Buttorff Christine, Girosi Federico, Lai Julie, Taylor Erin A, Lewis Sarah E, Ma Sai, Eibner Christine
RAND Corporation, Arlington, VA.
RAND Corporation, Santa Monica, CA.
Med Care. 2022 Apr 1;60(4):302-310. doi: 10.1097/MLR.0000000000001695.
The objective of this study was to examine the price sensitivity for provider visits among Medicare Advantage beneficiaries.
We used Medicare Advantage encounter data from 2014 to 2017 accessed as part of an evaluation for the Center for Medicare & Medicaid Innovation.
We analyzed the effect of cost-sharing on the utilization of 2 outcome categories: number of visits (specialist and primary care) and the probability of any visit (specialist and primary care). Our main independent variable was the size of the copayment for the visit, which we regressed on the outcomes with several beneficiary-level and plan-level control variables.
DATA COLLECTION/EXTRACTION METHODS: We included beneficiaries with at least 1 of 4 specific chronic conditions and matched comparison beneficiaries. We did not require beneficiaries to be continuously enrolled from 2014 to 2017, but we required a full year of data for each year they were observed. This resulted in 371,140 beneficiary-year observations.
Copay reductions were associated with increases in utilization, although the changes were small, with elasticities <-0.2. We also found evidence of substitution effects between primary care provider (PCP) and specialist visits, particularly cardiology and endocrinology. When PCP copays declined, visits to these specialists also declined.
We find that individuals with chronic conditions respond to changes in copays, although these responses are small. Reductions in PCP copays lead to reduced use of some specialists, suggesting that lowering PCP copays could be an effective way to reduce the use of specialist care, a desirable outcome if specialists are overused.
本研究的目的是检验医疗保险优势计划受益人群对就诊服务的价格敏感性。
我们使用了2014年至2017年医疗保险优势计划的就诊数据，这些数据是作为医疗保险和医疗补助创新中心评估的一部分获取的。
我们分析了费用分担对两类结果利用情况的影响：就诊次数（专科和初级保健）以及任何类型就诊（专科和初级保健）的概率。我们的主要自变量是就诊自付费用的金额，我们将其与多个受益人和计划层面的控制变量一起对结果进行回归分析。
数据收集/提取方法：我们纳入了患有4种特定慢性病中至少1种的受益人和匹配的对照受益人。我们不要求受益人在2014年至2017年期间持续参保，但要求对他们被观察的每一年都有一整年的数据。这产生了371,140个受益人年观测值。
自付费用的降低与利用率的增加相关，尽管变化很小，弹性< -0.2。我们还发现了初级保健医生（PCP）就诊和专科就诊之间存在替代效应的证据，特别是心脏病学和内分泌学方面。当PCP自付费用下降时，这些专科医生的就诊次数也会下降。
我们发现患有慢性病的个体对自付费用的变化有反应，尽管这些反应很小。PCP自付费用的降低导致某些专科医生的就诊次数减少，这表明降低PCP自付费用可能是减少专科医疗服务使用的有效方法，如果专科医生使用过度，这是一个理想的结果。
