Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114326

Chun-Chih Huang, PhD, International Health and Development, Tulane University, 1440 Canal Street, #2200, New Orleans, LA 70112, 504-621-9573, jhwandern@hotmail.com and Mahmud M. Khan, PhD, Department of Health Systems Management, Tulane University, 1440 Canal Street, New Orleans, LA 70112.

A number of studies have examined the factors associated with Medicare HMO penetration in a specific market. However, little is known about the effects of benefit package design on geographic penetration rates. This study examined the effect of various benefit-specific attributes of Medicare coordinated care plans on proportion of Medicare beneficiaries selecting the HMO plans. Data on Medicare HMO plans by county for the years 2000 to 2002 were obtained from various sources. Two-stage regression model has been used to examine the effects of degree of market competition, geographic and demographic characteristics of the population, performance measures of insurance contracts, plan attributes, and time. The results show that lower average out-of-pocket premium, lower average co-pay for outpatient visits, and zero co-pay for inpatient stay increases the proportion of Medicare beneficiaries joining HMO plans. For drug benefits, we find that the coverage of brand-name drugs or providing unlimited generic drugs increases the enrollment rate in Medicare HMO plans. However, if the drug benefits are restricted by formulary, Medicare HMO penetration rate declines. If a higher percent of Medicare HMOs contract with associations of physicians in independent practices (IPA), rather than with staff or group model types, the penetration rate in that county tends to increase. Furthermore, the higher is the number of plan options open to the consumers, the greater is the penetration rate.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Recognize the determinants of Medicare managed care penetration in county-based markets;
• Prioritize the benefit items in Medicare managed care plans that beneficiaries would care most;
• Design benefit packages for Medicare HMO which would attract Medicare beneficiaries;
• Develop suggestion for Medicare reform for higher Medicare managed care penetration.

Keywords: Medicare, HMOs

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.