| 来源类型 | Working Paper |
| 规范类型 | 报告 |
| DOI | 10.3386/w24038 |
| 来源ID | Working Paper 24038 |
| Service-level Selection: Strategic Risk Selection in Medicare Advantage in Response to Risk Adjustment | |
| Sungchul Park; Anirban Basu; Norma Coe; Fahad Khalil | |
| 发表日期 | 2017-11-20 |
| 出版年 | 2017 |
| 语种 | 英语 |
| 摘要 | The Centers for Medicare and Medicaid Services (CMS) has phased in the Hierarchical Condition Categories (HCC) risk adjustment model during 2004-2006 to more accurately estimate capitated payments to Medicare Advantage (MA) plans to reflect each beneficiary’s health status. However, it is debatable whether the CMS-HCC model has led to strategic evolutions of risk selection. We examine the competing claims and analyze the risk selection behavior of MA plans in response to the CMS-HCC model. We find that the CMS-HCC model reduced the phenomenon that MA plans avoid high-cost beneficiaries in traditional Medicare plans, whereas it led to increased disenrollment of high-cost beneficiaries, conditional on illness severity, from MA plans. We explain this phenomenon in relation to service-level selection. First, we show that MA plans have incentives to effectuate risk selection via service-level selection, by lowering coverage levels for services that are more likely to be used by beneficiaries who could be unprofitable under the CMS-HCC model. Then, we empirically test our theoretical prediction that compared to the pre-implementation period (2001-2003), MA plans have raised copayments disproportionately more for services needed by unprofitable beneficiaries than for other services in the post-implementation period (2007-2009). This induced unprofitable beneficiaries to voluntarily dis-enroll from their MA plans. Further evidence supporting this selection mechanism is that those dissatisfied with out-of-pocket costs were more likely to dis-enroll from MA plans. We estimate that such strategic behavior led MA plans to save $5.2 billion by transferring the costs to the federal government. |
| 主题 | Financial Economics ; Financial Institutions ; Public Economics ; National Fiscal Issues ; Health, Education, and Welfare ; Health |
| URL | https://www.nber.org/papers/w24038 |
| 来源智库 | National Bureau of Economic Research (United States) |
| 引用统计 | |
| 资源类型 | 智库出版物 |
| 条目标识符 | http://119.78.100.153/handle/2XGU8XDN/581712 |
| 推荐引用方式 GB/T 7714 | Sungchul Park,Anirban Basu,Norma Coe,et al. Service-level Selection: Strategic Risk Selection in Medicare Advantage in Response to Risk Adjustment. 2017. |
| 条目包含的文件 | ||||||
| 文件名称/大小 | 资源类型 | 版本类型 | 开放类型 | 使用许可 | ||
| w24038.pdf（1390KB） | 智库出版物 | 限制开放 | CC BY-NC-SA | 浏览 | ||
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