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健康保险市场竞争

Competition in Health Insurance Markets
Journal of Economic Perspectives · 2026 · [{"name": "Martin Gaynor", "affiliation": ["National Bureau of Economic Research"]}, {"name": "Amanda Starc", "affiliation": ["National Bureau of Economic Research"]}]

中文摘要

美国主要依赖私人医疗保险市场,但这些市场高度集中,且集中度随时间推移不断提高。我们记录了商业保险、医疗保险优势计划(Medicare Advantage)和医疗补助(Medicaid)市场的集中情况。随后,我们考察信息不对称——尤其是逆向选择——如何与市场势力相互作用,从而影响保费、保险计划设计与消费者福利。实证证据证实,保险公司整合会提高保费。我们讨论反垄断执法、风险调整、监管以及信息干预如何塑造这些市场中的竞争与消费者福利。

Abstract

The United States relies primarily on private health insurance markets, yet these markets are highly concentrated and becoming more so over time. We document concentration across commercial, Medicare Advantage, and Medicaid markets. We then examine how asymmetric information—particularly adverse selection—interacts with market power to shape premiums, plan design, and consumer welfare. Empirical evidence confirms that insurer consolidation raises premiums. We discuss how antitrust enforcement, risk adjustment, regulation, and informational interventions shape competition and consumer welfare in these markets.
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