医疗保险市场何时应存在纵向选择？

中文摘要

我们研究了受规制的医疗保险市场中提供保障水平选择（即“纵向选择”）的福利效应。我们强调，有效保障水平的异质性不足以成为引入选择的理由。当保费无法反映个人成本时，选择其有效保障水平可能并不符合消费者的最佳利益。我们证明，只有当支付意愿更高的消费者拥有更高的有效保障水平时，纵向选择才是有效率的。我们对这一条件进行了实证考察，发现只要能够强制执行最低保障水平，纵向选择带来的福利增益要么为零，要么在经济意义上很小。

Abstract

We study the welfare effects of offering choice over coverage levels-"vertical choice"-in regulated health insurance markets. We emphasize that heterogeneity in efficient coverage level is not sufficient to motivate choice. When premiums cannot reflect individuals' costs, it may not be in consumers' best interest to select their efficient coverage level. We show that vertical choice is efficient only if consumers with higher willingness-to-pay have a higher efficient level of coverage. We investigate this condition empirically and find that as long as a minimum coverage level can be enforced, the welfare gains from vertical choice are either zero or economically small.