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: 8181259
• 负责人: ADAM J ATHERLY
• 金额: $ 19.97万
• 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 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8181259
• 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. PUBLIC HEALTH RELEVANCE: This study will provide guidance to states about the likely effect of different policy choices embedded in the Patient Protection and Affordable Care Act of 2010 on the cost and use of preventive care in low income populations.

描述（由申请人提供）：该项目的目的是模拟 2010 年《患者保护和平价医疗法案》(PPACA) 中医疗补助医生费用临时变化、取消预防性护理共付率以及扩大医疗补助资格的影响。使用美国预防服务工作组 (USPSTF) 建议的医疗补助参与者进行预防性护理。 PPACA 拨款联邦资金，用于增加 2013 年和 2014 年医疗补助计划的医生费用至医疗保险费率。2014 年之后，联邦激励措施到期，由各州决定是否继续使用州资金来支付增加的费用，如果国会不资助延期。传统上，每个州都制定了自己的医疗补助报销率，并在资格规则和共付结构方面拥有广泛的自由裁量权。联邦医疗补助法没有定义预防性服务，也没有将这些服务纳入强制性福利类别，也没有跟踪每个医疗补助计划为成人提供的特定预防性服务。这导致医疗补助计划设计和预防性服务的使用存在巨大的地理差异，并非所有州都涵盖所有 USPSTF 服务，并且提供者报销和受益人费用分摊方面也存在巨大差异。本研究将研究之前医生费用的增加对 USPSTF 推荐的预防性护理服务的使用的影响，并模拟 PPACA 下额外使用增加的预计影响。同样，我们将估计 2014 年之后取消这一财务激励措施的影响。我们还将估计由于医生费用增加、共付额取消和资格扩大而导致这些预防性服务的使用增加的成本给父母和无子女的成年人。为了回答这些问题，我们将使用医疗支出小组调查 (MEPS) 和国家流动医疗调查 (NAMCS) 的数据。该项目将回答一个重要的研究问题，这对于下一步医疗改革至关重要。当联邦对更高医疗补助报销和计划扩展的补贴于 2014 年到期时，各州将决定保留哪些内容和放弃哪些内容。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。这项研究将为各州提供有关不同政策选择对低收入人群使用预防性护理可能产生的影响的指导。 公共卫生相关性：本研究将为各州提供指导，了解 2010 年《患者保护和平价医疗法案》中包含的不同政策选择对低收入人群预防性护理的成本和使用可能产生的影响。