Differences In Incentives Between Stand Alone Medicare Drug Coverage vs Medicare

独立医疗保险药物承保与医疗保险之间的激励差异

• 批准号: 7896221
• 负责人: KOSALI ILAYPERUMA SIMON
• 金额: $ 6.05万
• 依托单位: CORNELL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7896221
• 关键词: Accounting; Australia; Behavior; Benchmarking; Caring; Characteristics; Complement; Cost Sharing; Cream; Data; Data Set; Drug Costs; Drug Insurance; Drug Prescriptions; Enrollment; Ensure; Exhibits; Fee-for-Service Plans; Formularies; Funding Agency; Future; Government; Growth; Guidelines; Health; Health Care Costs; Hospital Costs; Incentives; Individual; Insurance Carriers; International; Lead; Marketing; Measures; Medical; Medicare; Medicare Part A; Modeling; National Formulary; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Policies; Policy Research; Preventive; Price; Public Policy; Recording of previous events; Relative (related person); Research; Rest; Scheme; Signal Transduction; Social Welfare; Structure; Surveys; Testing; Time; United States Centers for Medicare and Medicaid Services; base; beneficiary; cost; design; flexibility; non-drug; payment; prior authorization; programs; public health relevance; theories; tool

DESCRIPTION (provided by applicant): Under Medicare Part D, seniors can choose to receive drug coverage through either a stand-alone Prescription Drug Plan (PDP) or through Medicare Advantage (MAPDP), which bundles together Parts A, B and D. Theory predicts that MAPDPs, whose payoff function involves total health care costs, have a stronger incentive than PDPs to decrease the formulary generosity of drugs whose use signals that the patient also has high non-drug costs, during open enrollment periods when such potential enrollees can be discouraged from enrolling and current enrollees can be encouraged to disenroll (the selection hypothesis). After open enrollment, MAPDPs have stronger incentives to design formularies that optimize medical management by generously covering drugs whose use reduces hospital costs (Chandra, Gruber and McKnight, forthcoming) (the medical management hypothesis). The objective of this R03 application is to test whether MAPDP and PDP formulary designs during 2006-2010 are systematically different from each other in ways predicted by theory, within the confines of rules governing all Part D plan design. Our aims are: Specific Aim 1: To test whether MAPDP formularies are less generous than PDP formularies during open enrollment for drugs whose use signals that a patient also has high non-drug costs (Selection hypothesis). Specific Aim 2: To test whether MAPDP formularies are more generous than PDP formularies after open enrollment for drugs whose use can lower non-drug costs. (Medical management hypothesis). Specific Aim 3: To study factors that determine the magnitude of selection, the magnitude of medical management and how the net effect evolves over time. Our basic estimation strategy is a "differences in differences" approach using the fact that we expect MAPDP plans will exhibit the selection incentive in their generosity towards certain drugs during open enrollment relative to rest of the plan year, relative to PDP plans and exhibit the medical management incentive towards certain drugs during the rest of the year relative to the open enrollment period, relative to PDP plans. We plan to use several data sets that contain information on drug plan design of MAPDPs and PDPs, as well as information on the connection between hospital costs and use of certain drugs. The measures of plan generosity towards a drug include knowing whether it is on the formulary, and if so, knowing its co- payment structure, need for prior authorization, step therapy and quantity limits on refills. While there are some guidelines that all plans must follow regarding plan design, they are allowed considerable flexibility in design. We anticipate the results of our research will have a meaningful impact on public policy and research related to Medicare Part D by showing how the flexibility built into the design of the market is being used by MAPDP vs. PDP plans. PUBLIC HEALTH RELEVANCE: This proposal investigates whether Medicare drug coverage delivered through a comprehensive program (Medicare Advantage) takes into account the spillovers and connections between drug and non-drug costs in the design of their drug formularies relative to stand-alone drug coverage.

描述（由申请人提供）：在医疗保险第D部分，老年人可以选择通过独立的处方药计划（PDP）或Medicare Advantage（MAPDP）来接受药物覆盖范围，该部分将A，B和D捆绑在一起。理论预测，MAPDP可以预测，MAPDP的收益功能还涉及较高的医疗保健成本，而不是PDP较高的药物，其既有药物均具有强大的攻击性，而该公司具有更强的攻击性。成本，在开放式入学期间，可以鼓励参加此类潜在的入学者，并鼓励目前的参与者取消（选择假设）。公开注册后，MAPDP具有更强大的激励措施来设计式机制，通过慷慨地覆盖使用使用的药物来优化医疗管理的造成（Chandra，Gruber和McKnight，即将到来）（医疗管理假设）。此R03应用程序的目的是测试2006 - 2010年期间MAPDP和PDP配方设计是否以理论预测的方式与彼此之间的彼此不同。我们的目的是：特定目标1：测试MAPDP配方在开放式入学期间是否比PDP配方较大的药物，其使用信号表明患者也具有很高的非药物成本（选择假设）。特定目标2：测试MAPDP配方式是否比PDP配方在开放式入学率后对使用的药物降低非药物成本的范围更大。 （医疗管理假设）。特定目的3：研究决定选择幅度的因素，医疗管理的大小以及净效应如何随着时间的流逝而发展。 我们的基本估计策略是一种事实，即我们期望MAPDP计划将在公开注册期间相对于PDP计划的其余部分，在公开注册期间对某些药物的慷慨大方表现出一种“差异差异”方法，相对于PDP计划，并且相对于PDP计划，相对于一年中的其余药物，与PDP计划相对于某些药物的医疗管理激励了某些药物。我们计划使用几个数据集，其中包含有关MAPDP和PDP的药物计划设计信息的信息，以及有关医院费用与某些药物使用之间联系的信息。对药物的计划慷慨度量包括知道其是否在配方中，如果这样，知道其合作结构，需要事先授权，步骤治疗和补充量的数量限制。虽然有一些有关计划设计的指南必须遵循所有计划，但它们的设计灵活性很大。我们预计，我们的研究结果将对与Medicare D部分有关的公共政策和研究产生有意义的影响，这是如何通过MAPDP与PDP计划使用的。 公共卫生相关性：该提案调查了通过综合计划（Medicare Advantage）提供的Medicare药物覆盖范围是否考虑了与独立药物覆盖范围相对于其药物配方设计的药物和非药物成本之间的溢出和连接。