Does Managed Care Widen Infant Health Disparities? Evidence from Texas Medicaid

• 成果类型: Article
• 署名作者: Kuziemko, Ilyana; Meckel, Katherine; Rossin-Slater, Maya
• 署名单位: Princeton University; National Bureau of Economic Research; University of California System; University of California Los Angeles; Stanford University; IZA Institute Labor Economics
• 刊物名称: AMERICAN ECONOMIC JOURNAL-ECONOMIC POLICY
• ISSN/ISSBN: 1945-7731
• DOI: 10.1257/pol.20150262
• 发表日期: 2018
• 页码: 255-283
• 关键词: low-birth-weight; risk adjustment; american women; pregnant-women; prenatal-care; outcomes; mortality; selection; MARKETS; hmos

摘要

Medicaid programs increasingly finance competing, capitated managed care plans rather than administering fee-for-service (FFS) programs. We study how the transition from FFS to managed care affects high- and low-cost infants (blacks and Hispanics, respectively). We find that black-Hispanic disparities widen-e.g., black mortality and preterm birth rates increase by 15 percent and 7 percent, respectively, while Hispanic mortality and preterm birth rates decrease by 22 percent and 7 percent, respectively. Our results are consistent with a risk-selection model whereby capitation incentivizes competing plans to offer better (worse) care to low- (high-) cost clients to retain (avoid) them in the future.