Reid Rachel O, Deb Partha, Howell Benjamin L, Conway Patrick H, Shrank William H
Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA.
Centers for Medicare & Medicaid Services, Center for Medicare & Medicaid Innovation, Baltimore, MD, USA.
J Gen Intern Med. 2016 Feb;31(2):234-241. doi: 10.1007/s11606-015-3467-3. Epub 2015 Aug 18.
To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions.
We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions.
DESIGN, SETTING, PARTICIPANTS: We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011.
Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality.
Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7 %) and out-of-pocket costs (11.6 %) together explained nearly three times as much as quality ratings (13.6 %), but brand market share explained the most variation (35.3 %). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from $4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95 %CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95 %CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65 years were more willing to pay for higher-rated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans.
While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.
为便于在医疗保险优势市场中做出明智的决策，医疗保险和医疗补助服务中心在医疗保险计划查找网站上公布计划信息，包括成本、福利以及反映质量的星级评定。对于受益人在参保决策中如何权衡成本与质量，人们知之甚少。
我们旨在评估公开报告的医疗保险优势计划属性（即成本、质量和福利）与品牌市场份额以及受益人参保决策之间的关联。
设计、设置、参与者：我们对2011年首次参保医疗保险优势的847,069名受益人进行了全国性的、受益人的横断面分析。
将受益人与其计划选择集进行匹配，我们使用条件逻辑回归来估计计划属性与参保之间的关联，以评估计划属性和为质量支付意愿所解释的参保差异比例。
相对于模型所解释的总变异，保费（25.7%）和自付费用（11.6%）共同解释的计划选择变异几乎是质量评级（13.6%）的三倍，但品牌市场份额解释的变异最大（35.3%）。此外，虽然受益人愿意为评级更高的计划支付更多的年度总保费和自付费用（从二星半计划的4154.93美元到五星计划的5698.66美元），但在更高评级时支付意愿的增加有所减少，从评级从二星半提高到三星时的549.27美元（95%CI：541.10美元，557.44美元）降至评级从四星半提高到五星时的68.22美元（95%CI：61.44美元，75.01美元）。支付意愿在亚组间存在差异：64 - 65岁的受益人更愿意为评级更高的计划支付，而黑人和农村受益人则不太愿意为评级更高的计划支付。
虽然受益人更喜欢质量更高、成本更低的医疗保险优势计划，但在更高的星级评定中质量的边际效用会降低，并且他们的决策与计划的品牌市场份额密切相关。
