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J Health Econ. 2008 Dec;27(6):1451-61. doi: 10.1016/j.jhealeco.2008.07.014. Epub 2008 Aug 13.

Managed care and medical expenditures of Medicare beneficiaries.

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  • 1Harvard University, Boston, MA 02115, United States.


This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service (FFS) enrollees. We find that increasing penetration leads to reduced spending on FFS beneficiaries. In particular, our estimates suggest that the increase in HMO penetration during our study period led to approximately a 7% decline in spending per FFS beneficiary. Similar models for various measures of health care utilization find penetration-induced reductions consistent with our spending estimates. Finally, we present evidence that suggests our estimated spending reductions are driven by beneficiaries who have at least one chronic condition.

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