医疗保健中的外生退出、市场结构与均衡合同
Exogenous Exits, Market Structure, and Equilibrium Contracts in Health Care
AER: Insights · 2025 · [{"name": "Natalia Serna", "affiliation": ["Office of Diversity and Inclusion"]}]
中文摘要
本文量化了外生性健康保险公司退出对合同结构与医疗市场结果的因果效应，并提出市场集中度可能是产生这些效应的一个机制。利用哥伦比亚最大健康保险公司退出这一事件，我发现退出之后，相对于按人头付费合同，按服务项目付费合同的使用有所增加。在基线时医疗服务提供者集中度高于保险公司集中度的市场中，处理效应更大。结果表明，在医疗服务提供者拥有更高议价能力的市场中，均衡合同将财务风险置于保险公司一方。（JEL D86, G22, I13, I18, O15, O16）
Abstract
This paper quantifies the causal effects of exogenous health insurer exits on contract structure and health care market outcomes, proposing market concentration as a likely mechanism for these effects. Leveraging the termination of the largest health insurer in Colombia, I find that the use of fee-for-service contracts increased after the termination relative to capitation contracts. Treatment effects are larger in markets with higher provider than insurer concentration at baseline. Results suggest that equilibrium contracts place the financial risk on insurers in markets where providers have higher bargaining leverage. (JEL D86, G22, I13, I18, O15, O16)