Cost-Sharing, Use, and Outcomes of Post-Acute Care in Medicare Advantage Plans

描述（由申请人提供）：医疗保险在急症后护理方面的支出在过去十年中呈爆炸式增长，在不损害健康或增加其他卫生服务的抵消成本的情况下，促进了对减少急症后支出战略的强烈政策兴趣。在传统的医疗保险福利设计下，前20天的熟练护理设施护理和所有的家庭护理都是免费提供的（即不需要共同支付），这引起了人们对患者过度使用这些服务的动机的担忧，即使这些服务几乎没有价值。为了解决这一问题，奥巴马总统、医疗保险支付咨询委员会和鲍尔斯-辛普森赤字削减委员会都表示支持对急症后护理的使用实施共同支付。然而，没有经验证据基础来预测这些政策的影响。本提案的目的是通过准实验研究设计和管理式医疗保险计划参保人的全国样本，评估费用分摊变化对急症后护理的使用和结果的影响。该研究基于一系列广泛的初步研究结果，其核心假设是，共同支付将大幅减少急症后护理的使用，促使患者转向其他自付费用较低的急症后服务，将住院受益人从管理式护理计划中挤出，进入按服务收费的系统，并增加住院时间和再入院的可能性。我们的期望是，这个项目将为医疗保险受益人对急性期后共同支付的反应提供严格的估计，并为我们理解老年人的成本分担效应做出重大贡献，老年人被排除在20世纪70年代进行的具有里程碑意义的兰德健康保险实验之外。最后，本研究可以为促进更好的健康结果和适当使用急性后服务的最佳医疗保险福利政策提供信息，同时最大限度地减少对体弱老年人和医疗保险计划预算的负面意外后果。

DESCRIPTION (provided by applicant): Medicare spending on post acute care has exploded in the past decade, catalyzing intense policy interest in strategies to reduce post acute expenditures without harming health or increasing the offsetting costs of other health services. Under the traditional Medicare benefit design, the first 20 days of skilled nursing facility care ad all episodes of home care are provided free (i.e. without a copayment), raising concerns about patients' incentives to overuse these services, even when they are of little or no value. To address this concern President Obama, the Medicare Payment Advisory Commission, and the Bowles-Simpson deficit reduction committee have all expressed support for the imposition of a copayment for the use of post acute care. Yet, there is no empirical evidence base to predict the impact of such policies. The objective of this proposal is to evaluate the impact of changes in cost-sharing on the use and outcomes of post acute care using a quasi- experimental research design and a national sample of Medicare enrollees in managed care plans. The central hypotheses of the proposed research, which is based on the results of an extensive series of preliminary studies, are that copayments will sharply reduce the use of post acute care, induce shifts to other post acute services with lower out-of-pocket costs, drive hospitalized beneficiarie out of managed care plans into the fee- for-service system, and increase hospital length of stay and the probability of readmission. Our expectations are that this project will provide rigorous estimates of the response of Medicare beneficiaries to post acute copayments and contribute significantly to our understanding of the effect of cost-sharing among the elderly, who were excluded from the landmark RAND Health Insurance Experiment conducted in the 1970's. Finally, this research can inform optimal Medicare benefit policies that promote better health outcomes and the appropriate use of post acute services while minimizing negative unintended consequences for frail elderly and the Medicare program budget.