DISSEMINATING INFORMATION ON THE QUALITY OF HMOS

作为致力于评估和报告管理的医疗质量信息的领先私人机构，国家质量保证委员会(NCQA)于1991年开始向健康维护组织(HMO)提供认证，并自1993年以来公布HMO的绩效数据。NCQA的明显成功将注意力集中在如何衡量HMO质量以及这如何影响个人对健康计划的选择上。在这个问题上，必须指出，认证和业绩数据报告都是自愿的。事实上，截至1998年6月1日，超过一半的运营HMO仍未获得认证和/或扣留了NCQA的数据。目前还不清楚从这些未经认证或未报告的HMO状态中得出了关于高质量消费者的什么结论。本研究的目的是提供和分析卫生保健组织愿意或不愿意通过NCQA自愿传播质量信息的经验证据，以及NCQA信息是否会影响消费者对卫生保健组织的选择。利用联邦医疗保险和联邦雇员健康福利计划(FEHBP)的计划层面的时间序列数据，本文首先估计了NCQA信息对这两个计划的健康计划投保的影响。第二个任务是检验联邦医疗保险和联邦医疗保险中质量信息的不平等获取是否会导致不同的消费者反应。最后，本研究调查了医疗保健组织在多大程度上采用自愿信息披露作为对需求以及在成本和质量方面的竞争的战略反应。

As the leading private agency dedicated to assessing and reporting managed care quality information, the National Committee of Quality Assurance (NCQA) began providing accreditation to health maintenance organizations (HMOs) in 1991 and has publicized HMO performance data since 1993. The apparent success of NCQA has focused attention on how HMO quality is measured and how this affects individuals' choice of health plans. On this issue, it is important to note that both accreditation and performance data reporting are voluntary. Indeed, as of June 1, 1998, more than half of all operating HMOs remain non-accredited and/or withhold data from the NCQA. It is not clear what conclusions about quality consumers have drawn from these non-accredited or non-reporting HMO statuses. The purpose of this study is to present and analyze empirical evidence on why HMOs are willing or not willing to voluntarily disseminate quality information through the NCQA and whether the NCQA information affects consumers' choice of HMOs. Using the plan-level time series data from Medicare and the Federal Employee Health Benefits Program (FEHBP), my dissertation first estimates the impact of the NCQA information on the health plan enrollment in these two programs. The second task is to test whether the unequal access of quality information in Medicare and FEHBP leads to different consumer response. Finally, the study investigates to what extent HMOs adopt the voluntary information disclosure as a strategic response to the demand and to the competition in cost and quality.