The Effects of Market Structure and Payment Rate on the Entry of Private Health Plans into the Medicare Market.

Private insurance firms participating in Medicare can offer up to three principal plan types: coordinated care plans (CCPs), prescription drug plans (PDPs), and private fee-for-service (PFFS) plans. Firms can make entry and marketing decisions separately across plan types and geographic regions. In...

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Published in:Inquiry (00469580) Vol. 49; no. 1; pp. 15 - 37
Main Authors: Frakt, Austin B., Pizer, Steven D., Feldman, Roger
Format: Article
Published: Sage Publications Inc. Spring2012
Subjects:
Online Access:View this record in EBSCOhost
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        atl: The Effects of Market Structure and Payment Rate on the Entry of Private Health Plans into the Medicare Market.
      aug:
        au:
          Frakt, Austin B.
          Pizer, Steven D.
          Feldman, Roger
        affil:
          Health economist, Health Care Financing & Economics, VA Boston Healthcare System
          Assistant professor, Boston University's School of Medicine and School of Public Health
          Associate professor of health policy and management, Boston University School of Public Health
          Blue Cross Professor of Health Insurance, University of Minnesota School of Public Health
      su:
        Economic impact
        Medicare
        Marketing
        Economic competition
        Computer simulation
        Statistical correlation
        Cost control
        Forecasting
        Insurance
        Health insurance
        Pharmaceutical services insurance
        Managed care programs
        Mathematical models
        Medical needs assessment
        Medical care costs
        Population geography
        Profit
        Regression analysis
        Research
        Research funding
        Risk management in business
        Statistics
        Private sector
        Eligibility (Social aspects)
        Fee for service (Medical fees)
        Patient Protection & Affordable Care Act
        United States
      sug:
        subj:
          United States
          Economic impact
          Medicare
          Marketing
          Economic competition
          Computer simulation
          Statistical correlation
          Cost control
          Forecasting
          Insurance
          Health insurance
          Pharmaceutical services insurance
          Managed care programs
          Mathematical models
          Medical needs assessment
          Medical care costs
          Population geography
          Profit
          Regression analysis
          Research
          Research funding
          Risk management in business
          Statistics
          Private sector
          Eligibility (Social aspects)
          Fee for service (Medical fees)
          Patient Protection & Affordable Care Act
      ab: Private insurance firms participating in Medicare can offer up to three principal plan types: coordinated care plans (CCPs), prescription drug plans (PDPs), and private fee-for-service (PFFS) plans. Firms can make entry and marketing decisions separately across plan types and geographic regions. In this study, we estimate firm-level models of Medicare private plan entry using data from the years 2007 to 2009. Our models include a measure of market structure and separately identify CCP, PDP, and PFFS entry. We find evidence that entry barriers associated with CCP market concentration affect all three product types. We also find evidence of cross-product competition and common cost or demand factors that make entry with certain product combinations more likely. We predict that the market presence of CCPs and PFFS plans will decrease and that of PDPs will increase in response to payment reductions included in the new health reform law.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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