Effects of changes in Medicaid physician fees on use of preventive care

医疗补助医生费用的变化对预防性护理使用的影响

• 批准号: 8336741
• 负责人: ADAM J ATHERLY
• 金额: $ 22.44万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-24 至 2013-12-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8336741
• 关键词: Adult; Advisory Committees; Caring; Categories; Congresses; Cost Sharing; Data; Elements; Eligibility Determination; Excision; Expenditure; Fees; Funding; Future; Health; Incentives; Insurance; Laws; Low Income Population; Medicaid; Medical; Medical Assistance; Medicare; Modeling; Monitor; National Ambulatory Medical Care Survey; Parents; Patients; Physicians; Policies; Population; Preventive; Primary Care Physician; Primary Health Care; Provider; Research; Services; Structure; Surveys; Techniques; United States Centers for Medicare and Medicaid Services; Variant; beneficiary; copayment; cost; design; financial incentive; geographic difference; payment; programs; safety net; trend

DESCRIPTION (provided by applicant): The purpose of this project is to model the effects of temporary changes in Medicaid physician fees, removal of preventive care copayment rates and Medicaid eligibility expansion in the Patient Protection and Affordable Care Act of 2010 (PPACA) on the use of US Preventive Services Task Force (USPSTF) recommended preventive care among Medicaid enrollees. PPACA appropriates federal dollars to fund increases in physician fees for the Medicaid program to Medicare rates for 2013 and 2014. After 2014, the federal incentive expires and it is up to states to determine if they will continue to fund the payment increase using state funds if Congress does not fund an extension. Traditionally, each state has set its own Medicaid reimbursement rates and has had wide discretion in eligibility rules and copayment structure. Federal Medicaid law does not define preventive services, include these services under a mandatory benefit category or track specific preventive services covered for adults by each Medicaid program. This has led to substantial geographic variation in Medicaid plan design and use of preventive services, with not all USPSTF services covered in all states and substantial differences in provider reimbursement and beneficiary cost sharing. This study will examine the effect of the previous increases in physician fees on the use of USPSTF recommended preventive care services and model the projected impact of additional utilization increases under PPACA. Similarly, we will estimate the effects of the elimination of this financial incentive after 2014. We will also estimate the cost of increases in the use of these preventive services, resulting from the increase in physician fees, the removal of copayments, and the eligibility expansion to parents and childless adults. To answer these questions, we will use data from the Medical Expenditure Panel Survey (MEPS) and the National Ambulatory Medical Care Survey (NAMCS). The project will answer an important research question that will be critical for the next step in health reform. When the federal subsidies for higher Medicaid reimbursement and program expansions expire in 2014, states will make choices about which elements to retain and which to discard. It will be critical that there be scientific evidence regarding the impact of the different policy options. Currently, that evidence is lacking. This study will provide guidance to states about the likely effect of different policy choices on the use of preventive care in low income populations.

描述（由申请人提供）：该项目的目的是建模医疗补助医师费用暂时变化，删除预防保健共同承担率以及2010年患者保护和负担得起的医疗法案对美国预防措施工作组（USPSTF）建议预防性预防保健服务中的医疗服务纳罗尔群岛的使用中的临时变化。 PPACA拨款联邦资金以资助2013年和2014年医疗保险费率的医疗补助计划的医师费用增加。2014年之后，联邦激励措施到期，如果国会不资助延期，则由各州确定他们是否会继续使用州资金来资助付款资金。传统上，每个州都设定了自己的医疗补助报销率，并在资格规则和共同结构中拥有广泛的酌处权。联邦医疗补助法没有定义预防服务，包括在强制性福利类别下包括这些服务或每个医疗补助计划为成人涵盖的特定预防服务。这导致了医疗补助计划设计和预防服务的使用的实质地理差异，并非所有州涵盖的USPSTF服务以及提供商的报销和受益人成本共享的实质性差异。这项研究将研究医师费用增加对USPSTF建议的预防性护理服务的影响，并在PPACA下对额外利用率增加的预计影响进行建模。同样，我们将估计2014年以后消除这种经济激励的影响。我们还将估计使用这些预防服务增加的成本，这是由于医师费的增加，消除共生费以及扩大父母和无子女成人的资格扩大所致。为了回答这些问题，我们将使用医疗支出小组调查（MEP）和国家门诊医疗调查（NAMCS）中的数据。该项目将回答一个重要的研究问题，这对于健康改革的下一步至关重要。当联邦补贴更高的医疗补助报销和计划扩张在2014年到期时，各州将选择要保留哪些要素和丢弃哪些要素。至关重要的是，有关于不同政策选择的影响的科学证据。目前，缺乏证据。这项研究将向各州提供有关不同政策选择对低收入人群中预防保健的可能影响的指导。