医疗保险竞争能否奏效？来自 Medicare Advantage 的证据

中文摘要

我们估计了 Medicare Advantage 项目在其改革后的竞争性投标规则下所创造的经济剩余。我们利用 Medicare 受益人的全体数据，并构建了一个考虑市场势力与风险选择的计划投标模型。我们估计，Medicare Advantage 项目为参与者创造了可观的剩余（每参保人每月 217 美元），但这一剩余中约有三分之二被保险公司获取。我们利用该模型评估可能的项目改革所带来的影响，包括那些能够增强竞争、从而在不增加纳税人成本的情况下降低利润并提高消费者剩余的改革。

Abstract

We estimate the economic surplus created by the Medicare Advantage program under its reformed competitive bidding rules. We use data on the universe of Medicare beneficiaries and develop a model of plan bidding that accounts for both market power and risk selection. We estimate that the Medicare Advantage program generates substantial surplus to participants (of $217 per enrollee-month), but that approximately two-thirds of this surplus is captured by insurers. We use the model to evaluate the impact of possible program changes, including changes that could increase competition and lead to lower profits and higher consumer surplus without raising taxpayer costs.