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Quality information disclosure and health insurance demand: evidence from VA hospital report cards

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International Journal of Health Economics and Management Aims and scope Submit manuscript

Abstract

This study examines the effect of public reporting of quality information on the demand for public insurance. In particular, we examine the effect of the introduction of Veterans Affairs (VA) hospital quality report cards in 2008. Using data from the Current Population Survey in 2005–2015, we find that new information about the quality of a VA hospital had a significant effect on VA coverage among veterans living in the same Metropolitan Statistical Area (MSA). Despite the significant effect on VA coverage, the quality report did not have a spillover effect on veterans’ labor supply. Moreover, updated quality information released in later years, which was presented in a less straightforward form, led to no additional changes in VA coverage. These findings suggest that quality reports for public insurance programs can be used as a policy lever to facilitate take up decision among potential beneficiaries.

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Notes

  1. In 2017, the national income threshold is $40,694 for veterans with two dependents and $42,899 for veterans with three dependents. The national threshold is adjusted geographically for cost of living.

  2. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=1515.

  3. The Internet is a primary source of information about VA benefits. According to the National Survey of Veterans in 2010, the majority of Veterans access the Internet (72.3%) and expressed willingness to use the Internet to obtain information about VA benefits (68.8%).

  4. “Appendix” presents detailed procedure measures used to construct the HEDIS scores and the ORYX scores.

  5. The remaining 13 facilities were either not located in an MSA or located in an MSA that were not identified in the CPS.

  6. Educational attainment, rather than income, is used for sample restriction because labor supply decisions could be affected by demand for health insurance. Boyle and Lahey (2010) shows access to VA health care reduces labor supply of veterans. Therefore, income is potentially endogenous to VA take-up while educational attainment is likely exogenous.

  7. The point estimate is statistically significant at the 15% level.

  8. Four measures are constructed as controls: share of veterans with service-connected disability, share of veterans with low-rating service connected disability (rated 10% or lower), share of veterans with medium-rating service connected disability (rated 11–49%), and share of veterans with high-rating service connected disability (rated 50% or higher). These measures are constructed using veteran supplement weights.

  9. It is worth noting that instead of reporting the raw data for patient rating, Hospital Compare reports the percentages of patients who gave a high rating (9 or 10), a medium rating (7 or 8), a and low rating (6 and below). A hospital is coded as “received a patient rating above national average” if the percentage of patients who gave a high rating exceeds that of the national average (64%).

  10. VA Utilization Profile, https://www.va.gov/vetdata/docs/Quickfacts/VA_Utilization_Profile.pdf.

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  1. Department of Economics, University of New Mexico, 1915 Roma Ave NE, Albuquerque, NM, USA

    Xiaoxue Li

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Appendix

Appendix

See Table 8.

Table 8 Detailed quality measures used to construct the composite scores.
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Li, X. Quality information disclosure and health insurance demand: evidence from VA hospital report cards. Int J Health Econ Manag. 20, 177–199 (2020). https://doi.org/10.1007/s10754-019-09276-9

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