RURAL RESPONSE TO MEDICARE+CHOICE: CHANGE AND ITS IMPACT

这个项目将有助于正在进行的关于医疗保险计划变化的辩论。通过测试预测在农村县采用管理式医疗计划模式的假设，我们正在测试依靠管理式医疗和竞争性市场来纠正项目中感知到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，农村医疗服务提供者将至少采取初步步骤，创建医疗服务提供者赞助组织（pso），或在国家权威下管理医疗计划。2. 检验预测医疗保险管理医疗扩展到一些农村县的假设，而不是其他的。3. 对农村医疗服务提供者参与医疗管理计划的后果提出假设，重点如下：*在营销、财务、信息系统和谈判方面采用新的管理策略；*为保证质量而制订的程序；*无偿护理量的变化；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组成部分：1)对医疗保险管理医疗计划参保人数的变化进行实证总结，按县类型划分，包括农村偏远地区、与大都市相邻的农村地区和大都市；2)每六个月重复一次对国家举报人（农村卫生办公室）的调查，旨在衡量和描述农村医疗服务提供者为应对医疗保险政策变化而开展的活动；3)第一年对四个社区进行案例研究，第二年对六个社区进行案例研究，包括实地考察，以收集与第三个目标相关的活动的详细信息。第一部分使用来自HCFA、Interstudy和区域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医疗的传播作为支付变化、医疗保险人口特征（包括县人数）以及县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系列出版物每年与政策界和其他人分享。

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.