000			03167cam a22004097 4500
001			w23090
003			NBER
005			20211020105019.0
006			m o d
007			cr cnu||||||||
008			210910s2017 mau fo 000 0 eng d
100	1		_aCurto, Vilsa.
245	1	0	_aHealthcare Spending and Utilization in Public and Private Medicare / _cVilsa Curto, Liran Einav, Amy Finkelstein, Jonathan D. Levin, Jay Bhattacharya.
260			_aCambridge, Mass. _bNational Bureau of Economic Research _c2017.
300			_a1 online resource: _billustrations (black and white);
490	1		_aNBER working paper series _vno. w23090
500			_aJanuary 2017.
520	3		_aWe compare healthcare spending in public and private Medicare using newly available claims data from Medicare Advantage (MA) insurers. MA insurer revenues are 30 percent higher than their healthcare spending. Healthcare spending is 25 percent lower for MA enrollees than for enrollees in traditional Medicare (TM) in the same county with the same risk score. Spending differences between MA and TM are similar across sub-populations of enrollees and sub-categories of care, with similar reductions for "high value" and "low value" care. Spending differences primarily reflect differences in healthcare utilization; spending per encounter and hospital payments per admission are very similar in MA and TM. Geographic variation in MA spending is about 20 percent higher than in TM, but geographic variation in hospital prices is about 20 percent lower. We present evidence consistent with MA plans encouraging substitution to less expensive care, such as primary rather than specialist care, and outpatient rather than inpatient surgery, and with employing various types of utilization management. Some of the overall spending differences between MA and TM may be driven by selection on unobservables, and we report a range of estimates of this selection effect using mortality outcomes to proxy for selection.
530			_aHardcopy version available to institutional subscribers
538			_aSystem requirements: Adobe [Acrobat] Reader required for PDF files.
538			_aMode of access: World Wide Web.
588	0		_aPrint version record
690		7	_aH11 - Structure, Scope, and Performance of Government _2Journal of Economic Literature class.
690		7	_aH42 - Publicly Provided Private Goods _2Journal of Economic Literature class.
690		7	_aH51 - Government Expenditures and Health _2Journal of Economic Literature class.
690		7	_aI11 - Analysis of Health Care Markets _2Journal of Economic Literature class.
690		7	_aI13 - Health Insurance, Public and Private _2Journal of Economic Literature class.
700	1		_aEinav, Liran. _928975
700	1		_aFinkelstein, Amy. _910464
700	1		_aLevin, Jonathan D.
700	1		_aBhattacharya, Jay. _933048
710	2		_aNational Bureau of Economic Research.
830		0	_aWorking Paper Series (National Bureau of Economic Research) _vno. w23090.
856	4	0	_uhttps://www.nber.org/papers/w23090
856			_yAcceso en línea al DOI _uhttp://dx.doi.org/10.3386/w23090
942			_2ddc _cW-PAPER
999			_c325032 _d283594