Health plan enrollment and mortality in the Medicare program.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Dowd, B; Maciejewski, ML; O'Connor, H; Riley, G; Geng, Y

Published Date

  • June 2011

Published In

Volume / Issue

  • 20 / 6

Start / End Page

  • 645 - 659

PubMed ID

  • 20568081

Pubmed Central ID

  • 20568081

Electronic International Standard Serial Number (EISSN)

  • 1099-1050

Digital Object Identifier (DOI)

  • 10.1002/hec.1623

Language

  • eng

Conference Location

  • England