Dissertation Title:  "Economic Analyses of Medicare HMOs"

My dissertation consists of three essays, all of which attempt to broaden our knowledge of the economic implications of managed care, particularly for the elderly, in the market for health insurance. Managed care insurance combines physician and insurer behavior in such a way that is thought to reduce inefficiency in medical care and improve access to and delivery of preventive medicine. The first essay estimates how responsive Medicare managed care (or HMO) enrollment is to prices and finds that a $100 increase in monthly capitation payments led to a 3.8 percentage point increase in Medicare HMO enrollment in 1997. The second essay determines that the elderly who join HMOs cost approximately $1100 less than the average cost of those remaining in the traditional Medicare sector and this selection is leading to significant overpayments to managed care plans, particularly in the first year of enrollment. The third essay (joint with Ellen Meara) tries to shed light on the quality implications of managed care and finds that higher HMO enrollment leads to later diagnosis of lung cancer (which is largely untreatable) and, to a lesser extent, later diagnosis of colon, breast and cervical cancers, all of which have proven benefits for early diagnosis and treatment.