Description
- Abstract:
- The expansion of Medicare Advantage (MA) enrollment (from 23% of all enrollees in 2010 to 48% in 2022) presents a fundamental shift in how health care is financed and managed for elderly Americans. Privately administered MA plans are incentivized by the Centers for Medicare and Medicaid Services to deliver high quality and cost-efficient care to their enrollees. Existing evidence has shown that MA enrollees receive less intense PAC in less expensive settings of care compared to Traditional Medicare (TM) beneficiaries while patient outcomes following hospitalization are similar. However, due to differences in the characteristics of TM and MA enrollees it is unclear whether and to what extent MA enrollment influences PAC utilization and patient outcomes following hospitalization. Further, increased MA enrollment may result in spillover effects on TM beneficiaries, biasing direct comparisons of the two populations. The objective of this dissertation is to better understand the relationship between MA enrollment and both PAC utilization and associated patient outcomes. In chapter one I investigate the relationship between MA market penetration and PAC markets and the utilization of PAC services across the entire Medicare population, capturing both direct and spillover effects. I found that increased MA enrollment within a county resulted in small reductions in nursing home utilization and quality, and large reductions in both home health and inpatient rehabilitation utilization. In chapter two, I employ a novel matching approach to estimate the causal effect of MA enrollment on both PAC utilization and patient outcomes following hospitalization for hip fracture and stroke. I found that MA enrollment is associated with substantial reductions in inpatient rehabilitation use, and increased mortality following hospitalization. Collectively, evidence from this dissertation suggests that the MA program has resulted in substantial reductions in PAC service utilization, and worsened outcomes for patients with certain medical conditions.
- Notes:
- Thesis (Ph. D.)--Brown University, 2023
Citation
Lake, Derek Thomas,
"The Effect of Medicare Advantage Enrollment on Post-Acute Care Utilization and Associated Patient Outcomes"
(2023).
Health Services, Policy & Practice Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://repository.library.brown.edu/studio/item/bdr:dcvy68vr/
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Collection:
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Health Services, Policy & Practice Theses and Dissertations
Theses and Dissertations for the Health Services, Policy & Practice department....