SELECTION BIAS BY MEDICARE BENEFICIARIES WITH DIABETES

这项研究的目的是检查医疗保险的效果 HMO登记医疗保险受益人的死亡率和护理费用 在1994至1998年间罹患糖尿病。有两项主要的公共政策 对参加联邦医疗保险的慢性病患者的担忧 医疗保健组织：医疗保险是否通过鼓励慢性病患者来控制成本， 例如糖尿病患者，加入有TEFRA风险的医疗保健组织？和是质量 向这些参保者提供的护理和健康成果与#年的水平相当 按服务收费的部门？这项研究将提供对这两个方面的洞察 使用1992至1998年的医疗保险管理数据的问题。 该提议将扩展Dowd等人(1998)和Maciejeski最近的工作， 等人的研究。(2001)看对普通医疗保险人群的有偏见的选择 变成有TEFRA风险的医疗保健组织。它将使用唯一的数据集(国家医疗保险 糖尿病队列)，其中包括250万老年医疗保险受益人 1994年在收费服务计划中被诊断为糖尿病。这个 将讨论以下具体的研究问题： 1)更健康的糖尿病受益者是否有系统地参加医疗保险 卫生保健组织？ 2)患有糖尿病的HMO参与者的五年存活率是否与 仍在按服务收费(FFS)的糖尿病患者医疗保险受益人 部门？ 3)不健康的糖尿病受益人是否系统性地退出 医疗保险医疗保健组织？ 4)患有糖尿病的HMO退保者的FFS费用是否与Medicare不同 哪些受益者仍留在FFS部门？ 对我校招生退学模式的细致分析 长期患病人口，结合死亡率和成本分析， 将让您深入了解参加 医疗保险医疗保健组织。将对一批受益人进行分析，这些受益人包括 在1992-1993年间收费服务部门的糖尿病，所以结果不是 适用于之前参加Medicare HMO的糖尿病患者 1994年。

The purpose of this study is to examine the effect of Medicare HMO enrollment on the mortality and cost of care for Medicare beneficiaries with diabetes between 1994 and 1998. There are two major public policy concerns regarding individuals with chronic conditions that enroll in Medicare HMOs: Does Medicare contain costs by encouraging people with chronic diseases, such as people with diabetes, to join TEFRA-risk HMOs? and Are the quality of care and health outcomes provided to these enrollees comparable to those in the fee-for-service sector? This study will provide insight into both of these questions using Medicare administrative data from 1992 to 1998. This proposal will extend recent work by Dowd, et al., (1998) and Maciejewski, et al. (2001) looking at biased selection of the general Medicare population into TEFRA-risk HMOs. It will use a unique dataset (the National Medicare Diabetes Cohort), which contains 2.5 million elderly Medicare beneficiaries with diagnosed diabetes mellitus in fee-for-service plans in 1994. The following specific research questions will be addressed: 1) Do healthier beneficiaries with diabetes systematically enroll in Medicare HMOs? 2) Do HMO enrollees with diabetes have different five-year survival rates than Medicare beneficiaries with diabetes who remain in the fee-for-service (FFS) sector? 3) Do unhealthier beneficiaries with diabetes systematically disenroll from Medicare HMOs? 4) Do HMO disenrollees with diabetes have different FFS costs than Medicare beneficiaries who remain in the FFS sector? The careful analysis of enrollment and disenrollment patterns of this chronically ill population, combined with the mortality and cost analyses, will provide insight into the advantages and disadvantages of enrollment in Medicare HMOs. Analyses will be conducted on a cohort of beneficiaries with diabetes in thc fee-for-service sector in 1992-1993, so results are not generalizable to people with diabetes who enrolled in Medicare HMOs prior to 1994.