Assuntos
Medicare Part C , Cobertura Universal do Seguro de Saúde , Capitação , Financiamento Pessoal , Planos de Assistência de Saúde para Empregados , Gastos em Saúde , Humanos , Seguro de Saúde (Situações Limítrofes)/economia , Medicare Part C/economia , Medicare Part C/organização & administração , Medicare Part C/estatística & dados numéricos , Programas Nacionais de Saúde/organização & administração , Política , Estados Unidos , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/organização & administraçãoRESUMO
OBJECTIVES: To examine whether patients with newly diagnosed cancer respond differently to supplemental coverage than the general Medicare population. METHODS: A cohort of newly diagnosed cancer patients (n = 1,799) from the 1997-2007 Medicare Current Beneficiary Survey and a noncancer cohort (n = 9,726) were identified and matched by panel year. Two-year total medical care spending was estimated by using generalized linear models with gamma distribution and log link-including endogeneity-corrected models. Interactions between cancer and type of insurance allowed testing for differential effects of a cancer diagnosis. RESULTS: The cancer cohort spent an adjusted $15,605 more over 2 years than did the noncancer comparison group. Relative to those without supplemental coverage, beneficiaries with employer-sponsored insurance, other private with prescription drug coverage, and public coverage had significantly higher total spending ($3,510, $2,823, and $4,065, respectively, for main models). For beneficiaries with cancer, supplemental insurance effects were similar in magnitude yet negative, suggesting little net effect of supplemental insurance for cancer patients. The endogeneity-corrected models produced implausibly large main effects of supplemental insurance, but the Cancer × Insurance interactions were similar in both models. CONCLUSIONS: Medicare beneficiaries with cancer are less responsive to the presence and type of supplemental insurance than are beneficiaries without cancer. Proposed restrictions on the availability of supplemental insurance intended to reduce Medicare spending would be unlikely to limit expenditures by beneficiaries with cancer, but would shift the financial burden to those beneficiaries. Policymakers should consider welfare effects associated with coverage restrictions.
Assuntos
Gastos em Saúde , Seguro de Saúde (Situações Limítrofes)/economia , Seguro de Serviços Farmacêuticos/economia , Medicare/economia , Neoplasias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Estados UnidosAssuntos
Cirurgia Geral/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/organização & administração , Competição Econômica , Serviços Médicos de Emergência/legislação & jurisprudência , Cirurgia Geral/organização & administração , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Seguro de Saúde (Situações Limítrofes)/economia , Medicaid/legislação & jurisprudência , Medicaid/organização & administração , Medicare/legislação & jurisprudência , Medicare/organização & administração , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Centros Cirúrgicos/economia , Centros Cirúrgicos/legislação & jurisprudência , Estados Unidos , Recursos HumanosRESUMO
Medicare supplemental insurance (Medigap) provides important financial protections for many low- and moderate-income beneficiaries in Medicare's traditional fee-for-service program. However, conventional wisdom among policymakers holds that Medigap coverage substantially raises Medicare claims costs. This report uses detailed diagnosis data provided by three large Medigap insurers, information from the Medicare Current Beneficiary Survey, and the Medicare 5 percent sample file to reexamine the impact of Medigap coverage on Medicare spending. We conclude that previous studies might have overestimated the impact of Medigap coverage on Medicare costs and that past projections of potential Medicare cost savings from restrictions on Medigap coverage probably are overstated.