Description:

Hyein Cho (Northwestern): Provider-Insurer Integration and Healthcare Delivery

Abstract:  I examine how integration between healthcare providers and insurers affects care delivery. Unlike stand-alone providers, integrated providers bear financial responsibility as insurers, which may incentivize them to limit resource-intensive services or better coordinate care. In the Massachusetts Individual Exchange, I find that integration reduces utilization, mainly by reducing patients' visits to specialists. Integration lowers both the likelihood of patients visiting a specialist by 10 percentage points and, for those who do, the likelihood of seeking second opinions by 2.5 percentage points. This shift is accompanied by patients changing to new primary care practitioners (PCPs) who are more likely to be integrated with the insurer. To assess whether the reduction in specialist visits stems from integrated PCPs' stricter gatekeeping or improved PCP-specialist coordination, I develop and estimate a physician referral model. Model estimates show that integrated PCPs are stricter in referral, but see a more accurate information related to referral. Counterfactual analyses reveal that 90% of the reduction in specialist visits is explained by gatekeeping.

Please note the change in the location. This seminar will take place in KGH 1130.