The Science of Medicare Reform

描述(申请者提供)：本申请表主题为“用科学促进医疗改革”。医疗保险计划的未来对美国来说是最大的政策挑战之一。这一非常受欢迎的计划为老年人和其他原本无法获得所需医疗服务的人带来了全民医疗保险。实施联邦医疗保险D部分以涵盖处方药被广泛认为是成功的；但在某些方面，联邦医疗保险是不合时宜的。首先，它的按服务收费的补偿制度几乎从私人医疗保险中消失了。联邦医疗保险实行自付和免赔额，就像商业健康保险计划一样，但大约80%的受益人有补充保险，这减少了自付费用。因此，大多数受益人在做出医疗保健决定时没有充分考虑成本，甚至没有充分考虑联邦医疗保险的共同支付。其次，研究表明，美国不同地区的人均医疗保险支出存在巨大差异--这种差异无法用人口统计学或健康特征来解释。然而，资源使用率高的地区并不会有更好的健康结果。因此，联邦医疗保险覆盖的服务可能与许多地区的老年美国人的需求不太匹配。第三，该计划是联邦政府最大的财政负债。婴儿潮一代的老龄化将使医疗保险受益者人数膨胀。如果不改变计划，到2082年，医疗保险支出将从目前占国内生产总值的3%上升到17%。这项研究合作将设计和进行与医疗保险相关的研究、政策模拟和福利分析，以解决这些问题。一个由四个处于卫生经济和政策研究前沿的机构-斯坦福大学、南加州大学、兰德公司和加州大学伯克利分校-组成的多学科团队将专注于解决方案，以确保Medicare继续其成功的遗产。2009年的《美国复苏和再投资法案》提供了史无前例的11亿美元，用于探索比较有效性研究(CER)。然而，CER在医疗保险计划中的具体应用尚不存在。考虑到这些，我们的具体目标是：1)开发联邦医疗保险D部分市场计划选择的跨期优化模型；2)了解联邦医疗保险D部分市场的竞争；3)检查FBD对利用率、健康和支出的影响；4)应用比较有效性分析，以确定可能节省联邦医疗保险的临床领域；以及5)建立研究网络，以支持与联邦医疗保险相关的研究和政策。我们将通过各种活动促进合作和传播，包括将传播研究成果和促进以科学为基础的医疗保险改革的全国医疗保险：科学和政策会议。 公共卫生相关性：此应用程序专注于解决方案，以确保Medicare继续其成功的遗产。我们的多学科团队由四个处于卫生经济和政策研究前沿的机构组成，将设计和开展与联邦医疗保险相关的研究、政策模拟和福利分析，专注于解决方案，以确保联邦医疗保险继续其成功的遗产。

DESCRIPTION (provided by applicant): This application addresses the thematic area, "Using Science to Enable Health Care Reform." The future of the Medicare program poses one of the greatest policy challenges to the United States. This extraordinarily popular program has brought universal health insurance coverage to the elderly and others who would otherwise lack access to needed health services. The implementation of Medicare Part D to cover prescription drugs is widely viewed as a success; yet in several ways Medicare is an anachronism. First, its fee-for-service reimbursement system has all but vanished from private health insurance. Medicare imposes copayments and deductibles like commercial health insurance plans, but about 80% of beneficiaries have supplemental insurance, which reduces the out-of-pocket payments. Thus most beneficiaries do not fully consider costs-or even Medicare copayments-when making health care decisions. Second, research has demonstrated dramatic variation in per capita Medicare expenditures across regions of the U.S.-variation that cannot be explained by demographic or health characteristics. Yet high resource use regions do not have superior health outcomes. The services covered by Medicare may thus be a poor match to the needs of older Americans in many regions. Third, the program is the largest fiscal liability of the Federal government. The aging of the baby boomers will swell the population of Medicare beneficiaries. Absent program changes, Medicare expenditures will rise from 3% of gross domestic product today to 17% by 2082. This research collaboration will design and conduct Medicare-related research, policy simulation, and welfare analysis to address these issues. A multidisciplinary team spanning four institutions at the forefront of health economics and policy research- Stanford University, University of Southern California, RAND Corporation, and the University of California, Berkeley-will focus on solutions to ensure Medicare continues its legacy of success. The American Recovery and Reinvestment Act of 2009 provided an unprecedented $1.1 billion to explore comparative effectiveness research (CER). Yet specific applications of CER to the Medicare program do not yet exist. With these in mind, our Specific Aims are: 1) Develop intertemporal optimization models of plan choice in the Medicare Part D market; 2) Understand competition in the Medicare Part D marketplace; 3) Examine the consequences of FBD for utilization, health, and spending; 4) Apply comparative effectiveness analysis to identify clinical areas for potential savings in Medicare; and 5) Build a research network to support Medicare-related research and policy. We will promote collaboration and dissemination through various activities, including a national Medicare: Science and Policy Conference that will disseminate research findings and promote science-based Medicare reform. PUBLIC HEALTH RELEVANCE: This application focuses on solutions to ensure that Medicare continues its legacy of success. Our multidisciplinary team spanning four institutions at the forefront of health economics and policy research will design and conduct Medicare-related research, policy simulation, and welfare analysis that will focus on solutions to ensure Medicare continues its legacy of success.