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Do Medicare HMOs still reduce health services use after controlling for selection bias?

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Author Info

  • Michelle M. Mello

    (Department of Health Policy and Management, Harvard School of Public Health, Boston, USA)

  • Sally C. Stearns

    (Health Economics Research Unit, Medical School, University of Aberdeen, UK)

  • Edward C. Norton

    (Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, USA)

Abstract

This study models the relationship between Medicare beneficiary decisions to join Medicare HMOs and subsequent health services utilization. The relationship between health plan choice and utilization is thought to be endogenous because of favorable selection into HMOs. Previous studies found significantly lower inpatient utilization among Medicare HMO enrollees than among nonenrollees, but lacked strong controls for selection bias. Thus, a firm conclusion could not be drawn as to whether the observed differences were attributable to the HMO practice setting or to baseline differences in the illness profiles of the two groups studied. The present study uses simultaneous equations methods, including discrete factor estimation, to test the effect of Medicare HMOs on utilization when strong controls for selection bias are imposed. The model was run on a panel of 1993-1996 data from the Medicare Current Beneficiary Survey, supplemented with linked data on Medicare HMO characteristics and area supply characteristics. The study found that even when favorable selection is controlled for, Medicare HMOs significantly reduce both the probability of hospitalization and the number of inpatient days used by those who are hospitalized. Medicare HMOs do not, however, appear to reduce the use of physician services. Copyright © 2002 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.664
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 11 (2002)
Issue (Month): 4 ()
Pages: 323-340

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Handle: RePEc:wly:hlthec:v:11:y:2002:i:4:p:323-340

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References

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  1. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 31(3), pages 129-137.
  2. David M. Cutler, 1993. "The Incidence of Adverse Medical Outcomes Under Prospective Payments," NBER Working Papers 4300, National Bureau of Economic Research, Inc.
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  4. 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.
  5. Lee, Lung-Fei, 1978. "Unionism and Wage Rates: A Simultaneous Equations Model with Qualitative and Limited Dependent Variables," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 19(2), pages 415-33, June.
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  7. Heckman, James & Singer, Burton, 1984. "A Method for Minimizing the Impact of Distributional Assumptions in Econometric Models for Duration Data," Econometrica, Econometric Society, vol. 52(2), pages 271-320, March.
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Cited by:
  1. Glazer, Jacob & McGuire, Thomas G. & Cao, Zhun & Zaslavsky, Alan, 2008. "Using global ratings of health plans to improve the quality of health care," Journal of Health Economics, Elsevier, vol. 27(5), pages 1182-1195, September.
  2. Partha Deb & Pravin K. Trivedi, 2002. "Specification and Simulated Likelihood Estimation of a Non-normal Outcome Model with Selection: Application to Health Care Utilization," Hunter College Department of Economics Working Papers 02/5, Hunter College: Department of Economics, revised 2004.
  3. Balsa, Ana I. & Cao, Zhun & McGuire, Thomas G., 2007. "Does managed health care reduce health care disparities between minorities and Whites?," Journal of Health Economics, Elsevier, vol. 26(1), pages 101-121, January.
  4. Ellis, Randall P. & McGuire, Thomas G., 2007. "Predictability and predictiveness in health care spending," Journal of Health Economics, Elsevier, vol. 26(1), pages 25-48, January.
  5. Sylvia Brandt & Peter Marie, 2011. "Racial Disparities in Hospital Length of Stay for Asthma: Implications for Economic Policies," Journal of Family and Economic Issues, Springer, vol. 32(1), pages 152-169, March.
  6. Dan Shane; & Pravin Trivedi;, 2012. "What Drives Differences in Health Care Demand? The Role of Health Insurance and Selection Bias," Health, Econometrics and Data Group (HEDG) Working Papers 12/09, HEDG, c/o Department of Economics, University of York.
  7. Glazer, Jacob & McGuire, Thomas G., 2006. "Optimal quality reporting in markets for health plans," Journal of Health Economics, Elsevier, vol. 25(2), pages 295-310, March.
  8. Partha Deb & Pravin K. Trivedi, 2009. "Provider networks and primary-care signups: do they restrict the use of medical services?," Health Economics, John Wiley & Sons, Ltd., vol. 18(12), pages 1361-1380.
  9. Michael Chernew & Philip DeCicca & Robert Town, 2008. "Managed Care and Medical Expenditures of Medicare Beneficiaries," NBER Working Papers 13747, National Bureau of Economic Research, Inc.
  10. Baicker, Katherine & Chernew, Michael E. & Robbins, Jacob A., 2013. "The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization," Journal of Health Economics, Elsevier, vol. 32(6), pages 1289-1300.
  11. Zhou Yang & Donna B. Gilleskie & Edward C. Norton, 2004. "Prescription Drugs, Medical Care, and Health Outcomes: A Model of Elderly Health Dynamics," NBER Working Papers 10964, National Bureau of Economic Research, Inc.
  12. Ai, Chunrong & Norton, Edward C., 2003. "Interaction terms in logit and probit models," Economics Letters, Elsevier, vol. 80(1), pages 123-129, July.
  13. Cao, Zhun & McGuire, Thomas G., 2003. "Service-level selection by HMOs in Medicare," Journal of Health Economics, Elsevier, vol. 22(6), pages 915-931, November.
  14. Andrés Ramirez Hassan & Johnatan Cardona Jimenez, 2011. "An ordered categorical response model with endogenous switching: Simulation Exercises and an Application to State Health," DOCUMENTOS DE TRABAJO CIEF 010608, UNIVERSIDAD EAFIT.
  15. Powers, Eric A., 2005. "Interpreting logit regressions with interaction terms: an application to the management turnover literature," Journal of Corporate Finance, Elsevier, vol. 11(3), pages 504-522, June.
  16. Silvia Balia & Andrew M. Jones, 2007. "Unravelling the influence of smoking initiation and cessation on premature mortality using a common latent factor model," Health, Econometrics and Data Group (HEDG) Working Papers 07/06, HEDG, c/o Department of Economics, University of York.
  17. Barbara A. Mark & David W. Harless & Michael McCue, 2005. "The impact of HMO penetration on the relationship between nurse staffing and quality," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 737-753.
  18. Lim, Jae-Young & Jo, Changik, 2009. "The Effect of Patient's Asymmetric Information Problem on Medical Care Utilization with Consideration of a Patient's Ex-ante Health Status," Hitotsubashi Journal of Economics, Hitotsubashi University, vol. 50(2), pages 37-58, December.
  19. Yang, Zhou & Bishai, David & Harman, Jeffrey, 2008. "Convergence of body mass with aging: The longitudinal interrelationship of health, weight, and survival," Economics & Human Biology, Elsevier, vol. 6(3), pages 469-481, December.
  20. Munkin, Murat K. & Trivedi, Pravin K., 2003. "Bayesian analysis of a self-selection model with multiple outcomes using simulation-based estimation: an application to the demand for healthcare," Journal of Econometrics, Elsevier, vol. 114(2), pages 197-220, June.
  21. Bernard Friedman & H. Jiang, 2010. "Do Medicare Advantage enrollees tend to be admitted to hospitals with better or worse outcomes compared with fee-for-service enrollees?," International Journal of Health Care Finance and Economics, Springer, vol. 10(2), pages 171-185, June.

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