RURAL RESPONSE TO MEDICARE+CHOICE: CHANGE AND ITS IMPACT

该项目将有助于正在进行的关于医疗保险计划变化的辩论。通过测试假设预测模式采用管理式医疗计划在农村县，我们正在测试的政策方法，依靠管理式医疗和竞争性市场，以纠正感知的财务问题的程序。具体目标是：1.测试假设预测的情况下，农村提供者将采取至少初步步骤，以创建提供者赞助的组织（PSOs），或管理的护理计划下，国家权力。2.测试假设预测医疗保险管理的医疗扩展到一些农村县，而不是其他。3.发展假设农村提供者参与医疗保险管理的医疗计划的后果，重点放在以下方面：* 通过新的管理策略，在营销融资，信息系统和谈判; * 制定质量保证的过程; * 无偿护理量的变化;和 * 对当地控制和经济活动的影响。本计画的研究设计包含三个部分：1）以经验性的方式，以偏远农村、邻近大都市地区的农村、大都市地区为分类，总结Medicare管理式照护计划的投保人数变化; 2）以州为调查对象，（农村卫生办公室）每六个月重复一次，旨在衡量和描述农村提供者对医疗保险政策变化的反应;第一年对四个社区进行个案研究，第二年对六个社区进行个案研究，包括实地考察，以收集详细资料，说明与第三个目标有关的活动。第一部分使用HCFA，Interstudy和地区资源文件的数据来测试一个计量经济学模型，该模型解释了医疗保险管理式医疗的传播作为支付变化的函数，医疗保险人口的特征（包括县内的人数）以及县内的人口和经济背景。这项研究的结果将每年通过农村政策研究所的系列出版物与政策界和其他方面分享。

This project will contribute to ongoing debates concerning changes in the Medicare program. By testing hypotheses predicting the pattern of adopting managed care plans in rural counties, we are testing the policy approach of relying on managed care and competitive markets to redress perceived financial problems in the program. The specific aims are: 1. Test hypotheses predicting the circumstances under which rural providers will take at least the initial steps to create Provider Sponsored Organizations (PSOs), or managed care plans under state authority. 2. Test hypotheses predicting expansion of Medicare managed care into some rural counties, versus others. 3. Develop hypotheses concerning the consequences of rural provider participation in Medicare managed care plans, focused on the following: * adoption of new management strategies in marketing finance, information systems, and negotiations; * processes developed for quality assurance; * changes in volume of uncompensated care; and * effects on local control and economic activities. The research design for this project has three components: l) an empirical summary of changes in enrollment in Medicare managed care plans, by type of county including rural remote, rural adjacent to metropolitan areas and metropolitan; 2) a survey of state informants (offices of rural health) repeated every six months, designed to measure and describe activities by rural providers in response to changes in Medicare policies; and 3) case studies of four communities the first year and six the second year, including site visits, to gather detailed information describing activities relevant to the third aim. The first component use data from HCFA, Interstudy, and the Area Resource File to test an econometric model that explains the dissemination of Medicare managed care as a function of changes in the payment, characteristics of the Medicare population (including number in the county) and the population and economic context present in the county. Results of this study will be shared annually with the policy community and others through the publication series of the Rural Policy Research Institute.