BACKGROUND/RATIONALE:
Starting in 2006, MMA makes outpatient drug coverage available to all Medicare beneficiaries, mostly through private health insurance plans. Although attractive to veterans because of convenience and subsidized rates, these plans will offer coverage that is far from comprehensive, potentially placing veterans' health at additional risk (relative to VA care).
OBJECTIVE(S):
The proposed study has three objectives: Objective 1 is to study and quantify how veterans choose among their health insurance options. Objective 2 is to develop measures of comprehensiveness of coverage based on adjusted MCBS measures of VA use and cost. Objective 3 is to estimate the relationship between outcomes for veterans and the comprehensiveness of their drug and non-drug insurance coverage.
METHODS:
This study uses existing survey data and other publicly available data to achieve its objectives. We will estimate statistical models using linked MCBS, VA, and publicly available Medicare and geographic data. The first model will relate the generosity of Medicare drug benefits to elderly veterans' decisions to enroll in VA or rely on Medicare and private insurance. Second, we will validate and adjust if necessary the VA utilization and cost data in MCBS and then construct and validate utilization-based measures of insurance comprehensiveness as a function of plan characteristics. The third model will relate comprehensiveness of insurance coverage to risk-adjusted functional decline, mortality, and preventable hospitalization rates for veterans and non-veterans.
FINDINGS/RESULTS:
Our choice models indicate that veterans' insurance choices are affected by the distance between their residences and the nearest VAMC as well as by the average waiting times for VA appointments and other factors. Preliminary outcomes models have not found a relationship between comprehensiveness of coverage and hospitalization for ambulatory care sensitive conditions. There is some indication that comprehensiveness may be related to risk-adjusted mortality rates.
IMPACT:
This study will have methodological benefits for VA investigators and will produce specific findings that will be useful for VA administrators and policymakers. Investigators will benefit from our experience adjusting MCBS and using it to model VA utilization and costs as well as our effort to develop statistically sound measures of the comprehensiveness of insurance coverage. VA administrators and policymakers will benefit from this project because of the ongoing importance to VA of changes in Medicare coverage policies.
PUBLICATIONS:
Journal Articles
- Frakt AB, Pizer SD. Attribute substitution in early enrollment decisions into Medicare prescription drug plans. Health Economics. 2008; 17(4): 513-21.
- Pizer SD, Frakt AB, Feldman R. Predicting risk selection following major changes in Medicare. Health Economics. 2008; 17(4): 453-68.
