Financial assistance for low-income Medicare beneficiaries: Using natural experiments to assess effects on care and health outcomes

项目摘要/摘要 该AHRQ指导研究科学家职业发展奖(K01)授予Eric T.Roberts博士，以及 匹兹堡大学公共研究生院卫生政策和管理学助理教授 Health，将使罗伯茨博士成为一名健康经济学家，拥有医疗保险和医疗保健方面的专业知识 针对老龄化和低收入人口的政策。 为这项K01奖提出的研究将利用由资格门槛创造的自然实验 以及医疗保险补贴计划内的政策变化，以严格评估这些计划的影响 患者对医疗服务的利用、与医疗服务提供者的接触以及医疗保健。该项目将重点关注以下两个补贴计划： 低收入联邦医疗保险受益人：联邦医疗保险储蓄计划(MSP)，即部分医疗补助 支付医生服务和住院护理的自付费用的福利，以及D部分低收入 补贴(LIS)，帮助支付处方药。使用健康和退休研究链接到 联邦医疗保险和医疗补助申请，罗伯茨博士将研究补贴资格的中断如何影响 患者对护理的利用--包括服药依从性、医生就诊和住院--以及健康 状态。罗伯茨博士还将研究各州医疗补助政策之间的关系-具体地说，提供者 重新认证计划资格的付款率和规则-MSP注册和患者访问 关心。这项研究产生的证据可以指导改革，以增加MSP和LIS的好处 给低收入联邦医疗保险受益人和联邦医疗保险计划。 这个项目利用了罗伯茨博士的量化培训、医疗保险和医疗补助政策的知识，以及 关于健康差距的先前研究。这项工作将把罗伯茨博士的学术研究扩展到老龄化领域，同时 将研究方法纳入医药卫生服务研究。因此，对于这个K01奖，罗伯茨博士 将参与培训和职业发展活动，重点是获得老龄化和 医药卫生服务研究。通过健康服务研究人员和临床医生的指导 作为专家，罗伯茨博士还将重点将这些内容领域的培训应用于卫生政策研究。这 培训计划是对拟议研究的补充，并将使罗伯茨博士能够建立一个独立的 研究计划审查政策创新，以改善对低收入医疗保险受益人的护理， 量化政策改革对患者、付款人和卫生系统的临床和经济影响。

PROJECT SUMMARY / ABSTRACT This AHRQ Mentored Research Scientist Career Development Award (K01) for Dr. Eric T. Roberts, an assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health, will establish Dr. Roberts as a health economist with expertise in health insurance and health care policy for aging and low-income populations. Research proposed for this K01 award will harness natural experiments created by eligibility thresholds and policy variation within Medicare subsidy programs to rigorously evaluate how these programs affect patients' use of care, access to providers, and health. This project will focus on two subsidy programs for low-income Medicare beneficiaries: the Medicare Savings Programs (MSPs), which are partial Medicaid benefits that defray out-of-pocket costs for physician services and inpatient care, and the Part D Low-Income Subsidy (LIS), which helps to pay for prescription drugs. Using the Health and Retirement Study linked to Medicare and Medicaid claims, Dr. Roberts will examine how discontinuities in subsidy eligibility affect patients' use of care—including medication adherence, physician visits, and hospitalizations—and health status. Dr. Roberts will also examine the relationship between state Medicaid policies—specifically, provider payment rates and rules for recertifying program eligibility—with MSP enrollment and patients' access to care. Evidence generated from this research can guide reforms to increase the benefits of the MSPs and LIS to low-income Medicare beneficiaries and to the Medicare program. This project draws on Dr. Roberts' quantitative training, knowledge of Medicare and Medicaid policy, and prior research on health disparities. This work will extend Dr. Roberts' scholarship into the field of aging while incorporating methods in pharmaceutical health services research. Therefore, for this K01 award, Dr. Roberts will engage in training and career development activities that focus on acquiring expertise in aging and pharmaceutical health services research. Through mentorship from health services researchers and clinical experts, Dr. Roberts will also focus on applying training in these content areas to health policy research. This training plan complements the proposed research and will equip Dr. Roberts to establish an independent research program examining policy innovations to improve care for low-income Medicare beneficiaries, quantifying the clinical and economic impacts of policy reforms for patients, payers, and health systems.