Dataset Information

The impact of Medicare coverage policies on health care utilization.

ABSTRACT:

Objective

To determine whether Medicare coverage policies affect utilization of services in Medicare.

Data sources

We constructed an analysis data set for eight different procedures using secondary data obtained from Medicare claims (1999-2002) and Medicare coverage policies posted on Center for Medicare and Medicaid Services website.

Study design

We analyzed the impact of coverage policies using difference-in-difference approach in a regression framework.

Principal findings

We found that in only one case (transesophageal echocardiography) out of eight did utilization change (reduced by 13.6 percent) after the effective date of the local policies. There is no systematic pattern that policies affect utilization, and the type of coverage policy does not seem to play an important role in its impact.

Conclusions

Coverage policies have the potential but do not consistently impact utilization as policy makers intend and expect them to do. These findings raise significant policy questions about the effectiveness of Medicare coverage policies, which deserve further study.

SUBMITTER: Foote SB

PROVIDER: S-EPMC2517278 | biostudies-literature | 2008 Aug

REPOSITORIES: biostudies-literature

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Publications

The impact of Medicare coverage policies on health care utilization.

Foote Susan Bartlett SB Virnig Beth A BA Town Robert J RJ Hartman Lacey L

Health services research 20080512 4

<h4>Objective</h4>To determine whether Medicare coverage policies affect utilization of services in Medicare.<h4>Data sources</h4>We constructed an analysis data set for eight different procedures using secondary data obtained from Medicare claims (1999-2002) and Medicare coverage policies posted on Center for Medicare and Medicaid Services website.<h4>Study design</h4>We analyzed the impact of coverage policies using difference-in-difference approach in a regression framework.<h4>Principal find ...[more]

PMID: 18479413

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Project description:ImportanceMedicare Advantage (MA) has entailed a major expansion of government-financed, privately administered health insurance in the US. As policy makers consider options to expand Medicare further, it is informative to compare the performance of traditional Medicare (TM) and MA.ObjectiveTo assess whether MA is associated with differential changes in health care utilization and spending for beneficiaries entering Medicare from commercial insurance compared with beneficiaries entering TM.Design setting and participantsThis retrospective cohort study with a difference-in-differences analysis and propensity score matching compared health care utilization and spending between beneficiaries enrolling in MA and beneficiaries enrolling in TM with a Medicare Supplement plan 1 year before vs 1 year after their initial Medicare enrollment. Participants included beneficiaries aged 65 to 70 years who remained enrolled with a large insurer when transitioning from commercial insurance to Medicare between June 2018 and December 2018. Data were analyzed from February 2020 to October 2021.Main outcomes and measuresUse of, and spending on, institutional (Part A) and professional (Part B) medical services, measured as overall spending per member per month, and as rates of services per thousand members per year, including inpatient stays, inpatient days, physician visits, and injectable drug administrations.ResultsAmong 1082 matched beneficiaries (541 joining MA, 541 joining TM with a Supplement plan), 585 (54.1%) were female, and the mean (SD) age at Medicare enrollment was 66 (1.4) years. Prior to Medicare enrollment, there was no statistically significant difference in outcome trends between the MA and TM groups. The first year of MA enrollment was associated with a differential reduction in institutional (Part A) spending of $95 (95% CI, $7-$183) per member per month, corresponding to a differential reduction in inpatient stays of 63 (95% CI, 10-116) per thousand members per year. Medicare Advantage was associated with a differential reduction in total spending (Parts A and B) of $142 (95% CI, $0-$282) per member per month, which was 36% of total spending in TM. There was no differential reduction in professional (Part B) spending (per member per month, $47; 95% CI, $51-$145) or utilization.Conclusions and relevanceIn this cohort study with a difference-in-differences analysis, during the first year of Medicare coverage, MA was associated with large reductions in institutional (Part A) utilization and spending.

Dataset Information

The impact of Medicare coverage policies on health care utilization.

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

The impact of Medicare coverage policies on health care utilization.

Similar Datasets

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