Essays on Markets for Primary Care Services for Medicaid Adults

Health insurance reform;Medicaid;provider behavior;econometrics;not listed

Roberts, Eric T.Moffitt, Robert A. ;

Johns Hopkins University

关键词: Health insurance reform;    Medicaid;    provider behavior;    econometrics;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/38022/ROBERTS-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

This dissertation examines three questions about the Affordable Care Act’s (ACA) expansion of Medicaid to low-income adults in the United States.First, I forecast the use of primary care services in the Medicaid expansion population.I project that an additional 6.13 million visits per year will occur in office-based primary care settings if all states expand Medicaid.This figure is lower than other forecasts, but better reflects the health care use of the low-income, non-pregnant, and non-disabled adults who gained Medicaid eligibility under the ACA.I conclude that efforts to expand primary care capacity should focus on provider recruitment to underserved communities, rather than simply training more providers.Second, I examine whether it is possible to obtain an unbiased estimate of health care use conditional on Medicaid take-up, from non-experimental survey data.I use instrumental variables, a test of correlated regression residuals, and a simulation analysis to determine which confounders of Medicaid enrollment and health care use must be controlled in order to reduce estimation bias.I find that controlling for self-rated health, Body Mass Index, and acute health events helps to mitigate bias from statistical ;;asymmetric information.” Third, I examine the supply side of the market for primary care services in Medicaid.I develop a theoretical model of contracting between Medicaid Managed Care Organizations (MCOs) and office-based primary care providers, and focus on ;;mixed” MCOs that have both private and Medicaid enrollees.I hypothesize that mixed MCOs which credibly tie their purchases of Medicaid services to the private volume they are able to direct to providers will induce providers to see relatively more of their Medicaid enrollees, compared to a Medicaid-only MCO.I test this proposition using all-payer claims data from Massachusetts.I find that, as mixed plans’ share of private insurance enrollment in a provider;;s market increases, and as these plans engage in greater private volume channeling, their Medicaid enrollees obtain a greater share of visits from office-based providers who mostly accept private insurance.However, it is unclear whether this distribution of provider visits is welfare-improving: the mixed Medicaid MCOs have higher per-member costs, and it is not known their provider networks offer a better quality of care.Thesis readers:Dr. Gerard AndersonDr. Darrell Gaskin (advisor)Dr. Bradley HerringDr. Robert Moffitt (chair, email: [e-mail])Dr. Antonio Trujillo