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

项目总结/摘要 这个AHRQ指导研究科学家职业发展奖（K 01）博士。罗伯茨， 匹兹堡大学公共研究生院卫生政策和管理助理教授 健康，将建立罗伯茨博士作为一个健康经济学家的专业知识，在健康保险和医疗保健 老龄化和低收入人口政策。 为K 01奖提出的研究将利用资格门槛创造的自然实验 以及医疗保险补贴计划中的政策变化，以严格评估这些计划如何影响 患者对护理的使用、对提供者的访问以及健康。该项目将重点关注两项补贴计划， 低收入医疗保险受益人：医疗保险储蓄计划（MSP），这是部分医疗补助 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），这有助于支付处方药。使用健康和退休研究链接到 医疗保险和医疗补助索赔，罗伯茨博士将研究如何在补贴资格的不连续性影响 患者的护理使用-包括药物依从性，医生就诊和住院-以及健康 status.罗伯茨博士还将研究国家医疗补助政策之间的关系，具体来说，提供者 支付率和重新认证计划杀伤力的规则-与MSP登记和患者访问 在乎这项研究产生的证据可以指导改革，以增加MSP和LIS的效益 低收入医疗保险受益人和医疗保险计划。 罗伯茨博士的定量培训，医疗保险和医疗补助政策的知识， 之前对健康差异的研究。这项工作将把罗伯茨博士的奖学金扩展到老龄化领域， 将方法纳入医药卫生服务研究。因此，对于这个K 01奖，罗伯茨博士 将参与培训和职业发展活动，重点是获得老龄化方面的专业知识， 医药卫生服务研究。通过卫生服务研究人员和临床 罗伯茨博士还将专注于将这些内容领域的培训应用于卫生政策研究。这 培训计划补充了拟议的研究，并将装备罗伯茨博士建立一个独立的 一项研究计划，审查改善低收入医疗保险受益人护理的政策创新， 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.