Favorable selection in the Medicare+Choice program: new evidence.
Historically, studying the Medicare managed care favorable-selection issue has been difficult because direct data on managed care enrollees have been unavailable. In this study, we analyzed the first year of Balanced Budget Act (BBA)-mandated inpatient encounter data. Based on this comparison of actual managed care and fee-for-service (FFS) beneficiaries, it appears that there are significant differences between these populations. The most striking differences are found in the comparison of average risk factors, indicating a clear bias in the managed care populations toward beneficiaries predicted to be less costly.
Greenwald
L M
LM
Office of Strategic Planning, Health Care Financing Administration, Baltimore 21244, MD, USA. lgreenwald@hcfa.gov
Levy
J M
JM
Ingber
M J
MJ
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D006233:Persons with Disabilities; D004608:Eligibility Determination; D018588:Fee-for-Service Plans / Q000458:organization & administration / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D015273:Insurance Selection Bias; D020398:Medicare Part C / Q000458:organization & administration / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology