Effects of changes in Medicaid physician fees on use of preventive care

描述(由申请人提供)：本项目的目的是模拟2010年《患者保护和平价医疗法案》(PPACA)中医疗补助医生费用的临时变化、预防性医疗共同支付费率的取消以及医疗补助资格的扩大对美国预防服务工作组(USPSTF)建议的医疗补助参与者中的预防性医疗的使用的影响。PPACA拨款联邦美元，为2013和2014年医疗补助计划的医生费用增加提供资金，以提高联邦医疗保险的费率。2014年后，联邦激励措施到期，如果国会不为延期提供资金，它们是否会继续使用州资金为增加的支出提供资金，将由各州决定。传统上，每个州都有自己的医疗补助报销率，并在资格规则和共同支付结构方面拥有广泛的自由裁量权。联邦医疗补助法律没有定义预防性服务，没有将这些服务纳入强制性福利类别，也没有跟踪每个医疗补助计划涵盖的针对成年人的特定预防性服务。这导致医疗补助计划的设计和预防性服务的使用在地域上有很大差异，并非所有州都覆盖了USPSTF的所有服务，在提供者报销和受益人费用分担方面也存在很大差异。这项研究将考察先前医生费用增加对USPSTF推荐的预防保健服务使用的影响，并模拟PPACA下额外使用增加的预测影响。同样，我们将估计2014年后取消这一财政激励措施的影响。我们还将估计由于医生费用增加、取消共同支付以及将资格扩大到父母和没有子女的成年人而增加使用这些预防服务的成本。为了回答这些问题，我们将使用医疗支出小组调查(MEPS)和全国非卧床医疗保健调查(NAMCS)的数据。该项目将回答一个重要的研究问题，这个问题对下一步的卫生改革至关重要。当联邦政府对更高的医疗补助报销和计划扩展的补贴在2014年到期时，各州将选择保留和放弃哪些要素。至关重要的是，必须有关于不同政策选择的影响的科学证据。目前，缺乏这方面的证据。这项研究将为各州提供关于不同政策选择对低收入人口使用预防性保健的可能影响的指导。 公共卫生相关性：这项研究将就2010年《患者保护和平价医疗法案》中嵌入的不同政策选择对低收入人群预防性医疗成本和使用的可能影响向各州提供指导。

DESCRIPTION (provided by applicant): The purpose of this project is to model the effects of temporary changes in Medicaid physician fees, removal of preventive care copayment rates and Medicaid eligibility expansion in the Patient Protection and Affordable Care Act of 2010 (PPACA) on the use of US Preventive Services Task Force (USPSTF) recommended preventive care among Medicaid enrollees. PPACA appropriates federal dollars to fund increases in physician fees for the Medicaid program to Medicare rates for 2013 and 2014. After 2014, the federal incentive expires and it is up to states to determine if they will continue to fund the payment increase using state funds if Congress does not fund an extension. Traditionally, each state has set its own Medicaid reimbursement rates and has had wide discretion in eligibility rules and copayment structure. Federal Medicaid law does not define preventive services, include these services under a mandatory benefit category or track specific preventive services covered for adults by each Medicaid program. This has led to substantial geographic variation in Medicaid plan design and use of preventive services, with not all USPSTF services covered in all states and substantial differences in provider reimbursement and beneficiary cost sharing. This study will examine the effect of the previous increases in physician fees on the use of USPSTF recommended preventive care services and model the projected impact of additional utilization increases under PPACA. Similarly, we will estimate the effects of the elimination of this financial incentive after 2014. We will also estimate the cost of increases in the use of these preventive services, resulting from the increase in physician fees, the removal of copayments, and the eligibility expansion to parents and childless adults. To answer these questions, we will use data from the Medical Expenditure Panel Survey (MEPS) and the National Ambulatory Medical Care Survey (NAMCS). The project will answer an important research question that will be critical for the next step in health reform. When the federal subsidies for higher Medicaid reimbursement and program expansions expire in 2014, states will make choices about which elements to retain and which to discard. It will be critical that there be scientific evidence regarding the impact of the different policy options. Currently, that evidence is lacking. This study will provide guidance to states about the likely effect of different policy choices on the use of preventive care in low income populations. PUBLIC HEALTH RELEVANCE: This study will provide guidance to states about the likely effect of different policy choices embedded in the Patient Protection and Affordable Care Act of 2010 on the cost and use of preventive care in low income populations.