Article

International Journal of Health Care Finance and Economics

, 9:59

First online:

Nothing for something? Estimating cost and value for beneficiaries from recent medicare spending increases on HMO payments and drug benefits

  • Steven D. PizerAffiliated withDepartment of Veterans’ Affairs, Health Care Financing & Economics, VA Boston Health Care SystemBoston University Email author 
  • , Austin B. FraktAffiliated withDepartment of Veterans’ Affairs, Health Care Financing & Economics, VA Boston Health Care System
  • , Roger FeldmanAffiliated withUniversity of Minnesota

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Abstract

The Medicare Modernization Act of 2003 added a new outpatient prescription drug benefit to Medicare and increased payments to HMOs. We estimate a nested logit model of plan choice to quantify the welfare benefits from these two expansion paths. We find that the addition of stand-alone prescription drug plans was welfare improving and produced nine times as much value per government dollar as the increase in payments to HMOs. In light of these results, we suggest that HMO bidding procedures should be modified to reduce payments to HMOs by about $67 billion over the next 10 years.

Keywords

Medicare HMO payment Choice models Welfare

JEL Classifications

I 11 I 18