Exploration of Selection Bias Issues for the DoD Federal Employees Health Benefits Program Demonstration
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Congress established a demonstration that allows beneficiaries of the Department of Defense (DoD) health benefits program, who also are Medicare-eligible, to enroll in the Federal Employees Health Benefits Program (FEHBP). The three-year demonstration began January 1, 2000. The DoD Office of Health Affairs is evaluating the costs and other effects of the demonstration. One source of cost effects may be risk selection, where beneficiaries who choose the FEHBP option are more or less costly than those who do not enroll. Health Affairs asked RAND to apply current theory and knowledge to identify how selection bias might occur as Medicare-eligible DoD beneficiaries enrolled in FEHBP plans under this demonstration, and to suggest an analytic approach to estimate the effects of selection on DoD costs. This report presents the results of that analysis. It describes the supplemental health benefits options available to Medicare beneficiaries in the demonstration sites, reviews the theoretical literature on risk selection, and develops hypotheses regarding risk selection that can be tested in the evaluation of the demonstration. It also suggests analytic methods for measuring selection and estimating the extent to which it may occur for enrollments in the FEHBP demonstration. The methods are designed to estimate (1) the extent to which adverse selection occurs in Medicare supplemental insurance enrollments for the DoD FEHBP demonstration, and (2) how much effect selection has on DoD health care costs for Medicare-eligible beneficiaries.
Table of Contents
Chapter One
Introduction
Chapter Two
Health Plan Options and Gaps in the Demonstration Markets
Chapter Three
Selection Issues in FEHBP Benefits for Medicare-Eligible DoD Beneficiaries
Chapter Four
Hypotheses for Selection Behaviors in FEHBP Enrollments
Chapter Five
A Suggested Methodology to Evaluate Selection Bias
Appendix A
Nationwide Medicare and FEHBP Plan Coverage
Appendix B
Theoretical Model of Health Plan Offerings
Appendix C
Adair, Iowa
Appendix D
Coffee, Georgia
Appendix E
Dallas, Texas
Appendix F
Dover Air Force Base, Delaware
Appendix G
Fort Knox, Kentucky
Appendix H
Greensboro/Winston-Salem/High Point, North Carolina
Appendix I
Humboldt County, California
Appendix J
Naval Hospital, Camp Pendleton, California
Appendix K
New Orleans, Louisiana
Appendix L
Commonwealth of Puerto Rico
Research conducted by
The research described in this report was sponsored by the Office of the Secretary of Defense (OSD). The research was conducted jointly by RAND Health's Center for Military Health Policy Research and the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center supported by the OSD, the Joint Staff, the unified commands, and the defense agencies.
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