在受监管计划价格下的不利选择和网络设计:来自医疗补助计划的证据
Amanda R Kreider1, Timothy J Layton2, Mark Shepard2
1University of Pennsylvania, United States of America.
Journal of health economics
|June 30, 2024
概括
针对低收入人士的私人医疗计划往往限制了进入顶级医院的机会. 负面选择,即计划吸引更生病的患者,会对医疗补助计划产生重大影响,但小额奖金可以确保覆盖必要的专科医院.
科学领域:
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
- 保险市场动态 保险市场动态
背景情况:
- 针对穷人的健康计划经常限制人们获得专门医疗设施的机会.
- 不利选择是影响医疗补助计划内私人健康计划结构的关键因素.
研究的目的:
- 调查不利选择在私人医疗补助计划中对专科医院的有限访问中的作用.
- 分析网络变化的影响,特别是包括一家顶级癌症医院,对计划的入学率和利能力的影响.
主要方法:
- 一个自然实验的分析,涉及健康计划的网络变化.
- 检查招生数据以量化覆盖高需求的专科医院对不同患者群体的影响.
主要成果:
- 覆盖一家顶级癌症医院导致癌症患者的需求增加了50%,这表明严重的不良选择.
- 在没有癌症的入学者中没有观察到对需求的显著影响.
- 医疗补助计划中的固定保险人支付使抵消不利选择和诱导合同扭曲的努力复杂化.
结论:
- 医疗补助的支付结构在管理不利选择方面存在挑战,需要不可持续的支付率或高度准确的风险调整.
- 一个适度的,明确的奖金支付覆盖高需求的专科医院可以有效地减轻不利的选择,并确保有利可图的覆盖.
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