The Effects of Private Health Insurance in Publicly Funded Programs

在过去的30年里，医疗保健支出的增长速度超过了通货膨胀，使消费者、患者、雇主、政府项目和纳税人的预算紧张。政策制定者面临的关键挑战是如何设计有效控制成本的政策--减少不必要的支出，同时维持或增加高价值服务的支出。确定私人保险在促进有效利用护理方面的适当作用是这一挑战的重要组成部分。本研究的目的是通过研究美国医疗保险计划的经验，为私人医疗保险如何影响公共资助计划中医疗保健的利用、融资和结果提供新的证据。拟议的研究有以下两个具体目标：1）确定补充或取代医疗保险覆盖范围的不同类型的保险之间的风险选择的程度和来源，以及2）确定补充或取代医疗保险覆盖范围的私人保险如何影响医疗保险受益人的利用，融资和护理结果。使用计量经济学的方法来检查二级数据来源，我们将确定在市场上的保险补充或取代医疗保险覆盖范围的风险选择的程度和来源，在削弱或加剧风险选择的政策的作用，以及私人补充和替代保险对医疗保险受益人的利用，融资和护理结果的影响。对于一个特定的慢性病受益人的子集，我们将研究保险范围对护理过程的影响。该项目的主要数据来源将是健康和退休调查，医疗保险当前受益人调查和医疗支出小组调查。该项目将提供不同类型的私人保险对受益人和医疗保险计划的影响的证据。这一证据对于确定私人保险选择在多大程度上应被视为加强该计划的机制至关重要。反过来，来自医疗保险计划的证据将为决策提供有关私人医疗保险在其他政策背景下的作用的信息，例如促进州医疗补助计划中的私人覆盖，建立医疗保险交易所，以及在私人计划和公共管理的替代方案之间建立竞争。 公共卫生相关性：本研究的目的是通过研究美国医疗保险计划的经验，为私人医疗保险如何影响公共资助计划中医疗保健的利用、融资和结果提供新的证据。我们将研究这些市场的风险选择的程度和来源，以及不同类型的私人保险如何影响医疗保健的利用率，成本和结果。我们预计，这项研究将提供重要的证据，对医疗保险计划及其受益人的不同模式的融资健康保险的影响，以及在其他情况下类似的政策的潜在影响。

DESCRIPTION (provided by applicant): Health care spending has risen more quickly than inflation over the last 30 years, straining the budgets of consumers, patients, employers, government programs, and tax payers. The key challenge facing policy makers is how to design policies that contain costs efficiently - reducing unnecessary expenditures while maintaining or increasing expenditures on high value services. Determining the appropriate role of private insurance in promoting the efficient utilization of care is an important part of that challenge. The objective of this research is to provide new evidence on how private health insurance influences the utilization, financing, and outcomes of health care in publicly funded programs by examining the experience of the U.S. Medicare program. The proposed research has the following two specific aims: 1) To identify the extent and sources of risk selection between different types of insurance that either supplement or replace Medicare coverage, and 2) To determine how private insurance either supplementing or replacing Medicare coverage affects the utilization, financing, and outcomes of care for Medicare beneficiaries. Using econometric methods to examine secondary data sources, we will identify the extent and sources of risk selection in markets for insurance supplementing or replacing Medicare coverage, the role of policies in either attenuating or exacerbating risk selection, and the effects of private supplementary and replacement insurance on the utilization, financing, and outcomes of care for Medicare beneficiaries. For a subset of beneficiaries with particular chronic conditions, we will examine the effects of insurance coverage on process of care. The primary data sources for the project will be the Health and Retirement Survey, The Medicare Current Beneficiary Survey, and The Medical Expenditure Panel Survey. The project will provide evidence on the effects of different types of private coverage on both beneficiaries and the Medicare program. This evidence is essential for determining the extent to which private insurance options should be viewed as a mechanism to enhance the program. Evidence from the Medicare program, in turn, will inform decision-making regarding the role of private health insurance in other policy contexts, such as promoting private coverage in state Medicaid programs, establishing health insurance exchanges, and creating competition between private plans and a publicly administered alternative. PUBLIC HEALTH RELEVANCE: The objective of this research is to provide new evidence on how private health insurance influences the utilization, financing, and outcomes of health care in publicly funded programs by examining the experience of the U.S. Medicare program. We will examine the extent and sources risk selection in these markets as well as how the different types of private coverage enroll affect the utilization, cost, and outcomes of medical care. We anticipate that this research will provide important evidence on the effects of different models of financing health insurance on the Medicare program and its beneficiaries as well as on the potential effects of similar policies in other contexts.