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HMO Participation in Medicare+Choice

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  • John Cawley
  • Michael Chernew
  • Catherine McLaughlin

Abstract

In recent years, many health maintenance organizations (HMOs) have exited Medicare+Choice (M+C), the program that provides a managed‐care option to Medicare. This paper answers the following questions: How does the equilibrium number of HMOs participating in county M+C markets vary with the capitation payment they are offered? How large a payment is required at the margin to ensure that various percentages of county markets have a M+C HMO, or to ensure that various percentages of Medicare beneficiaries have the choice of a M+C plan in their county of residence? The strategy for identifying the effect of government payment on HMO participation relies on a natural experiment; in 1997, Congress divorced M+C payments to HMOs from changes in underlying costs. The results in this paper suggest that the Centers for Medicare & Medicaid Services (CMS) has consistently underestimated the payment necessary to support HMOs in rural, sparsely populated areas. We also find that it would require a large incremental payment to support HMOs in M+C for the final 10% of counties or final 10% of Medicare beneficiaries.

Suggested Citation

  • 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.
    • Handle: RePEc:bla:jemstr:v:14:y:2005:i:3:p:543-574
    DOI: 10.1111/j.1530-9134.2005.00073.x
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    References listed on IDEAS

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    1. Abraham, Jean, et al, 2000. "Enter at Your Own Risk: HMO Participation and Enrollment in the Medicare Risk Market," Economic Inquiry, Western Economic Association International, vol. 38(3), pages 385-401, July.
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    3. repec:mpr:mprres:2507 is not listed on IDEAS
    4. Bresnahan, Timothy F & Reiss, Peter C, 1991. "Entry and Competition in Concentrated Markets," Journal of Political Economy, University of Chicago Press, vol. 99(5), pages 977-1009, October.
    5. Timothy F. Bresnahan & Peter C. Reiss, 1987. "Do Entry Conditions Vary across Markets?," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 18(3, Specia), pages 833-882.
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    Cited by:

    1. 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.
    2. 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.
    3. Steven Pizer & Austin Frakt & Roger Feldman, 2009. "Nothing for something? Estimating cost and value for beneficiaries from recent medicare spending increases on HMO payments and drug benefits," International Journal of Health Economics and Management, Springer, vol. 9(1), pages 59-81, March.
    4. Austin B. Frakt & Steven D. Pizer & Roger Feldman, 2012. "Should Medicare adopt the Veterans health administration formulary?," Health Economics, John Wiley & Sons, Ltd., vol. 21(5), pages 485-495, May.
    5. Austin B. Frakt & Steven D. Pizer, 2008. "Attribute substitution in early enrollment decisions into Medicare prescription drug plans," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 513-521, April.
    6. Pelech, Daria, 2017. "Dropped out or pushed out? Insurance market exit and provider market power in Medicare Advantage," Journal of Health Economics, Elsevier, vol. 51(C), pages 98-112.
    7. 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.
    8. McCarthy, Ian M., 2018. "Quality disclosure and the timing of insurers’ adjustments: Evidence from medicare advantage," Journal of Health Economics, Elsevier, vol. 61(C), pages 13-26.
    9. Town, Robert & Liu, Su, 2003. "The Welfare Impact of Medicare HMOs," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 719-736, Winter.

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