Address correspondence to Susan Bartlett Foote, J.D., M.A., Professor, Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware Street, S.E., MMC 729, Minneapolis, MN 55455. E-mail: email@example.com. Beth A. Virnig, Ph.D., Associate Professor, and Robert J. Town, Ph.D., Associate Professor, are with the Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN. Lacey Hartman, M.P.P., Senior Research Scientist, is with the Minnesota Department of Health, St. Paul, MN.
Impact of Policy
The Impact of Medicare Coverage Policies on Health Care Utilization
Article first published online: 12 MAY 2008
© Health Research and Educational Trust
Health Services Research
Volume 43, Issue 4, pages 1285–1301, August 2008
How to Cite
Foote, S. B., Virnig, B. A., Town, R. J. and Hartman, L. (2008), The Impact of Medicare Coverage Policies on Health Care Utilization. Health Services Research, 43: 1285–1301. doi: 10.1111/j.1475-6773.2008.00836.x
- Issue published online: 16 JUL 2008
- Article first published online: 12 MAY 2008
- Medicare coverage;
- Medicare services;
- local coverage decisions (LCDs);
- Medicare utilization
Objective. To determine whether Medicare coverage policies affect utilization of services in Medicare.
Data Sources. We constructed an analysis data set for eight different procedures using secondary data obtained from Medicare claims (1999–2002) and Medicare coverage policies posted on Center for Medicare and Medicaid Services website.
Study Design. We analyzed the impact of coverage policies using difference-in-difference approach in a regression framework.
Principal Findings. We found that in only one case (transesophageal echocardiography) out of eight did utilization change (reduced by 13.6 percent) after the effective date of the local policies. There is no systematic pattern that policies affect utilization, and the type of coverage policy does not seem to play an important role in its impact.
Conclusions. Coverage policies have the potential but do not consistently impact utilization as policy makers intend and expect them to do. These findings raise significant policy questions about the effectiveness of Medicare coverage policies, which deserve further study.