The Impact of Health Care Market Concentration on Consumers' Experiences
Embargo until
2014-12-01
Date
2013-10-18
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Publisher
Johns Hopkins University
Abstract
Competition and choice in health care are viewed as solutions to some of the most pressing issues in health care in United States. In this set of thesis papers, we use several approaches to defining health insurance market structure to examine whether consumers in more competitive markets report having better experiences with their health plan than consumers in less competitive markets.
The first paper describes methods for developing measures of competition in the hospital and health insurance industries, presenting an empirical analysis of several approaches. The paper also describes trends in hospital and health insurance concentration and the relative concentration of insurance to hospital markets from 2003-2009. The paper concludes that both hospital and health insurance markets on average have remained highly concentrated from 2003-2009. On average, there was no significant change in the average HHI though some markets experienced greater change. The paper also finds that in the average metropolitan statistical area (MSA), the health insurance market is more concentrated than the hospital market.
The second paper examines the relationship between market competition and consumers’ experiences with their plans, access to care, and the percentage of spending for selected medical services paid out-of-pocket. The paper explores this relationship in two different settings, private group insurance and Medicaid managed care. This paper finds that in general, there is little to no significant association between the level of insurance concentration and consumers’ access to care or experience with their health plan.
The third paper builds upon the second paper by focusing on whether a consumer directly has a choice of health plans. The paper concludes that individuals who have a choice in health plans at their current main job do report slightly better access to care on most measures and higher satisfaction and fewer administrative problems with their health plan than those without a choice in plans.
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Keywords
health insurance competition, health market concentration, consumer experiences