How does managed care manage care? Evidence from public insurance

Abstract

In the United States, the fraction of individuals with public insurance is growing and the policies and markets that serve them are changing. Over two-thirds of Medicaid recipients are now enrolled in managed care organizations (MCOs), but little is known about how these plans operate. To study this market, I use data from New York Medicaid where managed care recipients are randomly assigned to plans. In chapter one, I estimate how physician and hospital networks impact health care use and spending. In chapter two, I study how production and selection vary across the managed care plans participating in New York Medicaid. Finally, in the third chapter, I turn to the Medicare program and examine how health care use and spending change at age 65 as adults switch from private to public coverage. Taken together, my dissertation chapters provide new perspective on how differences within public programs and between public and private programs, impact consumers.