平价医疗法案十年后: 保险交易所的产业组织
The Affordable Care Act After a Decade: Industrial Organization of the Insurance Exchanges
Annual Review of Economics · 2022 · [{"name": "Benjamin Handel", "affiliation": ["National Bureau of Economic Research", "University of California, Berkeley"]}, {"name": "Jonathan Kolstad", "affiliation": ["National Bureau of Economic Research", "University of California, Berkeley"]}]
中文摘要
《平价医疗法案》（ACA）设立的受监管保险交易所，旨在通过私人保险公司提供可负担、高效的医疗保险覆盖。研究这些交易所复杂的产业组织（IO），对于评估其在 ACA 实施第一个十年间的影响、并预测其未来效应至关重要。我们重新审视了医疗保健市场中内在的市场失灵——正是这些失灵使得关键的 ACA 交易所监管成为必要——并考察这些监管是否成功实现了扩大覆盖、创建稳健市场、提供产品多样性以及推动医疗服务交付创新等目标。我们讨论了迄今为止的实证产业组织研究，并指出现有研究中可在未来加以弥补的不足。最后，我们讨论了基于产业组织研究得出的政策启示，这些启示既适用于 ACA 交易所，也更广泛地适用于医疗保健领域私人保险的管理式竞争。
Abstract
The regulated insurance exchanges set up in the Affordable Care Act (ACA) were designed to deliver affordable, efficient health coverage through private insurers. It is crucial to study the complex industrial organization (IO) of these exchanges in order to assess their impacts during the first decade of the ACA and to project their effects going forward. We revisit the inherent market failures in health care markets that necessitate key ACA exchange regulations and investigate whether they have succeeded in their goals of expanding coverage, creating robust marketplaces, providing product variety, and generating innovation in health care delivery. We discuss empirical IO research to date and also highlight shortcomings in the existing research that can be addressed moving forward. We conclude with a discussion of IO research-based policy lessons for the ACA exchanges and, more generally, for managed competition of private insurance in health care.