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The Efficiency Consequences of Health Care Privatization: Evidence from Medicare Advantage Exits

Author

Listed:
  • Mark Duggan
  • Jonathan Gruber
  • Boris Vabson

Abstract

There is considerable controversy over the use of private insurers to deliver public health insurance benefits. We investigate the efficiency consequences of patients enrolling in Medicare Advantage (MA), private managed care organizations that compete with the traditional fee-for-service Medicare program. We use exogenous shocks to MA enrollment arising from plan exits from New York counties in the early 2000s, and utilize unique data that links hospital inpatient utilization to Medicare enrollment records. We find that individuals who were forced out of MA plans due to plan exit saw very large increases in hospital utilization. These increases appear to arise through plans both limiting access to nearby hospitals and reducing elective admissions, yet they are not associated with any measurable reduction in hospital quality or patient mortality.

Suggested Citation

  • Mark Duggan & Jonathan Gruber & Boris Vabson, 2015. "The Efficiency Consequences of Health Care Privatization: Evidence from Medicare Advantage Exits," NBER Working Papers 21650, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:21650
    Note: AG HC HE PE
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    References listed on IDEAS

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    1. Jason Brown & Mark Duggan & Ilyana Kuziemko & William Woolston, 2014. "How Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program," American Economic Review, American Economic Association, vol. 104(10), pages 3335-3364, October.
    2. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    3. 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.
    4. Glied, Sherry & Zivin, Joshua Graff, 2002. "How do doctors behave when some (but not all) of their patients are in managed care?," Journal of Health Economics, Elsevier, vol. 21(2), pages 337-353, March.
    5. 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.
    6. Duggan, Mark & Starc, Amanda & Vabson, Boris, 2016. "Who benefits when the government pays more? Pass-through in the Medicare Advantage program," Journal of Public Economics, Elsevier, vol. 141(C), pages 50-67.
    7. Laurence C. Baker, 2000. "Managed Care and Technology Adoption in Health Care: Evidence from Magnetic Resonance Imaging," NBER Working Papers 8020, National Bureau of Economic Research, Inc.
    8. Michelle M. Mello & Sally C. Stearns & Edward C. Norton, 2002. "Do Medicare HMOs still reduce health services use after controlling for selection bias?," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 323-340, June.
    9. 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.
    10. McClellan, Mark & Cutler, David & Newhous, Joseph P., 2000. "How Does Managed Care Do It?," Scholarly Articles 2643884, Harvard University Department of Economics.
    11. John Cawley & Michael Chernew & Catherine McLaughlin, 2005. "HMO Participation in Medicare+Choice," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 14(3), pages 543-574, September.
    12. Laurence C. Baker & Ciaran S. Phibbs, 2000. "Managed Care, Technology Adoption, and Health Care: The Adoption of Neonatal Intensive Care," NBER Working Papers 7883, National Bureau of Economic Research, Inc.
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    Cited by:

    1. Knutsson, Daniel & Tyrefors, Björn, 2020. "Quality and Efficiency Between Public and Private Firms: Evidence From the Ambulance Services," Working Paper Series 1365, Research Institute of Industrial Economics.
    2. Liran Einav & Amy Finkelstein & Maria Polyakova, 2016. "Private Provision of Social Insurance: Drug-specific Price Elasticities and Cost Sharing in Medicare Part D," NBER Working Papers 22277, National Bureau of Economic Research, Inc.
    3. Michael R. Richards & Coady Wing, 2019. "Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth?," Health Economics, John Wiley & Sons, Ltd., vol. 28(11), pages 1356-1369, November.
    4. Michael Geruso & Timothy Layton & Daniel Prinz, 2019. "Screening in Contract Design: Evidence from the ACA Health Insurance Exchanges," American Economic Journal: Economic Policy, American Economic Association, vol. 11(2), pages 64-107, May.

    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out

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