Impact of Care Quality and Coinsurance on End-stage Renal Disease Patients’ Disenrollment from Medicare Advantage

Li, Qijuan

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Year:: 2017
Contributor:: Li, Qijuan (creator); Mor, Vincent (Advisor); Trivedi, Amal (Reader); Galarraga, Omar (Reader); Chernew, Michael (Reader); Weiner, Daniel (Reader); Brown University. Department of Health Services, Policy and Practice (sponsor)
Genre:: theses
Subject:: Medicare advantage; End-stage renal disease; Star Rating; Coinsurance
Extent:: xi, 72 p.
DOI: https://doi.org/10.7301/Z0VX0F0H

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Abstract:: In the U.S., most End-stage Renal Disease (ESRD) patients are served by Traditional Medicare. However, there are still a significant number of patients enrolled in Medicare Advantage (MA) plans. This dissertation examined potential drivers for ESRD patients’ disenrollment from MA plans to Traditional Medicare and subsequent health outcomes. There are two particularly significant implications for this disenrollment. First, the disenrollment of ESRD patients from MA plans due to the favorable selection of MA plans would result in shifting cost from MA plans to Traditional Medicare. Second, the switch from MA plans to Traditional Medicare may cause worse health outcomes and higher costs for ESRD patients. This study used three quasi-experimental research designs based on seven national databases of Medicare enrollees spanning from 2007 to 2013. Chapter 1 observed a strong association between baseline MA plans’ star ratings and ESRD patients’ voluntary disenrollment from MA plans to Traditional Medicare in the year following initiation of dialysis. Chapter 2 revealed that the introduction of dialysis coinsurance among MA plans was associated with increased disenrollment of ESRD patients from MA plans, especially in case plans with four or more stars or among ESRD patients with higher socioeconomic status. Chapter 3 found that the introduction of dialysis coinsurance among MA plans was associated with increased disenrollment of ESRD patients from MA plans and higher utilization of hospital and post-acute nursing home care. These findings suggest: (1) that the rate of voluntary disenrollment among high-cost, high-need patients may be an important measure of MA plan quality and that policy stakeholders may want to monitor such disenrollment rates; (2) that low plan quality may lead to increased expenditures in Traditional Medicare by shifting this high-cost population from MA plans to Traditional Medicare; 3) that the effect of an increase in dialysis coinsurance on disenrollment was attenuated after the implementation of the Affordable Care Act but still significant; and 4) that increase in dialysis coinsurance may also lead to worse health outcomes and subsequent higher spending on ESRD patients, especially among higher quality plans.
Notes:: Thesis (Ph. D.)--Brown University, 2017

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Rights: In Copyright
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Citation

Li, Qijuan, "Impact of Care Quality and Coinsurance on End-stage Renal Disease Patients’ Disenrollment from Medicare Advantage" (2017). Health Services, Policy & Practice Theses and Dissertations. Brown Digital Repository. Brown University Library. https://doi.org/10.7301/Z0VX0F0H

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Health Services, Policy & Practice Theses and Dissertations

Theses and Dissertations for the Health Services, Policy & Practice department.
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