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Does contracting out increase the efficiency of government programs? Evidence from Medicaid HMOs

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  • Duggan, Mark

Abstract

State governments contract with health maintenance organizations (HMOs) to coordinate medical care for nearly 20 million Medicaid recipients. Identifying the causal effect of HMO enrollment on government spending and health care quality is difficult if, as is often the case, recipients have the option to enroll in a plan. To estimate the average effect of HMO enrollment, this paper exploits county-level mandates introduced during the last several years in the state of California that required most Medicaid recipients to enroll in a managed care plan. The empirical results demonstrate that the resulting switch from fee-for-service to managed care was associated with a substantial increase in government spending but no observable improvement in health outcomes, thus apparently reducing the efficiency of this large government program. The findings cast doubt on the hypothesis that HMO contracting has reduced the strain on government budgets.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Public Economics.

Volume (Year): 88 (2004)
Issue (Month): 12 (December)
Pages: 2549-2572

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Handle: RePEc:eee:pubeco:v:88:y:2004:i:12:p:2549-2572

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Web page: http://www.elsevier.com/locate/inca/505578

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References

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  1. Robert Kaestner & Lisa Dubay & Genevieve Kenney, 2002. "Medicaid Managed Care and Infant Health: A National Evaluation," NBER Working Papers 8936, National Bureau of Economic Research, Inc.
  2. Andrei Shleifer, 1998. "State Versus Private Ownership," NBER Working Papers 6665, National Bureau of Economic Research, Inc.
  3. Janet Currie & John Fahr, 2000. "Medicaid Managed Care: Effects on Children's Medicaid Coverage and Utilization," JCPR Working Papers 156, Northwestern University/University of Chicago Joint Center for Poverty Research.
  4. Mark G. Duggan, 2000. "Hospital Ownership And Public Medical Spending," The Quarterly Journal of Economics, MIT Press, vol. 115(4), pages 1343-1373, November.
  5. Glied, Sherry, 2000. "Managed care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 13, pages 707-753 Elsevier.
  6. Levinson, Arik & Ullman, Frank, 1998. "Medicaid managed care and infant health," Journal of Health Economics, Elsevier, vol. 17(3), pages 351-368, June.
  7. Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
  8. Baker, Laurence C., 1997. "The effect of HMOs on fee-for-service health care expenditures: Evidence from Medicare," Journal of Health Economics, Elsevier, vol. 16(4), pages 453-481, August.
  9. Randall P. Ellis & Thomas G. McGuire, 1993. "Supply-Side and Demand-Side Cost Sharing in Health Care," Journal of Economic Perspectives, American Economic Association, vol. 7(4), pages 135-151, Fall.
  10. Leemore Dafny & Jonathan Gruber, 2000. "Does Public Insurance Improve the Efficiency of Medical Care? Medicaid Expansions and Child Hospitalizations," NBER Working Papers 7555, National Bureau of Economic Research, Inc.
  11. McClellan, Mark & Cutler, David & Newhous, Joseph P., 2000. "How Does Managed Care Do It?," Scholarly Articles 2643884, Harvard University Department of Economics.
  12. Snyder, Christopher M., 1998. "Why do larger buyers pay lower prices? Intense supplier competition," Economics Letters, Elsevier, vol. 58(2), pages 205-209, February.
  13. David M. Cutler & Mark McClellan & Joseph P. Newhouse, 2000. "How Does Managed Care Do It?," RAND Journal of Economics, The RAND Corporation, vol. 31(3), pages 526-548, Autumn.
  14. Leibowitz, Arleen & Buchanan, Joan L. & Mann, Joyce, 1992. "A randomized trial to evaluate the effectiveness of a Medicaid HMO," Journal of Health Economics, Elsevier, vol. 11(3), pages 235-257, October.
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Cited by:
  1. Christopher C. Afendulis & Michael E. Chernew & Daniel P. Kessler, 2013. "The Effect of Medicare Advantage on Hospital Admissions and Mortality," NBER Working Papers 19101, National Bureau of Economic Research, Inc.
  2. Bennmarker, Helge & Grönqvist, Erik & Öckert, Björn, 2012. "Effects of contracting out employment services: Evidence from a randomized experiment," Working Paper Series, Center for Labor Studies 2012:21, Uppsala University, Department of Economics.
  3. Leemore Dafny, 2008. "Are Health Insurance Markets Competitive?," NBER Working Papers 14572, National Bureau of Economic Research, Inc.
  4. Mark G. Duggan, 2003. "Does Medicaid Pay Too Much for Prescription Drugs? A Case Study of Atypical Anti-Psychotics," NBER Working Papers 9626, National Bureau of Economic Research, Inc.
  5. Duggan Mark G & Evans William N, 2008. "Estimating the Impact of Medical Innovation: A Case Study of HIV Antiretroviral Treatments," Forum for Health Economics & Policy, De Gruyter, vol. 11(2), pages 1-39, January.
  6. Evans, William N. & Garthwaite, Craig & Wei, Heng, 2008. "The impact of early discharge laws on the health of newborns," Journal of Health Economics, Elsevier, vol. 27(4), pages 843-870, July.
  7. Melissa Boyle, 2009. "Health and Utilization Effects of Increased Access to Publicly Provided Health Care: Evidence from the U.S. Department of Veterans Affairs," Working Papers 0902, College of the Holy Cross, Department of Economics.
  8. Leemore S. Dafny, 2010. "Are Health Insurance Markets Competitive?," American Economic Review, American Economic Association, vol. 100(4), pages 1399-1431, September.

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