Heterogeneity in the impact of privatizing social health insurance: evidence from California's Medicaid program

Heterogeneity in the impact of privatizing social health insurance: evidence from California's Medicaid program

Collection:
Health Policy and Services Research
Series Title(s):
Working paper (Stanford Institute for Economic Policy Research)
Author(s):
Duggan, Mark, author
Garthwaite, Craig, author
Wang, Adelina Yanyue, author
Contributor(s):
Stanford Institute for Economic Policy Research, issuing body.
Publication:
[Stanford, CA] : Stanford Institute for Economic Policy Research (SIEPR), June 2021
Language(s):
English
Format:
Text
Subject(s):
Managed Care Programs
Medicaid
Outcome Assessment, Health Care
Privatization
Aged
Persons with Disabilities
California
United States
Genre(s):
Technical Report
Abstract:
State governments face the classic “make or buy” decision for the provision of Medicaid services. Over the past two decades, the majority of states have outsourced the provision of social health insurance through Medicaid Managed Care (MMC) programs. These programs have been extensively studied in the literature – with little evidence of large positive or negative effects. However, most states initially allowed older and sicker enrollees to remain enrolled in the government run fee for service (FFS) programs. It is possible that these more fragile enrollees could have a different experience in managed care. In this paper we study California’s mandatory enrollment of the senior and persons with disabilities (SPD) population in MMC. We find this mandatory enrollment caused an increased use of the emergency department and transfers between hospitals. This was not simply a hassle cost for enrollees--we also estimate an increase in mortality for the affected population. These effects were strongest for the sickest enrollees--the types of enrollees that might be expected to have a different experience with managed care. Our results suggest the adverse impact of MMC varies by the enrollee health, which should inform the optimal outsourcing decision for governments.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
Extent:
1 online resource (1 PDF file (83 pages, 1 unnumbered page))
Illustrations:
Illustrations
NLM Unique ID:
9918383973906676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918383973906676