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Enrollee Mix, Treatment Intensity, and Cost in Competing Indemnity and HMO Plans

Author

Listed:
  • Altman, Daniel
  • Cutler, David
  • Zeckhauser, Richard J.

Abstract

Why do indemnity insurance plans cost substantially more per capita—77% more in our study—than HMOs? We answer this question using data from a large organization’s insurance pool, covering 215,000 lives. We decompose cost differences for eight major medical conditions into four sources: demographics, incidence within demographic groups, treatment intensity, and prices per service. Greater incidence of disease in the indemnity plan (both from demographics themselves and within demographic groups) and higher prices each explain nearly 50% of the difference. Contrary to conventional wisdom, indemnity plans do not have greater treatment intensity.

Suggested Citation

  • Altman, Daniel & Cutler, David & Zeckhauser, Richard J., 2003. "Enrollee Mix, Treatment Intensity, and Cost in Competing Indemnity and HMO Plans," Scholarly Articles 2664300, Harvard University Department of Economics.
    • Handle: RePEc:hrv:faseco:2664300
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    Cited by:

    1. Rudy Douven, 2000. "Regulated competition in health insurance markets," CPB Research Memorandum 171.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    2. Ding, Yu & Liu, Chenyuan, 2021. "Alternative payment models and physician treatment decisions: Evidence from lower back pain," Journal of Health Economics, Elsevier, vol. 80(C).
    3. Cutler, David & Lincoln, Bryan & Zeckhauser, Richard, 2010. "Selection stories: Understanding movement across health plans," Journal of Health Economics, Elsevier, vol. 29(6), pages 821-838, December.
    4. Henke, Klaus-Dirk & Rich, Robert F. & Steinbach, Axel & Borchardt, Katja, 2004. "Auf dem Wege zu einer integrierten Versorgung: Neue sozialrechtliche Rahmenbedingungen unter Berücksichtigung der Erfahrungen aus den USA und am Beispiel Berlins," Discussion Papers 2004/12, Technische Universität Berlin, School of Economics and Management.
    5. David J. Cooper & James B. Rebitzer, "undated". "Physician Incentives In Managed Care Organizations: Medical Practice Norms and the Quality of Care," Economics Public Policy Brief Archive ppb_70, Levy Economics Institute.
    6. Abe Dunn & Adam Hale Shapiro, 2018. "Physician Competition and the Provision of Care: Evidence from Heart Attacks," American Journal of Health Economics, University of Chicago Press, vol. 4(2), pages 226-261, Spring.
    7. Karen Eggleston & Anupa Bir, 2009. "Measuring Selection Incentives in Managed Care: Evidence From the Massachusetts State Employee Insurance Program," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 76(1), pages 159-175, March.
    8. David J. Cooper & James B. Rebitzer, 2002. "Managed Care, Physician Incentives, and Norms of Medical," Microeconomics 0209001, University Library of Munich, Germany.
    9. Randall P. Ellis & Wenjia Zhu, 2016. "Health Plan Type Variations in Spells of Health-Care Treatment," American Journal of Health Economics, University of Chicago Press, vol. 2(4), pages 399-430, Fall.
    10. Ronen Avraham & Leemore S. Dafny & Max M. Schanzenbach, 2009. "The Impact of Tort Reform on Employer-Sponsored Health Insurance Premiums," NBER Working Papers 15371, National Bureau of Economic Research, Inc.
    11. Ana Aizcorbe & Tina Highfill, 2015. "Medical Care Expenditure Indexes for the US, 1980-2006," BEA Working Papers 0121, Bureau of Economic Analysis.
    12. Run Liang & Hao Wang, 2017. "Health insurance, market power, and social welfare," International Journal of Economic Theory, The International Society for Economic Theory, vol. 13(4), pages 427-442, December.
    13. Henri de Groot & Peter Mulder, 2011. "Energy-intensity developments for 19 OECD countries and 51 sectors," CPB Discussion Paper 171.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    14. Paul Veenendaal & Ton Manders, 2008. "Border tax adjustment and the EU-ETS, a quantitative assessment," CPB Document 171.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    15. Stephan F. Gohmann, 2005. "Preventive Care And Insurance Coverage," Contemporary Economic Policy, Western Economic Association International, vol. 23(4), pages 513-528, October.
    16. David Bardey & Jean‐Charles Rochet, 2010. "Competition Among Health Plans: A Two‐Sided Market Approach," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 19(2), pages 435-451, June.
    17. Rudy Douven, 2000. "Regulated competition in health insurance markets," CPB Research Memorandum 171, CPB Netherlands Bureau for Economic Policy Analysis.
    18. Galina Besstremyannaya, 2016. "Differential Effects of Declining Rates in a Per Diem Payment System," Health Economics, John Wiley & Sons, Ltd., vol. 25(12), pages 1599-1618, December.
    19. David J. Cooper & James B. Rebitzer, 2002. "Managed Care, Physician Incentives, and Norms of Medical Practice: Racing to the Bottom or Pulling to the Top?," Economics Working Paper Archive wp_353, Levy Economics Institute.
    20. Sacks, Daniel W., 2018. "Why do HMOs spend less? Patient selection, physician price sensitivity, and prices," Journal of Public Economics, Elsevier, vol. 168(C), pages 146-161.

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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

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