Journal of Economic Perspectives · 2026 · [{"name": "Mark Shepard", "affiliation": ["John F. Kennedy University"]}, {"name": "Jacob Wallace", "affiliation": ["Yale New Haven Health System"]}]
中文摘要
医疗补助（Medicaid）是美国规模最大的公共项目之一——为超过7500万低收入美国人提供医疗保险——其参保者中超过四分之三通过私人"管理式医疗"（managed care）保险公司获得医疗服务。本文就将医疗补助外包给私人保险公司这一做法的经济学提出三个核心观点。第一，关于医疗补助私有化的实证证据喜忧参半：外包并未实质性降低公共成本或改善医疗服务质量。第二，我们提出一个称为"采购型竞争"（procured competition）的框架，用以刻画医疗补助管理式医疗作为公共采购与受监管竞争之混合体的独特结构。第三，我们讨论该模型中涉及采购、竞争与消费者选择的关键政策杠杆。全文始终强调尚待探讨的开放性研究问题，并认为：各州在设计这些项目时呈现的巨大差异，加之关于"何种做法有效"的证据有限，构成了一个有望产出高影响力学术成果的研究领域。
Abstract
Medicaid is one of the largest public programs in the United States—providing health insurance to over 75 million low-income Americans—and over three quarters of its enrollees receive care via private “managed care” insurers. In this article, we make three central points about the economics of contracting out Medicaid to private insurers. First, the empirical evidence on Medicaid privatization is mixed: contracting out has not meaningfully reduced public costs or improved quality of care. Second, we propose a framework, which we call “procured competition,” to describe the unique structure of Medicaid managed care as a hybrid of public procurement and regulated competition. Third, we discuss the key policy levers across procurement, competition, and consumer choice in this model. Throughout, we highlight open research questions, arguing that the enormous variation in how states design these programs—combined with limited evidence on what works—represents a promising area for high-impact scholarship.