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Health plan enrollment and mortality in the Medicare program

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  • Bryan Dowd
  • Matthew L. Maciejewski
  • Heidi O'Connor
  • Gerald Riley
  • Yisong Geng

Abstract

Prior studies have found that Medicare health maintenance organization (HMO) enrollees have lower mortality (over a fixed observation period) than beneficiaries in traditional fee‐for‐service (FFS) Medicare. We use Medicare Current Beneficiary Survey (MCBS) data to compare 2‐year predicted mortality for Medicare enrollees in the HMO and FFS sectors using a sample selection model to control for observed beneficiaries characteristics and unobserved confounders. The difference in raw, unadjusted mortality probabilities was 0.5% (HMO lower). Correcting for numerous observed confounders resulted in a difference of −0.6% (HMO higher). Further adjustment for unobserved confounders resulted in an estimated difference of 3.7 and 4.2% (HMO lower), depending on the specification of geographic‐fixed effects. The latter result (4.2%) was statistically significant and consistent with prior studies that did not adjust for unobserved confounding. Our findings suggest there may be unobserved confounders associated with adverse selection in the HMO sector, which had a large effect on our mortality estimates among HMO enrollees. An important topic for further research is to identify such confounders and explore their relationship to mortality. The methods presented in this paper represent a promising approach to comparing outcomes between the HMO and FFS sectors, but further research is warranted. Copyright © 2010 John Wiley & Sons, Ltd.

Suggested Citation

  • Bryan Dowd & Matthew L. Maciejewski & Heidi O'Connor & Gerald Riley & Yisong Geng, 2011. "Health plan enrollment and mortality in the Medicare program," Health Economics, John Wiley & Sons, Ltd., vol. 20(6), pages 645-659, June.
  • Handle: RePEc:wly:hlthec:v:20:y:2011:i:6:p:645-659
    DOI: 10.1002/hec.1623
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    References listed on IDEAS

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    Cited by:

    1. 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.
    2. Christopher C. Afendulis & Michael E. Chernew & Daniel P. Kessler, 2017. "The Effect of Medicare Advantage on Hospital Admissions and Mortality," American Journal of Health Economics, MIT Press, vol. 3(2), pages 254-279, Spring.

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