School of Public Health
Permanent URI for this communityhttp://hdl.handle.net/1903/1633
The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item Competition and Consolidation in Medicare Advantage(2020) Chao, Sandra; DuGoff, Eva H.; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Medicare Advantage (MA) serves roughly one in three (24 out of 68 million) Medicare beneficiaries and this number is expected to grow to about half (40 out of 80 million) of Medicare beneficiaries by 2030. Given this expected increase in demand for MA health plans, it is important to assess the relationship between market structure and benefit generosity to ensure that beneficiaries have equal access to high quality plans at low prices.Purpose: The purpose of this research is to assess how policy changes and market structures influence Medicare Advantage plan benefit designs. Data and Methods: This study uses publicly available MA data from the Centers for Medicare & Medicaid Services and the Area Health Resources File. Retrospective cross-sectional analyses examine contract consolidation and reconsolidation from 2012–2020, market competition and supplemental benefits in 2013, and market competition and maximum out-of-pocket limits in 2018. Key Results: Contract consolidations have declined in recent years, likely as a result of a policy that changed the calculation method of the star ratings among consolidated contracts. During the years that contract consolidations peaked, market concentration also increased. We find that the odds of a plan in a nonconcentrated market offering a transportation supplemental benefit is 2.8 times higher than a plan operating in a highly concentrated market, when holding all other predictors constant (p < 0.001). Similarly, plans in nonconcentrated service areas are 2.4 times more likely to offer a hearing benefit (p < 0.001) and 2.3 times more likely to offer a dental benefit (p < 0.001) than plans in highly concentrated markets. Regarding maximum out-of-pocket limits, we find that the odds of a plan in a highly concentrated market having a higher maximum limit is 1.6 times higher than a plan with a nonconcentrated market, when holding all other predictors constant (p = 0.049). Conclusion: MA contract consolidations have declined since 2016 but market concentration continues to increase. Market structure is important because we find that MA market concentration is associated with the offering of supplemental benefits and the level of maximum out-of-pocket limits.Item PERCEPTION OF PATIENT-PROVIDER COMMUNICATION AND ITS ASSOCIATION WITH HEALTH SERVICES UTILIZATION(2012) Villani, Jennifer; Mortensen, Karoline; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The Patient Protection and Affordable Care Act of 2010 has generated an unprecedented emphasis on patient satisfaction and patient-centered care. This dissertation is composed of a series of papers on how patients perceive the quality of care delivered by their healthcare providers and its relationship to their usage of health services. The main hypothesis is that higher perceived quality of care is associated with more effective use of health services. The studies use nationally representative data from the Medical Expenditure Panel Survey (MEPS) with the research grounded in Andersen's Behavioral Model of Health Services Use. In the first study, I explore whether differences in satisfaction between English- and Spanish-speaking Hispanics can be explained by acculturation and concordance with their providers with regard to race, ethnicity, gender, and language. I use the econometric Blinder-Oaxaca decomposition method to quantify the contributions of each measured characteristic for explaining disparities in patient satisfaction. In the second study, I examine whether a lack of patient-centeredness and poor access to a regular provider are associated with greater nonemergent emergency department (ED) utilization. I employ a hurdle model to account for the two-part decision making process of whether to use the ED and how often to use the ED for nonemergent purposes. In the third study, I investigate the relationship between patient-centered care and receipt of six recommended clinical preventive services including screening for breast cancer, cervical cancer, colorectal cancer, high cholesterol, hypertension, and vaccination against influenza. I use multivariate logistic regression models to determine the probability of compliance with national prevention guidelines. The results reveal the importance of how patients perceive interpersonal communication with their healthcare providers. In the first study, acculturation is implicated as a major contributor to differences in patient satisfaction with communication. Furthermore, the results from the second study indicate language concordance between patients and providers is related to less nonemergent ED use. Findings from the third study suggest a pattern of greater compliance with clinical preventive service recommendations when patients perceive receiving patient-centered care from their providers. Implications for policy and practice are presented.