Siran M. Koroukian

Department of Epidemiology and Biostatistics
Case Western Reserve University
Wolstein Research Building, Suite 1200
2103 Cornell Road
Cleveland, OH 44106-7281

E-Mail: EmailAddress: hidden: you can email any NBER-related person as first underscore last at nber dot org
Institutional Affiliation: Case Western Reserve University

NBER Working Papers and Publications

September 2013Impact of Mortality-Based Performance Measures on Hospital Pricing: the Case of Colon Cancer Surgeries
with Avi Dor, Partha Deb, Michael Grossman, Gregory Cooper, Fang Xu: w19447
We estimate price regressions for surgical procedures used to treat colon cancer, a leading cause of cancer mortality. Using a claims database for self-insured employers, we focus on transaction prices, rather than more commonly available billing data that do not reflect actual payments made. Although the responsiveness of prices to hospital performance depends on the impact of quality on the slope of the quantity-demand of the payers, which are not known a priory, it is often assumed that higher performing hospitals are able to command higher prices. To test this hypothesis we construct performance rankings, based on hospital excess-mortality and incorporate them into our price models. We are interested in the type information available to large payers who negotiate prices on behalf o...
April 2004Managed Care Discounting: Evidence from the MarketScan Database
with Avi Dor, Michael Grossman: w10437
The paper examines price discounting by health maintenance organizations and preferred provider organizations in markets for hospital services. Our empirical analysis focuses on transaction prices for angioplasty, which is a relatively common procedure, with well defined 'product' characteristics. After controlling for patient and procedure heterogeneity and market power we find that on average prices for PPOs are 8% lower than fee-for-service plans, followed by point-of-service HMOs who capture a 24% discount. Our results are in general agreement with earlier work that shows that managed care discounts are 'real', after accounting for process of care.

Published: Avi Dor & Siran M. Koroukian & Michael Grossman, 2004. "Managed Care Discounting: Evidence from the MarketScan Database," INQUIRY: The Journal of Health Care Organization, Provision, and Financing, vol 41(2), pages 159-169.

March 2004Transaction Prices and Managed Care Discounting for Selected Medical Technologies: A Bargaining Approach
with Avi Dor, Michael Grossman: w10377
It is generally assumed that managed care has been successful at capturing discounts from medical providers, but the implications have been a matter of debate. Critics argue that managed care organizations attain savings by reducing intensity of services, while others have argued that savings are 'real' and are a consequence of discounts per unit of care. To address this, we obtain separate transaction prices for hospital episodes (treatment) and for the narrowly defined surgical procedure, using the example of heart bypass surgery. Both sets of prices were drawn from a database of insurance claims of self-insured firms that offer a menu of insurance options. We use a Nash-Bargaining framework to obtain price discounts by type of insurance. Adjusting for product and patient heterogeneity,...

Published: Dor, Avi, Michael Grossman and Siran M. Koroukian. “Hospital Transaction Prices and Managed-Care Discounting for Selected Medical Technologies.” American Economic Review 94, 2 (May 2004): 352-356.

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