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Do Medicare HMOs cost shift?

R Feldman1, D Wholey, J B Christianson

  • 1Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis 55455-0381, USA.

Inquiry : a Journal of Medical Care Organization, Provision and Financing
|November 11, 1998
PubMed
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Health maintenance organizations (HMOs) do not shift costs from Medicare to commercial premiums. This study found no evidence of cost shifting within the HMO industry, supporting a growing skeptical consensus on the cost-shifting hypothesis.

Area of Science:

  • Health Economics
  • Healthcare Management
  • Public Policy

Background:

  • The cost-shifting hypothesis suggests that healthcare organizations shift costs between different payer groups.
  • Previous research focused on healthcare providers; this study examines the health maintenance organization (HMO) industry.
  • Understanding cost-shifting dynamics is crucial for healthcare policy and pricing strategies.

Purpose of the Study:

  • To test the hypothesis that HMOs increase commercial premiums in response to lower Medicare payments.
  • To provide the first examination of the cost-shifting hypothesis within the US HMO industry.
  • To identify factors influencing HMO commercial premiums.

Main Methods:

  • Analysis of annual data for all US HMOs with Medicare risk contracts from 1990-1995.

Related Experiment Videos

  • Inclusion of a comparison group of HMOs without Medicare contracts during the same period.
  • Econometric analysis to assess the relationship between Medicare payments and commercial premiums.

    • Main Results:

    • No statistically significant evidence was found for cost shifting from Medicare to commercial premiums by HMOs.
    • HMOs did not increase commercial premiums when Medicare reimbursement rates decreased.
    • Increased competition and for-profit status were associated with lower HMO commercial premiums.

    Conclusions:

    • The study refutes the cost-shifting hypothesis within the HMO industry.
    • Findings support a skeptical consensus regarding the prevalence of cost shifting from Medicare.
    • Competition and for-profit status are significant determinants of HMO pricing.