Salience, Myopia, and Complex Dynamic Incentives: Evidence from Medicare Part D
Salience, Myopia, and Complex Dynamic Incentives: Evidence from Medicare Part D
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DOI：
10.3386/w21104
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发表时间：
2015-04
期刊：
影响因子：
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通讯作者：
C. Dalton;Gautam Gowrisankaran;R. Town
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文献类型：
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作者：
C. Dalton;Gautam Gowrisankaran;R. Town
标准的医疗保险D部分药物保险合同是非线性的，在覆盖范围内减少补贴，导致动态购买问题。我们考虑了那些在年初到达差距附近的参与者，并表明他们应该期望以高概率进入差距，这意味着，在新古典偏好的基准模型下，差距对他们的影响应该很小。我们发现，这些注册者在甜甜圈洞之前的一段时间内支出持平，而在差距内支出大幅下降，这为基准模型提供了证据。我们从结构上估计了行为动态药物购买模型，发现价格显着性模型，其中注册者不将未来的价格纳入他们的决策，在所有适合的数据。对于一个具有全国代表性的样本，全价显着性将减少31%的注册支出。彻底消除差距将使保险公司的支出增加27%，而只有仿制药的差距覆盖率为7%。
The standard Medicare Part D drug insurance contract is nonlinear—with reduced subsidies in a coverage gap—resulting in a dynamic purchase problem. We consider enrollees who arrived near the gap early in the year and show that they should expect to enter the gap with high probability, implying that, under a benchmark model with neoclassical preferences, the gap should impact them very little. We find that these enrollees have flat spending in a period before the doughnut hole and a large spending drop in the gap, providing evidence against the benchmark model. We structurally estimate behavioral dynamic drug purchase models and find that a price salience model where enrollees do not incorporate future prices into their decision making at all fits the data best. For a nationally representative sample, full price salience would decrease enrollee spending by 31%. Entirely eliminating the gap would increase insurer spending 27%, compared to 7% for generic-drug-only gap coverage.