公共保险计划中的医疗服务配给：来自医疗补助计划（Medicaid）的证据

中文摘要

我们研究公共医疗保险计划用于配给医疗服务的两种机制：外包给私营管理式医疗计划，以及对处方药实施数量限制。利用得克萨斯州医疗补助计划（Medicaid）中的一项自然实验，我们发现，转向管理式医疗以及放宽严格的药品数量上限，增加了获得高价值药品和门诊服务的机会，并减少了可避免的住院。计划成本显著增加，表明成本与质量之间存在权衡。我们提供了提示性证据，表明住院减少可归因于药品数量上限的放宽，而支出增加中的很大一部分可归因于转向管理式医疗。

Abstract

We study two mechanisms used by public health insurance programs for rationing health care: outsourcing to private managed care plans and quantity limits for prescription drugs. Leveraging a natural experiment in Texas’s Medicaid program, we find that the shift to managed care and the relaxation of a strict drug cap increased access to high-value drugs and outpatient services and reduced avoidable hospitalizations. Program costs increased significantly, indicating a trade-off between cost and quality. We provide suggestive evidence attributing the reduction in hospitalizations to the relaxation of the drug cap and much of the spending increase to the shift to managed care. (JEL G22, H75, I13, I18, I38)