成功的替代品？医保优势中的公私竞争
Substitutes for Success? Public Versus Private Competition in Medicare Advantage
Journal of Economic Perspectives · 2026 · [{"name": "Tim Layton", "affiliation": ["University of Virginia"]}, {"name": "Luca Maini", "affiliation": ["Harvard University"]}, {"name": "J. Michael McWilliams", "affiliation": ["Health Care Foundation"]}]
中文摘要
我们评估了竞争在 Medicare Advantage (医保优势计划) 中不断演变的作用及其对受益人福利的影响。我们阐述了来自公共选项 (public option)、传统 Medicare (Traditional Medicare) 以及 Medicare Advantage 内部其他私营保险公司的竞争, 如何作为相互替代的机制, 激励计划提供价值。我们表明, 尽管历史上参保人在传统 Medicare 与 Medicare Advantage 之间的选择曾提供了一种至关重要的竞争动态, 但在偏向私营计划的慷慨支付驱动下, 传统 Medicare 作为竞争者的实力已显著下降。因此, 确保参保人获得价值的重担已转移到 Medicare Advantage 市场内部的竞争之上。虽然县级层面私营保险公司之间的竞争有所加剧, 但这一增长主要由大型全国性承保商的扩张推动, 而非源于新进入者。由于存在显著的进入壁垒, 保险公司仍握有相当大的市场势力, 这引发了人们对该项目能否激励私营保险公司利用公共资金为受益人实现价值最大化的担忧。
Abstract
We assess the evolving role of competition in Medicare Advantage and its implications for beneficiary welfare. We describe how competition from the public option, traditional Medicare, and other private insurers within Medicare Advantage act as substitutes in incentivizing plans to deliver value. We show that while historically the choice between traditional Medicare and Medicare Advantage provided a vital competitive dynamic, traditional Medicare's strength as a competitor has declined significantly, driven by generous payments favoring private plans. Consequently, the burden of ensuring value for enrollees has shifted to competition within the Medicare Advantage market. While county-level competition among private insurers has increased, this growth is primarily driven by the expansion of large national carriers rather than new entrants. Insurers still wield substantial market power due to significant barriers to entry, raising concerns about the ability of the program to incentivize private insurers to use public dollars to maximize value for beneficiaries.