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含免赔额保险合同中对动态激励的反应:来自双重差分-断点回归设计的证据

The response to dynamic incentives in insurance contracts with a deductible: Evidence from a differences-in-regression-discontinuities design
Journal of Public Economics · 2022 · Tobias J. Klein、Martin Salm、Suraj Upadhyay

中文摘要

我们开发了一种新方法,以量化患者如何在含免赔额的医疗保险合同中对动态激励作出反应。我们的方法在双重差分-断点回归设计中利用了两种变异来源:免赔额合同在年初重置,以及费用分担上限逐年变化。使用来自一家大型荷兰健康保险公司的丰富理赔级数据,我们发现个体是前瞻性的。通过将免赔额增加100欧元来改变动态激励,导致医疗保健支出在年初的头几天减少约3%,在年度水平上减少6%。我们发现,对动态激励的反应是费用分担方案对医疗保健支出总体效应的重要组成部分——其程度远超以往文献所提示的。

Abstract

We develop a new approach to quantify how patients respond to dynamic incentives in health insurance contracts with a deductible. Our approach exploits two sources of variation in a differences-in-regression-discontinuities design: deductible contracts reset at the beginning of the year, and cost-sharing limits change over the years. Using rich claims-level data from a large Dutch health insurer we find that individuals are forward-looking. Changing dynamic incentives by increasing the deductible by €100 leads to a reduction in healthcare spending of around 3% on the first days of the year and 6% at the annual level. We find that the response to dynamic incentives is an important part of the overall effect of cost-sharing schemes on healthcare expenditures—much more so than what the previous literature has suggested.
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