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• Article | American Economic Journal: Economic Policy | February 2019

  Does It Matter if Your Health Insurer Is For Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending

  Leemore S. Dafny

  There is limited empirical evidence about the impact of for-profit health insurers on various outcomes. I study the effects of conversions to for-profit status by Blue Cross Blue Shield (BCBS) affiliates in 11 states, spanning 28 geographic markets. I find both the BCBS affiliate and its rivals increased premiums following conversions in markets where the converting affiliate had substantial market share. Medicaid enrollment rates also increased in these markets, a pattern consistent with "crowd in" of families who were formerly privately insured. The results suggest for-profit insurers are likelier than not-for-profit insurers to exercise market power when they possess it.

  Keywords: health insurance; medical loss ratio; Blue Cross; Corporate Governance; Health; Insurance; For-Profit Firms; Insurance Industry; United States;

  Citation:

  Dafny, Leemore S. "Does It Matter if Your Health Insurer Is For Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending." American Economic Journal: Economic Policy 11, no. 1 (February 2019): 222–265.  View Details

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• Article | Health Affairs

  Decreases In Readmissions Credited to Medicare's Program to Reduce Hospital Readmissions Have Been Overstated

  Christopher Ody, Lucy Msall, Leemore S. Dafny, David Grabowski and David Cutler

  Medicare’s Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups’ having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples. Either the HRRP had no effect on readmissions, or it led to a system-wide reduction in readmissions that was roughly half as large as prior estimates have suggested.

  Keywords: readmission rates; Hospitals; acute care hospitals; Medicare; myocardial infarction; heart failure; Health Care and Treatment;

  Citation:

  Ody, Christopher, Lucy Msall, Leemore S. Dafny, David Grabowski, and David Cutler. "Decreases In Readmissions Credited to Medicare's Program to Reduce Hospital Readmissions Have Been Overstated." Health Affairs 38, no. 1 (January 2019): 36–43.  View Details

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• Other Article | New England Journal of Medicine

  Does CVS–Aetna Spell the End of Business as Usual?

  Leemore S. Dafny

  Citation:

  Dafny, Leemore S. "Does CVS–Aetna Spell the End of Business as Usual?" New England Journal of Medicine 378, no. 7 (February 15, 2018): 593–595.  View Details

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