医疗保险计划有何影响？来自医疗补助计划随机分配的证据

中文摘要

利用医疗补助受益人被随机分配至管理式医疗计划这一机制，我们发现，尽管各计划的费用分担安排相同，但不同计划对医疗支出的影响存在显著差异。与加入支出最高的计划相比，加入支出最低的计划使医疗支出至少减少25%，且主要通过减少服务数量实现。支出较低的计划并非仅仅减少“浪费性”支出，而是广泛减少医疗服务供给——包括低成本、高价值医疗服务的供给——并降低受益人的满意度和健康水平。消费者需求与支出走势一致：计划特定支出增加10%，与市场份额增加40%相关。这些事实对政府的签约问题和项目成本增长具有启示意义。（JEL G22、H51、I13、I18、I38）

Abstract

Exploiting the random assignment of Medicaid beneficiaries to managed care plans, we find substantial plan-specific spending effects despite plans having identical cost sharing. Enrollment in the lowest-spending plan reduces spending by at least 25 percent—primarily through quantity reductions—relative to enrollment in the highest-spending plan. Rather than reducing “wasteful” spending, lower-spending plans broadly reduce medical service provision—including the provision of low-cost, high-value care—and worsen beneficiary satisfaction and health. Consumer demand follows spending: a 10 percent increase in plan-specific spending is associated with a 40 percent increase in market share. These facts have implications for the government’s contracting problem and program cost growth. (JEL G22, H51, I13, I18, I38)