医疗补助扩张和私人保险"挤出" (1999-2019) 的情况
1University of Iowa College of Public Health; Department of Health Management and Policy.
概括
美国的医疗补助扩张导致18-64岁成年人的私人保险覆盖率下降了1.5%. 这种"挤出"效应被观察到超过二十年,突出显示了长期影响.
科学领域:
- 卫生经济学 卫生经济学
- 公共政策 公共政策
- 计量经济学 计量经济学
背景情况:
- 医疗补助计划的扩张历来引起了人们对私人医疗保险"挤出"的担忧.
- 之前的研究受限于短时间框架和州级数据.
- 这项研究提供了一个全面的,长期的国家分析.
研究的目的:
- 评估医疗补助扩展对美国私人保险覆盖率的影响.
- 通过使用20年的数据集和先进的计量经济学技术来解决先前研究的局限性.
- 量化私人保险挤出的程度,归因于医疗补助扩张.
主要方法:
- 利用美国人口普查局关于18-64岁成人 (1999-2019) 私人保险覆盖的数据.
- 采用了一个分阶段的双向固定效应差异回归模型.
- 应用了四种新的计量经济学方法来缓解分阶采用带来的偏差,并测试了预处理趋势和异质效应.
主要成果:
- 医疗补助的扩张与私人保险利率的统计学上显著下降1.5%点有关 (p < 0.001).
- 随着时间的推移,观察到众筹效应的显著异质性,在扩张后大约四年达到顶峰.
- 众筹的规模表明,它对私人保险市场产生了显著的影响,尽管有争议.
结论:
- 医疗补助计划的扩展对全国私人医疗保险覆盖率产生了可衡量的负面影响.
- 这些发现强调了在评估卫生政策干预措施时考虑长期和全国范围的影响的重要性.
- 建议进行进一步的研究,以充分理解这种挤出效应的含义.
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