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HEDIS measures and managed care enrollment.

D P Scanlon1, M Chernew

  • 1Pennsylvania State University, USA.

Medical Care Research and Review : MCRR
|May 18, 1999
PubMed
Summary
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Employees did not significantly change health plan enrollment based on Healthcare Effectiveness Data and Information Set (HEDIS) ratings. Informal information from peers and personal experience appear more influential in healthcare choices.

Area of Science:

  • Health Services Research
  • Healthcare Management
  • Consumer Health Behavior

Background:

  • Healthcare Effectiveness Data and Information Set (HEDIS) measures are designed to assess health plan performance.
  • Understanding factors influencing consumer choice in health insurance is crucial for market dynamics and quality improvement.

Purpose of the Study:

  • To investigate the relationship between health plan enrollment and HEDIS-based performance ratings.
  • To determine if employees responded to performance data when selecting health plans.

Main Methods:

  • Analysis of health plan enrollment data from a large firm for the year 1996.
  • Estimation of plan market share regressions, controlling for price, plan type, HEDIS ratings, and individual HEDIS measures.

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Main Results:

  • Employees showed a weak response to the provided HEDIS ratings when making health plan enrollment decisions.
  • Potential reasons for low responsiveness include difficulty understanding ratings or lack of awareness.
  • Informal information sources (personal experience, social networks) likely play a significant role in plan selection.

Conclusions:

  • HEDIS ratings alone may not be sufficient drivers of consumer health plan choice.
  • The influence of informal information suggests a need for clearer communication of quality metrics.
  • Future strategies should consider how to integrate formal quality data with informal information channels.