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Supply-Side Responses to Public Quality Ratings: Evidence from Medicare Advantage

Author

Listed:
  • Ian M. McCarthy

    (Department of Economics, Emory University)

  • Michael Darden

    (Department of Economics, Tulane University)

Abstract

Since 2009, the Centers for Medicare and Medicaid Services (CMS) has distributed quality star ratings for Medicare Advantage (MA) contracts to better inform Medicare-eligible individuals of MA plan quality. This paper examines the extent to which the quality star rating scheme affected insurer behavior in the MA market. We identify the causal effect of 2009 star ratings on 2010 MA premiums using a regression discontinuity design that exploits plausibly random variation around threshold values underlying the star rating calculations. We find that contracts with higher star ratings in 2009 significantly increased their average 2010 monthly premiums relative to contracts just below the respective threshold values, with increases of more than $26 per month among 3.5- and 4-star contracts. We present additional evidence that the estimated premium increases in 2010 are not purely the result of demand shifts in the prior year. Furthermore, the 2009 star ratings have a significant effect on plan mix, where 3-star contracts disproportionately dropped their $0 premium plans while 2.5-, 3.5-, and 4-star contracts disproportionately expanded plans into new markets, particularly plans with positive monthly premiums. Broadly, our analysis reveals a relatively large supply-side response to published quality ratings, suggesting some level of caution as policy makers extend quality rating systems into new health-care markets.

Suggested Citation

  • Ian M. McCarthy & Michael Darden, 2017. "Supply-Side Responses to Public Quality Ratings: Evidence from Medicare Advantage," American Journal of Health Economics, University of Chicago Press, vol. 3(2), pages 140-164, Spring.
  • Handle: RePEc:ucp:amjhec:v:3:y:2017:i:2:p:140-164
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    1. repec:mpr:mprres:3849 is not listed on IDEAS
    2. Michael Darden & Ian M. McCarthy, 2015. "The Star Treatment: Estimating the Impact of Star Ratings on Medicare Advantage Enrollments," Journal of Human Resources, University of Wisconsin Press, vol. 50(4), pages 980-1008.
    3. David S. Lee & Thomas Lemieux, 2010. "Regression Discontinuity Designs in Economics," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 281-355, June.
    4. Heski Bar‐Isaac & Guillermo Caruana & Vicente Cuñat, 2012. "Information Gathering Externalities for a Multi‐Attribute Good," Journal of Industrial Economics, Wiley Blackwell, vol. 60(1), pages 162-185, March.
    5. Leemore Dafny, 2009. "Estimation and Identification of Merger Effects: An Application to Hospital Mergers," Journal of Law and Economics, University of Chicago Press, vol. 52(3), pages 523-550, August.
    6. Jean Marie Abraham & Martin Gaynor & William B. Vogt, 2007. "Entry And Competition In Local Hospital Markets," Journal of Industrial Economics, Wiley Blackwell, vol. 55(2), pages 265-288, June.
    7. David Dranove & Mark A. Satterthwaite, 1992. "Monopolistic Competition When Price and Quality are Imperfectly Observable," RAND Journal of Economics, The RAND Corporation, vol. 23(4), pages 518-534, Winter.
    8. 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.
    9. Karen Stockley & Thomas McGuire & Christopher Afendulis & Michael E. Chernew, 2014. "Premium Transparency in the Medicare Advantage Market: Implications for Premiums, Benefits, and Efficiency," NBER Working Papers 20208, National Bureau of Economic Research, Inc.
    10. Imbens, Guido W. & Lemieux, Thomas, 2008. "Regression discontinuity designs: A guide to practice," Journal of Econometrics, Elsevier, vol. 142(2), pages 615-635, February.
    11. Joseph P. Newhouse & Mary Price & John Hsu & J. Michael McWilliams & Thomas G. McGuire, 2015. "How Much Favorable Selection Is Left in Medicare Advantage?," American Journal of Health Economics, University of Chicago Press, vol. 1(1), pages 1-26, Winter.
    12. David Dranove & Ginger Zhe Jin, 2010. "Quality Disclosure and Certification: Theory and Practice," Journal of Economic Literature, American Economic Association, vol. 48(4), pages 935-963, December.
    13. Leemore Dafny & David Dranove, 2008. "Do report cards tell consumers anything they don't already know? The case of Medicare HMOs," RAND Journal of Economics, RAND Corporation, vol. 39(3), pages 790-821, September.
    14. Gretchen Jacobson & Anthony Damico & Tricia Neuman & Marsha Gold, 2014. "Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes," Mathematica Policy Research Reports 5321106981d4410ca6d8f9061, Mathematica Policy Research.
    15. Huang, Sean Shenghsiu & Hirth, Richard A., 2016. "Quality rating and private-prices: Evidence from the nursing home industry," Journal of Health Economics, Elsevier, vol. 50(C), pages 59-70.
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    Cited by:

    1. Bingxiao Wu & Jeah Jung & Hyunjee Kim & Daniel Polsky, 2019. "Entry regulation and the effect of public reporting: Evidence from Home Health Compare," Health Economics, John Wiley & Sons, Ltd., vol. 28(4), pages 492-516, April.
    2. Michele Fioretti & Hongming Wang, 2019. "Subsidizing Inequality: Performance Pay and Risk Selection in Medicare," SciencePo Working papers Main hal-03393070, HAL.
    3. repec:hal:spmain:info:hdl:2441/4bg68glinb8r8roh0akvprtu9u is not listed on IDEAS
    4. repec:hal:wpspec:info:hdl:2441/4bg68glinb8r8roh0akvprtu9u is not listed on IDEAS
    5. repec:spo:wpmain:info:hdl:2441/4bg68glinb8r8roh0akvprtu9u is not listed on IDEAS
    6. 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.
    7. repec:spo:wpecon:info:hdl:2441/4bg68glinb8r8roh0akvprtu9u is not listed on IDEAS
    8. Jinyang Chen & Chaoqun Wang, 2023. "“The reputation premium”: does hospital ranking improvement lead to a higher healthcare spending?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(5), pages 817-830, July.

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    More about this item

    Keywords

    quality information; Medicare Advantage; health insurance; insurance premiums;
    All these keywords.

    JEL classification:

    • C51 - Mathematical and Quantitative Methods - - Econometric Modeling - - - Model Construction and Estimation
    • D21 - Microeconomics - - Production and Organizations - - - Firm Behavior: Theory
    • D43 - Microeconomics - - Market Structure, Pricing, and Design - - - Oligopoly and Other Forms of Market Imperfection
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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