Dissertations and Theses
Date of Degree
6-5-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (Ph.D.)
Department
Health Policy and Management
Advisor(s)
Mustafa Hussein
Naomi Zewde
Committee Members
Mustafa Hussein
Naomi Zewde
Nelson Varas-Díaz
Nicholas Freudenberg
Keywords
Medicare, Puerto Rico, Health Insurance, Privatization, Marketing, Healthcare financing
Abstract
Over time, Medicare Advantage (MA) has seen an increase in enrollment in the United States and Puerto Rico. This program, which is the privatized version of traditional Medicare, has faced critiques in recent years for being focused on profit maximization and reducing accessibility to Medicare beneficiaries. In Puerto Rico, the majority of Medicare beneficiaries (95%) choose a MA plan over traditional Medicare. Despite being the primary financier of healthcare in Puerto Rico and covering populations that require extensive healthcare services, individuals over 65 and those with disabilities, there are still numerous research gaps about the MA industry. This dissertation examines the impact of Medicare Advantage insurance companies on the healthcare system in Puerto Rico over a ten-year period, focusing on financial performance, marketing practices, and quality outcomes. Chapter 2 explores the financial performance of the top four health insurance companies managing Medicare Advantage in Puerto Rico. Chapter 3 goes into the marketing practices of MA companies to understand the messages they convey and some of their possibly deceptive and predatory practices. Chapter 4 then assesses the quality outcomes of the top four health insurance companies managing MA have changed overtime. The findings reveal that while MA plans have increased their market share and profitability, this success has not necessarily translated into improved healthcare access or quality for beneficiaries. Marketing strategies have been employed to attract more participants to MA plans, often without offering the essential information needed for Medicare beneficiaries to make informed decisions. Areas such as preventive services have seen improvement, while more costly quality measures like chronic disease management have remained stagnant or seen a reduction overtime. The dissertation argues that the MA program should have regulatory adjustments to increase patient care priorities which are sometimes overshadowed by private insurance companies.
Recommended Citation
Rivera-Rodríguez, Sergio Andrés, "Medicare Advantage Dominance in Puerto Rico’s Healthcare System: Exploring its Financial Landscape, Marketing Strategies and Quality Measures using the Commercial Determinants of Health Framework" (2025). CUNY Academic Works.
https://academicworks.cuny.edu/sph_etds/111
