Abstract

Objective: Public reporting of health care quality is an increasingly popular policy tool aimed at solving the market failure of asymmetric information. By putting information about health care quality in the public domain, policymakers hope to give consumers the information they need to shop on the basis of quality and give providers the incentive to compete on the basis of quality. However, it is possible that provider and consumer response to these policies is heterogeneous, such that some consumers will benefit while others—perhaps the most vulnerable--may be unaffected or even worse off. In the United States, individuals enrolled in both Medicare and Medicaid (“duals”) are attracting increasing health policy attention due to their disproportionate use of health care services and costs. To qualify for Medicaid, an individual must have very low income and, in most states, deplete all but $2000 of assets. In addition to being poor, duals are more likely than non-duals to have chronic health conditions and to be racial and ethnic minorities. The objective of this study is to test whether duals are less likely to respond to, and benefit from, quality information than non-duals, and why, examining barriers related to information access and to supply and location of providers.

Data and Methods: The nursing home sector has long been a target of concern about low quality of care, and duals are often disproportionately affected by these quality problems. Public reporting of nursing home quality is an important policy initiative intended to improve quality. Thus, in this study, we use 2006–2010 national resident-level assessment (MDS) data from nursing homes, merged with claims data and individual characteristics from Medicare data.

Results: Preliminary results reveal that, rather than choosing higher-quality facilities, duals have increased propensity to be admitted to low-quality facilities under public reporting. Analysis of the underlying causes of this difference is underway.

Policy Implications: By assessing the relative importance of barriers to effective use of quality information by duals, we identify promising avenues to improve access to high-quality care for a particularly vulnerable population.

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