中文摘要
私人健康保险市场中的消费者具有高度惯性。文献反复发现，消费者愿意支付数千美元来保留其健康计划。然而，惯性的成因尚未得到充分理解，尽管这些成因对于判断能否通过减少惯性来改善福利以及哪些类型的政策能有效做到这一点至关重要。利用加利福尼亚州健康保险市场的行政数据，我们借助注意力不足与健康计划选择的两阶段模型，分别识别出惯性的三个来源——对医疗服务提供者连续性的偏好、注意力不足以及麻烦成本。我们发现，消除注意力不足和麻烦成本将使重复选择同一健康计划的概率降低53个百分点，且减少注意力不足和麻烦成本的干预措施是互补的。2018年，注意力不足和麻烦成本使消费者损失了超过10亿美元的消费者剩余，约合每户每年1,790美元，相当于中位数家庭所支付年度保费的一半，其中注意力不足是消费者剩余损失的最大来源。我们得出结论，旨在减少惯性计划选择的干预措施应同时聚焦于麻烦成本，尤其是注意力不足，而非对医疗服务提供者连续性的偏好。
Abstract
Consumers in private health insurance markets are highly inertial. The literature has repeatedly found consumers are willing to pay thousands of dollars to keep their health plan. However, the causes of inertia are not well understood, despite their importance in determining whether welfare can be improved by reducing inertia and which types of policies would be effective in doing so. Using administrative data from California’s Health Insurance Marketplace, we separately identify three sources of inertia—tastes for provider continuity, inattention, and hassle costs—using two-stage models of inattention and health plan choice. We find that eliminating inattention and hassle costs would reduce repeated health plan choice by 53 percentage points and that interventions to reduce inattention and hassle costs are complements. Inattention and hassle costs cost consumers over a billion dollars in foregone consumer surplus in 2018, roughly $1,790 per household per year or half the annual premium paid by the median household, with inattention accounting for the largest source of forgone surplus. We conclude that interventions to reduce inertial plan choice should jointly focus on hassle costs and particularly inattention, but not tastes for provider continuity.