Health Effects of Managed Care Among the Near-Ederly

描述（由申请人提供）：HMO使用按人头付费的方式可以激励提供者降低成本，可能是通过降低所提供的服务，而HMO对注册者的竞争则激励这些计划增加他们提供的服务。理想情况下，这些抵消性的激励措施会引导计划对服务和护理质量做出有效的选择。经验研究已经清楚地证明了HMO在降低住院治疗费用方面的成功，特别是通过降低住院率。Melnick及其同事（1992）、Gaskin和Hadley（1997）、Rosko（2001）和其他人的研究表明，在市场上存在大量管理式医疗渗透的情况下，医院价格和平均成本较低。但是，HMO是否对老年人的健康状况有任何可感知的影响，如果有，这种影响的性质，在很大程度上仍然是一个悬而未决的问题。 这项研究的目的是分析参加管理式护理计划对近老年人健康的影响。候选人将利用1994年、1996年、1998年和2000年健康与退休调查（HRS）收集的信息来实现这一目标。 该研究的三个具体目标是：1）使用说明个人健康计划性质的明确指定模型（即，无论是HMO，PPO还是FFS计划）; 2）在估计这些时，控制几个右侧变量的可能内隐，特别是计划类型，这是因为许多近长者从他们当前或前雇主提供的计划菜单中选择保险范围; 3）比较和对比HMO，PPO和FFS计划对近长者健康的影响。

DESCRIPTION (provided by the applicant): The use of capitation by HMOs gives providers an incentive to reduce costs, possibly by lowering the services provided, while HMO competition for enrollees gives these plans an incentive to increase the services they provide. Ideally, these countervailing incentives lead plans to make efficient choices about services and care quality. Empirical research has now clearly demonstrated the success of HMOs in reducing the cost of inpatient care, especially through lowering hospitalizations. Work by Melnick and colleagues (1992), Gaskin and Hadley (1997), Rosko (2001), and others suggests that hospital prices and average costs are lower in the presence of large managed care penetration in the market. But whether HMOs have any perceivable effects on the health status of older adults and, if so, the nature of such effects, is still largely an open question. The goal of the proposed study is to analyze the effects of enrollment in a managed care plan on the health of near-elderly adults. The candidate will work toward this goal using information gathered in the 1994, 1996, 1998, and 2000 waves of the Health and Retirement Survey (HRS). The three specific aims of the study are to: 1) Estimate health production functions for several self-reported measures of health, using well-specified models that account for the nature of an individual's health plan (i.e., whether it is an HMO, a PPO, or a FFS plan); 2) While estimating these, control for the possible endogeneity of several right-hand-side variables, particularly plan type, which occurs because many near-elders choose their insurance coverage from a menu of plans offered by either their current or former employer; and 3) Compare and contrast the effects of HMOs, PPOs, and FFS plans on the health of near-elders.