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Payment Policy and Inefficient Benefits in the Medicare+Choice Program

  • Steven D. Pizer
  • Austin B. Frakt
  • Roger Feldman
Article

Abstract

We investigated whether constraints on premium rebates by health plans in the Medicare+Choice program result in inefficient benefits. Since relationships between revenue and benefits could be confounded by unobserved variation in the cost of coverage, we took advantage of a natural experiment that occurred following passage of the Benefits Improvement and Protection Act of 2000. Our findings indicate that benefits in zero premium plans were more sensitive to changes in payment rates than were benefits in plans that charged nonzero premiums. These results strongly suggest that current Medicare policy induces plans to offer benefits that are not valued by enrollees at or above their cost.

health insurance efficiency rebates 

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References

  1. Bailey, G. (Acting Director, Medicare Managed Care Group) (2001). “Status of BIPA Implementation.” Health Care Financing Administration. Baltimore, Maryland, February 16.Google Scholar
  2. Centers for Medicare and Medicaid Services. (2002). Medicare Managed Care Contract Report, February 1.Google Scholar
  3. Cutler, D.M. and R. J. Zeckhauser. (2000). “The Anatomy of Health Insurance.” In A. J. Culyer and J. P. Newhouse (eds.), Handbook of Health Economics (Vol. 1A). Amsterdam: Elsevier.Google Scholar
  4. Efron, B. (1993). An Introduction to the Bootstrap. New York: Chapman and Hall.Google Scholar
  5. Feldman, R., B. Dowd and R. Coulam. (2001). “Premium Rebates and the Quiet Consensus on Market Reform for Medicare.” Health Care Financing Review 23(2), 19–33.Google Scholar
  6. Feldman, R., C. Wisner, B. Dowd and J. B. Christianson. (1993). “An Empirical Test of Competition in the Medicare HMO Market.” In R. J. Arnould, R. F. Rich and W. D. White (eds.), Competitive Approaches to Health Policy Reform. Washington, DC: Urban Institute Press.Google Scholar
  7. Gaynor, M. and G. F. Anderson. (1995). “Uncertain Demand, the Structure of Hospital Costs, and the Cost of Empty Hospital Beds.” Journal of Health Economics 14(3), 291–317.Google Scholar
  8. Gold, M. and J. McCoy. (2002). “Choice Continues to Erode in 2002.” Monitoring Medicare+Choice Fast Facts Number 7 (January). http://www.mathematica-mpr.com/PDFs/fastfacts7.pdf.Google Scholar
  9. Gold, M. (2001). “Medicare+Choice: An Interim Report Card.” Health Affairs 20(4), 120–138.Google Scholar
  10. Health Care Financing Administration. (2001). “M+C Enrollees Affected by Non-Renewals and Service Area Reductions for 2001.” Health Care Financing Administration. Baltimore, Maryland, July 21.Google Scholar
  11. Knickman, J. R. and A. M. Folz. (1985). “A Statistical Analysis of Reasons for East-West Differences in Hospital Use.” Inquiry 22(1), 45–58.Google Scholar
  12. Maddala, G. S. (1983). Limited Dependent and Qualitative Variables in Econometrics. Cambridge: Cambridge University Press.Google Scholar
  13. McBride, T. D. (1998). “Disparities in Access to Medicare Managed Care Plans and their Benefits.” Health Affairs 17(6), 170–180.Google Scholar
  14. Medicare Payment Advisory Commission (MedPAC). (2000). “Medicare+Choice: Trends Since the Balanced Budget Act.” Report to the Congress: Medicare Payment Policy.Washington D.C.: MedPAC (March), 117–126.Google Scholar
  15. Nyman, J. A. (1999). “The Value of Health Insurance: The Access Motive.” Journal of Health Economics 18(2), 141–152.Google Scholar
  16. Pizer, S. D. and A. B. Frakt. (2002). “Payment Policy and Competition in the Medicare+Choice Program.” Health Care Financing Review, forthcoming.Google Scholar
  17. Rosen, S. (1974). “Hedonic Prices and Implicit Markets: Product Differentiation in Pure Competition.” Journal of Political Economy 82(1), 34–55.Google Scholar
  18. Schmalensee, R. (1989). “Inter-Industry Studies of Structure and Performance.” In R. Schmalensee and R. Willig (eds.), Handbook of Industrial Organization. Amsterdam: Elsevier.Google Scholar
  19. U.S. General Accounting Office. (2000). Medicare+Choice: Plan Withdrawals Indicate Difficulty of Providing Choice While Achieving Savings.GAO/HEHS-00–183.Washington: U.S. General Accounting Office, September 2000.Google Scholar
  20. Wholey, D. R., R. Feldman and J. B. Christianson. (1995). “The Effect of Market Structure on HMO Premiums.” Journal of Health Economics 14(1), 81–105.Google Scholar
  21. Wholey, D. R., J. B. Christianson and S. Sanchez. (1993). “Professional Reorganization: The Effect of Physician and Corporate Interests on the Formation of Health Maintenance Organizations.” American Journal of Sociology 99, 175–211.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Steven D. Pizer
    • 1
  • Austin B. Frakt
    • 2
  • Roger Feldman
    • 3
  1. 1.Department of Veterans AffairsBoston University School of Public Health and Health Economist, Center for Health Quality, Outcomes, and Economic ResearchBedford
  2. 2.Abt Associates IncUSA
  3. 3.Division of Health Services Research and Policy, School of Public HealthUniversity of MinnesotaUSA

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