RAND Corporation in Arlington, Virginia, USA.
Health Aff (Millwood). 2013 May;32(5):891-9. doi: 10.1377/hlthaff.2012.0147.
With Medicare spending projected to increase to 24 percent of all federal spending and to equal 6 percent of the gross domestic product by 2037, policy makers are again considering ways to curb the program's spending growth. We used a microsimulation approach to estimate three scenarios: imposing a means-tested premium for Part A hospital insurance, introducing a premium support credit to purchase health insurance, and increasing the eligibility age to sixty-seven. We found that the scenarios would lead to reductions in cumulative Medicare spending in 2012-36 of 2.4-24.0 percent. However, the scenarios also would increase out-of-pocket spending for enrollees and, in some cases, cause millions of seniors not to enroll in the program and to be left without coverage. To achieve substantial cost savings without causing substantial lack of coverage among seniors, policy makers should consider benefit changes in combination with other options, such as some of those now being contemplated by the Obama administration and Congress.
预计到 2037 年，医疗保险支出将占所有联邦支出的 24%，占国内生产总值的 6%，政策制定者再次考虑控制该计划支出增长的方法。我们使用微观模拟方法估计了三种情况：对 A 部分医疗保险征收收入测试保费，引入保费补贴信用以购买健康保险，以及提高参保年龄至六十七岁。我们发现，这些方案将导致 2012 年至 2036 年期间医疗保险支出累计减少 2.4%至 24.0%。然而，这些方案也会增加参保者的自付费用，在某些情况下，导致数百万老年人不参加该计划，并且没有得到覆盖。为了在不导致老年人大量缺乏覆盖的情况下实现大量节省成本，政策制定者应考虑结合其他方案（如奥巴马政府和国会正在考虑的一些方案）来改变福利。
