Learning from Program Differences between Medicaid and Medicare

从医疗补助和医疗保险之间的计划差异中学习

• 批准号: 10379884
• 负责人: Thomas G. McGuire
• 金额: $ 30.1万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10379884
• 关键词: Address; Adult; Affect; Age; Aging; American; California; Caring; Characteristics; Chronic; Contracts; Control Groups; Data; Dental; Disabled Persons; Drug Prescriptions; Drug usage; Elderly; Eligibility Determination; Enrollment; Federal Government; Fee Schedules; Fees; Health; Health Insurance; Health Promotion; Healthcare Systems; Home; Hospitalization; Individual; Insurance; Insurance Benefits; Insurance Coverage; Laboratories; Learning; Link; Low income; Managed Care; Managed Care Programs; Medicaid; Medicaid eligibility; Medicare; Medicare/Medicaid; Methods; Montana; Nature; New Jersey; North Dakota; Outcome; Pathway interactions; Patient Care; Pattern; Personal Satisfaction; Persons; Pharmaceutical Preparations; Physicians; Policies; Population; Privatization; Provider; Quasi-experiment; Research Design; Resources; Rhode Island; Role; Services; Social Security; Source; Structure; System; Time; United States; United States Social Security Administration; Variant; Vision; Work; Wyoming; base; beneficiary; care delivery; care outcomes; community based service; design; differences in access; disability; dual eligible; evidence base; flexibility; geographic difference; health care availability; health care delivery; health care quality; improved; insight; mortality; novel; payment; prior authorization; programs; social; treatment group; trend

ABSTRACT Medicare and Medicaid are the largest social health insurance programs in the United States, together providing health insurance for over 130 million Americans. While the programs share some key attributes, they also differ in important ways, with the key institutional difference being that states have significant control over the design of their Medicaid programs while Medicare is managed at the national level. Despite their importance to the U.S. health care system, there is little rigorous quasi-experimental work studying how the two programs compare to each other in terms of their effects on health care access, quality, and outcomes for enrollees. In this project, we will examine the relative effects of these two programs by following adults with disabilities who are enrolled in Medicaid before age 65 into Medicare at age 65 and beyond—that is, as disabled adults with only Medicaid switch to become dual-eligibles enrolled in both Medicaid and Medicare. Adults with disabilities who are dually enrolled in both Medicaid and Medicare before age 65 will serve as the control group, as they do not experience a transition between programs at age 65. Studying these changes to dual eligibility will allow us to isolate the average effects of state Medicaid programs on patient care and outcomes relative to a structurally different Medicare program (e.g., with a wider set of participating providers than Medicaid), as well as to explore variation in these effects across features of state Medicaid programs. In Aim 1, we will estimate how enrollees' care and outcomes differ in these two programs. In Aim 2, we will explore the mechanisms behind the program differences. To do this, we will leverage the fact that there is not one Medicaid program but 51, with varying levels of provider access and payment. Specifically, we will analyze how the Medicaid-Medicare transition differs in states with high provider payments (relative to Medicare) vs. states with low provider payments. We will do the same to compare states that contract out the provision of Medicaid benefits to private managed care plans vs. states that do not. This will provide new evidence on the extent to which these two important factors explain overall Medicaid-Medicare differences and will have implications for program design. In Aim 3, we focus on one specific component of the Medicaid and Medicare benefit packages: prescription drugs. We will use the introduction of Medicare Part D (which shifted dual- eligibles from Medicaid drug coverage to Medicare drug coverage) to assess how the drug benefit component of these two programs differentially affects enrollees' use of drugs and related health outcomes. Here, we will also leverage variation across state Medicaid programs to explore mechanisms, focusing on variation in state use of caps on the number of prescriptions beneficiaries can fill and prior authorization requirements. These analyses will provide critical lessons for the effects of important program design decisions (payment rates, managed care, drug caps, prior authorization) on health care delivery and health outcomes for low-income and disabled Americans.

抽象的 Medicare和Medicaid是美国最大的社会健康保险计划 为超过1.3亿美国人提供健康保险。当程序共享一些关键属性时，他们 在重要方面也有所不同，关键的机构差异是国家对 医疗保险在国家一级管理的医疗补助计划的设计。尽管他们 对于美国医疗保健系统的重要性，几乎没有严格的准实验性工作研究 两个程序在对医疗保健访问，质量和结果的影响方面相比 注册。在这个项目中，我们将通过跟随成年人与 在65岁及以后的65岁之前，已在65岁及以后的Medicare招收医疗补助的残疾人，也就是说 只有医疗补助的残疾成年人才能成为医疗补助和医疗保险的双重盗用。 在65岁之前在医疗补助和医疗保险中双重招收的残疾人将作为 对照组，由于他们没有经历65岁的计划之间的过渡。研究这些更改 双重资格将使我们能够隔离州医疗补助计划对患者护理的平均影响和 相对于结构上不同的Medicare计划的结果（例如，有一系列参与的提供商 比医疗补助），以及在州医疗补助计划的特征中探索这些影响的变化。 AIM 1，我们将估计这两个程序中注册的护理和成果如何不同。在AIM 2中，我们将 探索程序差异背后的机制。为此，我们将利用没有 一个医疗补助计划，但51个计划，提供者的访问和付款水平不同。具体来说，我们将分析 医疗补助 - 医疗保健转型在高度提供商付款（相对于Medicare）vs的州中的不同。 提供者付款低的州。我们将做同样的事情来比较签约规定的州 医疗补助对私人托管护理计划与没有的州的福利。这将提供有关 这两个重要因素解释了整体医疗补助密歇根州的差异的程度，并将有 对程序设计的影响。在AIM 3中，我们专注于Medicaid和Medicare的一个特定组成部分 福利包：处方药。我们将使用Medicare D部分的引入（这转移了双重 - 从医疗补助药物覆盖到Medicare药物覆盖范围的资格，以评估药物益处部分 在这两个方案中，有不同的影响会影响注册药物的使用和相关的健康结果。在这里，我们会的 还利用各州医疗补助计划的差异来探索机制，重点是状态变化 在处方数量上使用帽子的受益人可以填写和事先授权要求。这些 分析将为重要计划设计决策的影响提供关键课程（付款率， 托管护理，毒品上限，事先授权）低收入和 残疾的美国人。