Health plan report cards and managed care enrollment

173 Pages·1998·5.7 MB·English

by  Scanlon, Dennis Patrick

HealthPlanReportCardsandManagedCareEnrollment
I
by
DennisPatrickScanlon
Adissertationsubmittedinpartialfulfillmentof
therequirementsforthedegreeof
DoctorofPhilosophy
(HealthServicesOrganizationandPolicy)
inTheUniversityofMichigan
1998
DoctoralCommittee:
AssociateProfessorCatherineMcLaughlin,Co-chair
AssistantProfessorMichaelChemew,Co-chair
ProfessorGarySolon
ProfessorJ.WilliamThomas
©DennisPatrickScanlon1998
AllRightsReserved
InmemoryofThomasJ.Scanlon(1938-1989)
ACKNOWLEDGMENTS
Knowledge is notobtained in isolation, but is achievedthrough the wisdom,
guidance, support, andnurturingprovided byothers. Throughoutmy "career" as a
student,andmostrecentlyduringmydoctoralstudiesattheUniversityofMichigan,
many individuals have been responsible formy learning and academic success. A
separatedissertationwouldberequiredtolistthemanyfacultymembers,fellowstudents,
students,family,andfriendsthathaveprovidedsupportthroughtheyears. Iamgrateful
toeachofyou,andtothefollowingorganizationsandindividuals.
First,Iwouldliketothanktheanonymouscorporationforprovidingauniqueand
richdatasetfortheanalysis. IamalsogratefultotheAgencyforHealthCarePolicyand
Research (AHCPR) and the Horace H. Rackham School ofGraduate Studies at the
UniversityofMichiganforprovidinggenerous financial supportinthe formofpre-
doctoralfellowships. Finally,IwishtothanktheHealthCareFinancingAdministration
(HCFA)forfinanciallysupportingmyresearchviaadissertationgrant(GrantNo.30-P-
90670/5).
Iwould liketo thankmyparents, Thomas and Ann, fortheirbeliefinpost-
secondary education, despite never having the opportunity to complete college
themselves. Ihavebenefitedgreatlyfi-omthesacrificesthattheyunselfishlymade,and
willbeforeverindebted.
Iamgratefiiltothemembersofmydissertationcommittee-MichaelCheraew,
CatherineMcLaughlin,GarySolon,andBillThomas-fortheircollectiveenthusiasm,
skill,advice,anddedicationthroughoutmyresearchproject. Icouldnothavechosena
bettergroupoffacultymemberstoserveinthiscapacity. Specifically,I'dliketothank
Catherineforherexpertiseonhealthinsurancemarketsandforherabilitytoquicklyand
cleariyidentifyproblemsandopportunitiesthataroseduringtheresearchprocess. Iam
gratefiiltoGaryforhiseconometricexpertiseandforhisnaturalabilitytocommunicate
complexstatisticsinamannerthatiseasilyunderstandable. IamthankftiltoBillforhis
111
expertise on quality measurement and risk adjustment in health care and for his
knowledgeaboutthepurchasingstrategiesoflargeemployers.
IamindebtedtoMikeforbeinginvolvedinthisprojectfromitsveryconception.
Heexemplifiesthefinestqualitiesoftheacademicmentor. Fewfacultymembersare
dedicatedenoughtotravelfromPittsburghtoBostonviaPhiladelphiatohelpadoctoral
studentexplainto acorporationwhytheyshouldgivehimdata forhisdissertation.
Mike'ssupportanddedicationtothesuccessofthisprojectwereunwavering. Iam
appreciativeofhiseconomicinsight,econometricexpertise,practicality,andtimeliness.
Ihavetrulyenjoyedourcollaborationthesepastyearsandlookforwardtocontinuing
thatcollaborationinthefiiture.
Finally, I am grateful to mywifeJennifer, forherconstant love, dedication,
supportandencouragement. Shehasmadenumeroussacrificestoallowmetopursue
thisdegree--itsconfermentwillbeequallyasmuchheraccomplishmentasmine.
IV
TABLEOFCONTENTS
DEDICATION....
jj
ACKNOWLEDGMENTS
iii
LISTOFFIGURES
vi
LISTOFTABLES
vii
LISTOFAPPENDICES
ix
CHAPTER
L DISSERTATIONOVERVIEW
1
IL ECONOMICTHEORYOFHEALTHPLAN
CHOICE
: 12
IIL REVIEWOFTHELITERATURE 27
IV. DATA 57
V.ECONOMETRICMETHODS 74
VL RESULTS
83
VH. DISCUSSION 103
LISTOFFIGURES
Figure
2-1 HealthPlanChoiceFromaDiscreteMenuofOptions 22
2-2 TheValueFunction 23
2-3 MarquisandHolmer'sValueFunction 24
VI
LISTOFTABLES
Table
1-1 HealthPlanReportCards 9
3-1 VariablesIncludedinStudiesofHealthPlanChoice 49
3-2 EmpiricalStudiesofHealthPlanChoicebyPublicationDate 50
4-la 1995SampleBreakdownFrom1995EnrollmentDataSet 68
4-lb SampleSizesforHealthPlanChoiceAnalyses 69
4-2 HealthPlanQualityDomainsandtheirMeasures 70
4-3 MeansandStandardDeviations 7I
6-la EstimatesoftheRelationshipBetweenChoiceofHealthPlan
andPlanAttributes;activenon-unionemployeeschoosingsingle
coverage g^
6-2a EstimatesoftheRelationshipBetweenChoiceofHealthPlan
andPlanAttributes;activenon-unionemployeeschoosing
familycoverage or
6-3a EstimatesoftheRelationshipBetweenChoiceofHealthPlan
andPlanAttributes;activeunionemployeeschoosingsingle
coverage g^
6-4a EstimatesoftheRelationshipBetweenChoiceofHealthPlan
andPlanAttributes;Medicareeligibleretireeschoosingsingle
coverage oy
6-5a EstimatesoftheRelationshipBetweenChoiceofHealthPlan
andPlanAttributes;non-Medicareretireeschoosingsingle
coverage no
6-6a EstimatesoftheRelationshipBetweenChoiceofHealthPlan
andPlanAttributes;pooledretireesamplechoosingsingle
coverage gg
vu
6-7a EstimatesoftheRelationshipBetweenChoiceofHealthPlan
andPlanAttributes;1995newemployeeschoosingsingle
coverage
100
6-8a EstimatesoftheRelationshipBetweenChoiceofHealthPlan
andPlanAttributes;1995planswitcherschoosingsingle
coverage
101
VIU
LISTOFAPPENDICES
AppendJY
A. AppendixA ,,^
B. AppendixB
1^3
IX