Adverse selection and network design under regulated plan prices: Evidence from Medicaid

IF 3.4 2区 经济学 Q1 ECONOMICS
Amanda R. Kreider , Timothy J. Layton , Mark Shepard , Jacob Wallace
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引用次数: 0

Abstract

Health plans for the poor increasingly limit access to specialty hospitals. We investigate the role of adverse selection in generating this equilibrium among private plans in Medicaid. Studying a network change, we find that covering a top cancer hospital causes severe adverse selection, increasing demand for a plan by 50% among enrollees with cancer versus no impact for others. Medicaid’s fixed insurer payments make offsetting this selection, and the contract distortions it induces, challenging, requiring either infeasibly high payment rates or near-perfect risk adjustment. By contrast, a small explicit bonus for covering the hospital is sufficient to make coverage profitable.

受管制计划价格下的逆向选择和网络设计:来自医疗补助的证据。
针对贫困人口的医疗计划越来越多地限制他们前往专科医院就诊。我们研究了逆向选择在医疗补助的私人计划中产生这种平衡的作用。通过研究网络变化,我们发现覆盖一家顶级癌症医院会导致严重的逆向选择,使患癌症的参保者对计划的需求增加 50%,而对其他参保者则没有影响。医疗补助的固定保险人支付使得抵消这种选择及其引起的合同扭曲具有挑战性,要么需要高得离谱的支付率,要么需要近乎完美的风险调整。相比之下,对承保医院的小额明确奖励足以使承保有利可图。
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来源期刊
Journal of Health Economics
Journal of Health Economics 医学-卫生保健
CiteScore
6.10
自引率
2.90%
发文量
96
审稿时长
49 days
期刊介绍: This journal seeks articles related to the economics of health and medical care. Its scope will include the following topics: Production and supply of health services; Demand and utilization of health services; Financing of health services; Determinants of health, including investments in health and risky health behaviors; Economic consequences of ill-health; Behavioral models of demanders, suppliers and other health care agencies; Evaluation of policy interventions that yield economic insights; Efficiency and distributional aspects of health policy; and such other topics as the Editors may deem appropriate.
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