Implications of Switching Costs for Medicare Premium Support

医疗保险保费支持转换成本的影响

基本信息

批准号：
8620426
负责人：
ADAM J ATHERLY
金额：
$ 11.6万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-30 至 2015-06-30
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): The overarching goal of this project is to evaluate the extent of switching costs in Medicare health plans to understand whether they are large enough to undermine the ability of competitive markets to function in a premium support context. To do this, we will analyze whether Medicare beneficiaries are sufficiently responsive to changes in health plan premiums and benefits for "premium support" style Medicare reforms to be a viable strategy to control Medicare spending. The Medicare program faces substantial financial challenges over the next several decades. The Medicare Trustees project that the Part A trust fund will become insolvent by 2025 and that the entire program is on an unsustainable spending trajectory. Although there are many different proposals for how to deal with the impending spending crisis, most falls into one of two groups: care redesign and premium support. Care redesign seeks to preserve the basic structure of the existing Fee-For-Service (FFS) model while introducing incentives to provide care more efficiently. The second idea - premium support - has health plans submit "bids" to the government for a basic benefit package. The government uses these bids to set its contribution to premiums. Plans that provide better value are rewarded with high market share, while those that do not are penalized by losing market share. This is the essential logic behind the structure of Medicare Part D prescription drug coverage, a program that has achieved high beneficiary satisfaction and program costs substantially below projections. However, whether this Part D result would translate to a premium support model that included broader coverage is unclear. Although there have been substantial efforts to evaluate the impact of care redesign in Medicare - CMS is currently funding numerous evaluations of care redesigns, such as bundled payment initiatives and Accountable Care Organizations - there has been relatively little effort to evaluate the viability of premium suppor models, despite its prominence as a possible reform option. The project draws data from the Medicare Current Beneficiary Survey, a representative longitudinal dataset. Analytically, we will estimate the magnitude of switching costs using a mixed logit model, observing plan choices over time. We will explicitly model the impact of plan "loyalty" on plan choices, and will allow "loyalty" to be a random coefficient. The random coefficient will allow us to identify not only the mean value of loyalty, but also to identify factors which predict loyalty.

描述（由申请人提供）：该项目的总体目标是评估 Medicare 健康计划的转换成本程度，以了解其是否大到足以破坏竞争市场在优质支持环境下运作的能力。为此，我们将分析医疗保险受益人是否对健康计划保费和“保费支持”式医疗保险改革福利的变化做出足够的反应，使其成为控制医疗保险支出的可行策略。医疗保险计划在未来几十年面临巨大的财务挑战。医疗保险受托人预计，A 部分信托基金将在 2025 年破产，整个计划将处于不可持续的支出轨道上。尽管对于如何应对即将到来的支出危机有许多不同的建议，但大多数都属于两类之一：护理重新设计和高级支持。护理重新设计旨在保留现有按服务付费（FFS）模式的基本结构，同时引入激励措施以更有效地提供护理。第二个想法是高级支持，让健康计划向政府提交基本福利计划的“投标”。政府利用这些投标来确定其对保费的贡献。提供更好价值的计划会获得高市场份额，而那些没有提供更好价值的计划则会因失去市场份额而受到惩罚。这是 Medicare D 部分处方药承保结构背后的基本逻辑，该计划已实现较高的受益人满意度，且计划成本大大低于预测。然而，D 部分的结果是否会转化为包含更广泛覆盖范围的高级支持模式尚不清楚。尽管已经做出了大量努力来评估医疗保险中护理重新设计的影响 - CMS 目前正在资助许多护理重新设计的评估，例如捆绑支付计划和负责任的护理组织 - 但评估保费支持模式的可行性的努力相对较少，尽管它作为一种可能的改革选择而受到重视。该项目从医疗保险当前受益人调查中提取数据，这是一个具有代表性的纵向数据集。通过分析，我们将使用混合 Logit 模型来估计转换成本的大小，并随着时间的推移观察计划选择。我们将明确模拟计划“忠诚度”对计划选择的影响，并允许“忠诚度”成为随机系数。随机系数不仅使我们能够识别忠诚度的平均值，还可以确定预测忠诚度的因素。