Essays on the Heterogeneous Effects of Medicare Advantage
Over the past several years, there has been a dramatic change in the structure of Medicare. While beneficiaries historically obtained coverage exclusively through a government-administered version of the program known as ?traditional Medicare,? one-third of beneficiaries now receive coverage through private plans under Medicare Advantage (MA). A prior literature examined how increases in MA enrollment have affected beneficiary well-being on average. However, nuanced policymaking also requires an understanding of the distributional implications of MA. This theme broadly ties together the two aims of my dissertation. My first aim is to identify the effect of MA enrollment on utilization and quality of care among dual eligibles. Dual eligibles merit special attention because they are financially vulnerable, tend to have significant health needs, face unique barriers to care, and are expensive to treat. I will rely on a regression discontinuity design to evaluate the effect of MA enrollment on utilization patterns (hospitalizations and length of stay) and quality of care (potentially-preventable hospitalizations, 30-day rehospitalizations, and all-cause mortality) among this population. My second aim is to identify the extent to which MA star ratings reflect differences in plan quality versus enrollee characteristics. This is important because policymakers and many beneficiaries currently give substantial credence to star ratings as a measure of plan performance. I will use regression analyses to identify how much of the variation in star ratings is explained by observed beneficiary characteristics, and will use the result to compare standardized star ratings to current measures. I will also rely on a switcher analysis to evaluate whether there is selective enrollment into high-star plans based on unobserved differences across enrollees.
Agency for Health Care Research and Quality, HHS
Funding Period: 9/1/2018 to 8/31/2019