外生退出、市场结构与医疗保健中的均衡合约

中文摘要

本文量化了健康保险公司外生退出对合约结构和医疗保健市场结果的因果效应，并提出市场集中度是产生这些效应的一种可能机制。利用哥伦比亚最大健康保险公司终止运营这一事件，我发现终止运营后，按服务付费合约相对于按人头付费合约的使用有所增加。在基期医疗服务提供方集中度高于保险方集中度的市场中，处理效应更大。结果表明，在医疗服务提供方拥有较高议价能力的市场中，均衡合约将财务风险置于保险方一侧。(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)