Dissertation Title: "Consumer's Values on Health Care Services"
This thesis includes three studies on consumers' values on health care services. The first study compares Americans' attitudes on medical technology with those of people in thirteen other industrialized countries and show that Americans, particularly elderly Americans, are more interested than others in new medical discoveries and consider themselves well informed about those issues. These findings suggest that the American public will offer greater resistance than people in other countries to policies that restrain expenditures on new medical technology. This poses a particular problem for policy makers trying to slow the growth of future health care, especially Medicare expenditures.
In the second paper, to ensure a fair comarison of health plan performance evaluated by patients, I developed and tested case-mix models for pediatric Consumer Assessment of Health Plans Survey (CAHPS) that adjust for differences in the types of patients treated by different plans when comparing plans' average CAHPS scores. This study had three objectives: 1) identify child and parent variables that should be adjusted for when comparing health plans using child CAHPS data, 2) examine whether different case-mix models are necessary for Medicaid and commercially insured children, and 3) examine whether the coefficients of these variables are homogeneous across plans.
In the third study, I examined Medicaid enrollees' assessments of their own and their children's care compared to those of commercial insurance enrollees, using the CAHPS. I compared adjusted means of plan ratings and reports by commercially insured and Medicaid patients. The Medicaid global ratings were higher or at least similar to commercial ratings. However, Medicaid adults and children reported worse experiences than the commercially insured. In regression analyses, patient reports of experience explained more of the variation of global ratings than plan-effects or patient characteristics. Among the five composites of patient experience measures, 'communication with doctors' was the strongest predictor of the global ratings for overall care and of doctor and specialist ratings.