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Health Aff (Millwood). 2019 Apr;38(4):554-560. doi: 10.1377/hlthaff.2018.05390.

Adjusted Mortality Rates Are Lower For Medicare Advantage Than Traditional Medicare, But The Rates Converge Over Time.

Author information

1
Joseph P. Newhouse ( joseph_newhouse@harvard.edu ) is the John D. MacArthur Professor of Health Policy and Management in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts; the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston; and the Harvard Kennedy School, in Cambridge, Massachusetts; and a faculty research fellow at the National Bureau of Economic Research in Cambridge.
2
Mary Price is a senior consulting data analyst at the Mongan Institute Health Policy Center, Massachusetts General Hospital, in Boston.
3
J. Michael McWilliams is the Warren Alpert Foundation Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School.
4
John Hsu is director of the Clinical Economics and Policy Analysis Program at the Mongan Institute Health Policy Center, Massachusetts General Hospital, and an associate professor in the Departments of Medicine and of Health Care Policy, Harvard Medical School.
5
Jeffrey Souza is a biostatistician in the Department of Health Care Policy, Harvard Medical School.
6
Bruce E. Landon is a professor in the Departments of Health Care Policy and of Medicine and a faculty member in the Center for Primary Care, all at Harvard Medical School.

Abstract

Overall mortality rates, adjusted for age, sex, and Medicaid status, in Medicare Advantage have been below those in traditional Medicare for many years. Much attention has been paid to the resulting issue of favorable selection in Medicare Advantage. The common study design used to estimate causal effects of Medicare Advantage on utilization and outcomes compares new Medicare Advantage beneficiaries immediately before and after enrollment in Medicare Advantage with beneficiaries who choose to remain in traditional Medicare. What has not been studied is the mortality experience of a cohort that initially chooses enrollment in Medicare Advantage versus one that chooses traditional Medicare. In this study we found that the adjusted mortality rate of a cohort newly enrolled in Medicare Advantage was initially well below that of a cohort newly enrolled in traditional Medicare, but the difference markedly decreased after five years. As a result, the common study design is flawed because it assumes that any initial difference in mortality risk remains constant after enrollment in Medicare Advantage. In other words, those initially choosing Medicare Advantage become sicker relative to traditional Medicare beneficiaries over five years. Whether the mortality rates would fully converge if a period longer than five years were observed is a topic for further research.

KEYWORDS:

Medicare; Medicare Advantage; mortality risk; selection

PMID:
30933606
PMCID:
PMC6555557
[Available on 2020-04-01]
DOI:
10.1377/hlthaff.2018.05390

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