existing beneficiary cost sharing has been of particular interest. We propose to construct a microsimulation model of Medicare spending that will focus on the extent to which current-law cost sharing rules may slow spending growth in the future, when health care constitutes a significant share of disposable income for many elderly Americans. This mechanism has not been explicitly accounted for in current forecasts. It is uncertain how large this effect may be and what the associated distributional consequences will be. Our contribution will be to provide better current-law forecasts by explicitly incorporating budget constraints and by using an individual, as opposed to a representative agent, models (because heterogeneity can bias representative agent models). Further, our model will be a tool that forecasters can use to explore the sensitivity of results to various assumptions and to assess distributional consequences of cost growth. We have 3 aims. Aim 1: Develop a current-law microsimulation module of Medicare spending for beneficiaries over the age of 65, conditional on supplemental coverage, which reformulates and integrates the role of income effects in restraining demand growth. Aim 2: Develop a current-law microsimulation module of insurance demand for Medicare beneficiaries over the age of 65 that, consistent with demand and risk theory, describes how cost growth will influence the distribution of supplemental coverage in the future. Aim 3: Conduct validation testing and sensitivity analysis on the integrated microsimulation model and use the model to conduct policy analysis examining the potential impact of current-law cost sharing requirements on the future trajectory of health care spending. PUBLIC HEALTH RELEVANCE: Project Narrative: This project will construct a microsimulation model for that will quantify the common intuition that budget constraints will, over time, slow Medicare spending growth. Our contribution will be to improve existing current-law forecasts by making this intuition explicit and by allowing forecasters to better understand how cost sharing may slow spending. Unlike existing models, our model will be grounded in economic theory and model spending relative to income at the beneficiary level.

描述（由申请人提供）：每年，医疗保险和医疗补助服务中心（CMS）的精算师办公室（OACT）和国会预算办公室（CBO）都会评估医疗保险信托基金的财政健康状况。这些预测是在假设现行法律仍然有效（没有政策变化）的情况下进行的。如果当前的政策环境阻碍市场机制减缓成本增长，现行法律的预测可能产生不可持续的预测。预测者面临的挑战是，过去的经验并没有明确表明医疗保健总支出增长会持续放缓，但预测者普遍认为，随着医疗保健支出在收入中所占比例的增加，医疗保健总支出增长将放缓。这种信念反映在CBO和OACT模型中，它们假设支出增长将随着时间的推移而减少，尽管两者都不依赖于基本的行为模型来证明这些假设是正确的。最近，医疗保健和医疗服务委员会的咨询小组呼吁，要更好地了解在现行法律下，可能会减缓支出的机制。现有受益人分担费用的效果特别令人感兴趣。我们建议构建一个医疗保险支出的微观模拟模型，该模型将关注当前法律成本分担规则可能在多大程度上减缓未来的支出增长，届时医疗保健将成为许多美国老年人可支配收入的重要组成部分。目前的预测没有明确考虑到这一机制。目前还不确定这种影响会有多大，以及相关的分配后果会是什么。我们的贡献将是通过明确地结合预算约束和使用个体模型（而不是代表性代理模型）来提供更好的现行法律预测（因为异质性会使代表性代理模型产生偏差）。此外，我们的模型将成为预测者可以用来探索结果对各种假设的敏感性和评估成本增长的分配后果的工具。我们有三个目标。目标1：为65岁以上的受益人开发一个现行法律的医疗保险支出微观模拟模块，以补充保险为条件，重新制定并整合收入效应在抑制需求增长中的作用。目标2：开发65岁以上医疗保险受益人保险需求的现行法律微观模拟模块，与需求和风险理论相一致，描述成本增长将如何影响未来补充保险的分配。目标3：对综合微观模拟模型进行验证测试和敏感性分析，并使用该模型进行政策分析，检查现行法律成本分担要求对医疗保健支出未来轨迹的潜在影响。