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      Effects of Supplemental Coverage on Use of Services by Medicare Enrollees

      research-article
      , Ph.D., , M.S.
      Health Care Financing Review
      CENTERS for MEDICARE & MEDICAID SERVICES

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          Abstract

          This article estimates the extent to which private insurance supplements affect use of services by Medicare enrollees. Three types of supplements to Medicare's coverage are examined—Health Maintenance Organizations (HMOs), medigap (MGP) plans, and employment-based indemnity (EBI) plans. While each kind of supplement reduces cost sharing on Medicare-covered services, only HMOs do so without increasing enrollees' overall use of services. Use of services by HMO enrollees is about 4 percent lower than use by similar Medicare enrollees with no insurance supplement. By contrast, use of services by enrollees with MGP coverage is 28 percent higher, and use of services by enrollees with EBI plans is 17 percent higher.

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          Health insurance and the demand for medical care: evidence from a randomized experiment.

          We estimate how cost sharing, the portion of the bill the patient pays, affects the demand for medical services. The data come from a randomized experiment. A catastrophic insurance plan reduces expenditures 31 percent relative to zero out-of-pocket price. The price elasticity is approximately -0.2. We reject the hypothesis that less favorable coverage of outpatient services increases total expenditure (for example, by deterring preventive care or inducing hospitalization).
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            A controlled trial of the effect of a prepaid group practice on use of services.

            Does a prepaid group practice deliver less care than the fee-for-service system when both serve comparable populations with comparable benefits? To answer this question, we randomly assigned a group of 1580 persons to receive care free of charge from either a fee-for-service physician of their choice (431 persons) or the Group Health Cooperative of Puget Sound (1149 persons). In addition, 733 prior enrollees of the Cooperative were studied as a control group. The rate of hospital admissions in both groups at the Cooperative was about 40 per cent less than in the fee-for-service group (P less than 0.01), although ambulatory-visit rates were similar. The calculated expenditure rate for all services was about 25 per cent less in the two Cooperative groups (P less than 0.01 for the experimental group, P less than 0.05 for the control group). The number of preventive visits was higher in the prepaid groups, but this difference does not explain the reduced hospitalization. The similarity of use between the two prepaid groups suggests that the mix of health risks at the Cooperative was similar to that in the fee-for-service system. The lower rate of use that we observed, along with comparable reductions found in non-controlled studies by others, suggests that the style of medicine at prepaid group practices is markedly less "hospital-intensive" and, consequently, less expensive.
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              Stata statistical software: release 8.0

              (2003)
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                Author and article information

                Journal
                Health Care Financ Rev
                Health Care Financ Rev
                HCFR
                Health Care Financing Review
                CENTERS for MEDICARE & MEDICAID SERVICES
                0195-8631
                1554-9887
                Fall 1997
                : 19
                : 1
                : 5-17
                Article
                hcfr-19-1-5
                4194496
                10180002
                d699044c-14ab-4011-bfda-c57a0b83fe0b
                Copyright @ 1997
                History
                Categories
                Innovations in Fee-for-Service Financing and Delivery

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