What Does a Provider Network Do? Evidence from Random Assignment in Medicaid Managed Care
中文摘要
利用纽约超过50,000名医疗补助计划（Medicaid）参保者的随机分配，我提供了因果证据，表明覆盖范围较窄的医疗服务提供者网络是一种缺乏精准性的医疗支出削减工具。这类网络虽然能够控制支出，但其作用机制是产生麻烦成本，从而减少医疗服务使用量，而对支付给医疗服务提供者的价格影响较小。被分配到覆盖范围较窄网络的参保者，对必要和不必要的医疗服务的使用均较少，对其医疗保险计划的满意度也较低。利用我的因果效应估计构建反事实情景，我识别出一种替代性分配政策：将消费者与覆盖范围较窄、但包含其医疗服务提供者的网络相匹配，从而在不损害满意度的情况下减少支出。
Abstract
Leveraging the random assignment of over 50,000 Medicaid enrollees in New York, I present causal evidence that narrower networks are a blunt instrument for reducing health care spending. While narrower networks constrain spending, they do so by generating hassle costs that reduce quantity, with modest effects on prices paid to providers. Enrollees assigned to narrower networks use fewer of both needed and unneeded services and are less satisfied with their plans. Using my causal estimates to construct counterfactuals, I identify an alternative assignment policy that reduces spending without harming satisfaction by matching consumers with narrower networks that include their providers. (JEL H51, H75, I13, I18, I38)