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。通过测试预测农村县采用管理式医疗计划模式的假设，我们正在测试依赖管理式医疗和竞争市场来纠正该计划中感知的财务问题的政策方法。具体目标是：1.测试假设，预测在何种情况下，农村提供者将至少采取初步步骤创建提供者赞助组织(PSO)，或在国家授权下制定管理性护理计划。2.测试假设，预测医疗保险管理的医疗服务将扩展到一些农村县，而不是其他县。3.提出关于农村提供者参与医疗保险管理保健计划的后果的假设，重点放在以下方面：*在营销融资、信息系统和谈判方面采用新的管理战略；*为质量保证制定的程序；*无偿保健数量的变化；以及*对地方控制和经济活动的影响。本项目的研究设计包括三个部分：L)对参加联邦医疗保险管理保健计划的人数变化的经验总结，按县类型划分，包括偏远的农村、毗邻大都市地区和大都市的农村；2)每六个月重复一次的州信息提供人(农村保健办公室)调查，旨在衡量和描述农村提供者针对医疗保险政策变化所开展的活动；以及3)对第一年和第二年的四个社区的案例研究，包括实地访问，以收集描述与第三个目标相关的活动的详细信息。第一个组成部分使用来自HCFA、InterStudy和区域资源文件的数据来测试计量经济学模型，该模型解释了医疗保险管理保健的传播作为支付变化、医疗保险人口特征(包括县内的人数)以及该县现有的人口和经济背景的函数。这项研究的结果将通过农村政策研究所的出版物系列，每年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.