Income Effects and Current Law Forecasts of Health Care Spending Growth

医疗保健支出增长的收入影响和现行法律预测

• 批准号: 7725722
• 负责人: MICHAEL E CHERNEW
• 金额: $ 45.9万
• 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: 2009-08-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7725722
• 关键词: Accounting; Address; American; Behavior; Belief; Budgets; Caring; Characteristics; Conflict (Psychology); Cost Sharing; Country; Data Aggregation; Economics; Elderly; Environment; Face; Funding; Future; Growth; Health; Healthcare; Heterogeneity; Income; Individual; Insurance; Intuition; Laws; Marketing; Medicare; Modeling; Patients; Perception; Persons; Policies; Policy Analysis; Relative (related person); Resource Sharing; Risk; Role; Services; Solvents; Taxes; Testing; Time; Trust; United States Centers for Medicare and Medicaid Services; Validation; base; beneficiary; cost; experience; improved; interest; programs; public health relevance; theories; tool; trend

DESCRIPTION (provided by applicant): Each year the Office of the Actuary (OACT) at the Center for Medicare and Medicaid Services (CMS) and the Congressional Budget Office (CBO) assess the fiscal health of the Medicare trust funds. These forecasts are required to assume current law remains in force (no policy changes). Current-law forecasts may produce unsustainable projections if the current policy environment inhibits market mechanisms from slowing cost growth. The challenge for forecasters is that past experience does not clearly indicate any persistent slowing in aggregate health care spending growth, yet forecasters generally believe that spending growth will slow as health care spending consumes a greater share of income. This belief is reflected in both the CBO and OACT models, which assume spending growth will diminish over time, though neither relies on underlying models of behavior to justify the assumptions. Recent CMS advisory panels have called for improved understanding of the mechanisms that, under current law, might slow spending. The effect of existing beneficiary cost sharing has been of particular interest. We propose to construct a microsimulation model of Medicare spending that will focus on the extent to which current-law cost sharing rules may slow spending growth in the future, when health care constitutes a significant share of disposable income for many elderly Americans. This mechanism has not been explicitly accounted for in current forecasts. It is uncertain how large this effect may be and what the associated distributional consequences will be. Our contribution will be to provide better current-law forecasts by explicitly incorporating budget constraints and by using an individual, as opposed to a representative agent, models (because heterogeneity can bias representative agent models). Further, our model will be a tool that forecasters can use to explore the sensitivity of results to various assumptions and to assess distributional consequences of cost growth. We have 3 aims. Aim 1: Develop a current-law microsimulation module of Medicare spending for beneficiaries over the age of 65, conditional on supplemental coverage, which reformulates and integrates the role of income effects in restraining demand growth. Aim 2: Develop a current-law microsimulation module of insurance demand for Medicare beneficiaries over the age of 65 that, consistent with demand and risk theory, describes how cost growth will influence the distribution of supplemental coverage in the future. Aim 3: Conduct validation testing and sensitivity analysis on the integrated microsimulation model and use the model to conduct policy analysis examining the potential impact of current-law cost sharing requirements on the future trajectory of health care spending. PUBLIC HEALTH RELEVANCE: Project Narrative: This project will construct a microsimulation model for that will quantify the common intuition that budget constraints will, over time, slow Medicare spending growth. Our contribution will be to improve existing current-law forecasts by making this intuition explicit and by allowing forecasters to better understand how cost sharing may slow spending. Unlike existing models, our model will be grounded in economic theory and model spending relative to income at the beneficiary level.

描述（由申请人提供）：每年医疗保险和医疗补助服务中心（CMS）的精算师办公室（OACT）和国会预算办公室（CBO）评估Medicare Trust资金的财政健康。这些预测必须假设现行法律仍然有效（没有政策变更）。如果当前的政策环境抑制了市场机制的减缓成本增长，那么当前法律的预测可能会产生不可持续的预测。预报员面临的挑战是，过去的经验并未清楚地表明总体医疗保健支出增长的持续放缓，但预报员通常认为，随着医疗保健支出消耗更大的收入，支出的增长会放缓。这种信念反映在CBO和OACT模型中，这些模型假设支出增长会随着时间的流逝而减少，尽管两者都不依赖于基本的行为模型来证明假设合理。最近的CMS咨询小组呼吁改善对根据现行法律可能减缓支出的机制的理解。现有的受益人成本共享的影响特别令人感兴趣。我们建议构建一种医疗保险支出的微仿真模型，该模型将重点介绍当前法律成本分享规则可能会减缓未来支出增长的程度，而当医疗保健构成许多美国老年人的可支配收入中。该机制尚未在当前的预测中明确考虑。不确定这种效果可能是多大的，以及相关的分布后果。我们的贡献将是通过明确合并预算约束并使用个人而不是代表代理的模型来提供更好的现有法律预测（因为异质性可以偏向代表性代理模型）。此外，我们的模型将是一个预报员可以用来探索结果对各种假设的敏感性并评估成本增长的分配后果的工具。我们有3个目标。 AIM 1：为65岁以上的受益人开发医疗保险支出的当前法律微观仿真模块，其条件是补充覆盖范围，该模块将收入效应在限制需求增长中的作用进行了重新制定和整合。 AIM 2：为65岁以上的医疗保险受益人开发一个现行法律的微仿真模块，该模块与需求和风险理论一致，描述了成本增长将如何影响将来补充覆盖范围的分布。 AIM 3：对集成微仿真模型进行验证测试和敏感性分析，并使用该模型进行政策分析，以研究现行法律成本共享要求对医疗保健支出未来轨迹的潜在影响。 公共卫生相关性：项目叙述：该项目将构建一个微仿真模型，以量化预算限制将随着时间的流逝而减缓Medicare支出增长的共同直觉。我们的贡献是通过明确的直觉来改善现有的当前法律预测，并允许预报员更好地了解成本共享如何减缓支出。与现有模型不同，我们的模型将基于经济理论和模型支出相对于受益人一级的收入。