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Is there a Relationship Between HMO Quality of Care and Financial Performance? Evidence from Texas HMOs


  • Troy Quast

    () (Department of Economics and International Business, Sam Houston State University)


The profits earned by health insurance companies have been under intense scrutiny by policymakers and the general public. However, attempts to reduce insurance company profits could affect the quality of care that they provide to their enrollees. This study investigates whether there is a relationship between the profitability of an HMO and the quality of care that its enrollees receive. The sample is comprised of health maintenance organizations in Texas from 2000 to 2008. Quality of care is proxied by HEDIS compliance rates for selected child and female health measures, while profits are measured both on a dollar and percentage basis. Annual data are used that are disaggregated by market area. The results suggest that there is a statistically significant relationship between profits and some measures of quality. Specifically, the child health measures used here are positively related to profits, in that increases (decreases) in profits are associated with increases (decreases) in quality. By contrast, there is not a statistically significant relationship between the available female health measures and profits. Further, for the child health measures, instrumental variable models that attempt to address to the potential endogeneity of quality and profits are consistent with the possibility that changes in profits have a causal effect on quality of care.

Suggested Citation

  • Troy Quast, 2010. "Is there a Relationship Between HMO Quality of Care and Financial Performance? Evidence from Texas HMOs," Working Papers 1007, Sam Houston State University, Department of Economics and International Business.
  • Handle: RePEc:shs:wpaper:1007

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    1. Darren Grant & William Green, 2013. "Grades as incentives," Empirical Economics, Springer, vol. 44(3), pages 1563-1592, June.
    2. Gerald S. Oettinger, 2002. "The Effect Of Nonlinear Incentives On Performance: Evidence From "Econ 101"," The Review of Economics and Statistics, MIT Press, vol. 84(3), pages 509-517, August.
    3. Patrick Bolton & Xavier Freixas & Joel Shapiro, 2012. "The Credit Ratings Game," Journal of Finance, American Finance Association, vol. 67(1), pages 85-112, February.
    4. Pascal Courty & Gerald Marschke, 2004. "An Empirical Investigation of Gaming Responses to Explicit Performance Incentives," Journal of Labor Economics, University of Chicago Press, vol. 22(1), pages 23-56, January.
    5. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    6. Darren Grant, 2010. "Dead On Arrival: Zero Tolerance Laws Don'T Work," Economic Inquiry, Western Economic Association International, vol. 48(3), pages 756-770, July.
    7. Horowitz, Joel L. & Härdle, Wolfgang, 1994. "Testing a Parametric Model Against a Semiparametric Alternative," Econometric Theory, Cambridge University Press, vol. 10(05), pages 821-848, December.
    8. Reback, Randall, 2008. "Teaching to the rating: School accountability and the distribution of student achievement," Journal of Public Economics, Elsevier, vol. 92(5-6), pages 1394-1415, June.
    9. Muradian, Roldan, 2001. "Ecological thresholds: a survey," Ecological Economics, Elsevier, vol. 38(1), pages 7-24, July.
    10. Radha Iyengar, 2008. "I'd rather be Hanged for a Sheep than a Lamb: The Unintended Consequences of 'Three-Strikes' Laws," NBER Working Papers 13784, National Bureau of Economic Research, Inc.
    11. Charles Perrings & David Pearce, 1994. "Threshold effects and incentives for the conservation of biodiversity," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 4(1), pages 13-28, February.
    12. Horowitz, J.L., 1992. "Testing a Parametric Model Against a Semiparametric Alternative," Papers 9219, Tilburg - Center for Economic Research.
    13. Becker, William E. & Rosen, Sherwin, 1992. "The learning effect of assessment and evaluation in high school," Economics of Education Review, Elsevier, vol. 11(2), pages 107-118, June.
    14. Adonis Yatchew, 1998. "Nonparametric Regression Techniques in Economics," Journal of Economic Literature, American Economic Association, vol. 36(2), pages 669-721, June.
    15. Friedman, David & Sjostrom, William, 1993. "Hanged for a Sheep--The Economics of Marginal Deterrence," The Journal of Legal Studies, University of Chicago Press, vol. 22(2), pages 345-366, June.
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