Do health insurers innovate? Evidence from the anatomy of physician payments
Do health insurers innovate? Evidence from the anatomy of physician payments
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DOI：
10.1016/j.jhealeco.2017.07.001
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发表时间：
2017-09-01
影响因子：
3.5
通讯作者：
Molnar, Timea Laura
中科院分区：
文献类型：
--
作者：
Clemens, Jeffrey;Gottlieb, Joshua D.;Molnar, Timea Laura
在美国，私人健康保险公司的主要角色之一是代表受益人协商医生的支付率。我们表明，这些费率通常是参照政府基准设定的，并询问私人保险公司多久会定制他们的收费计划，以避免这种违约。我们利用医疗保险支付的变化和医疗保险费率的大幅加价来解决这个问题。虽然医疗保险的费率是有影响力的，但在我们的数据中，25%的医生服务，代表了45%的覆盖支出，偏离了基准。偏离的普遍性和方向上的异质性表明，私人市场围绕医疗保险的简单定价进行协调，但当足够的价值受到威胁时，就会放弃它。(C) 2017 Elsevier B.V.版权所有
One of private health insurers' main roles in the United States is to negotiate physician payment rates on their beneficiaries' behalf. We show that these rates are often set in reference to a government benchmark, and ask how often private insurers customize their fee schedules away from this default. We exploit changes in Medicare's payments and dramatic bunching in markups over Medicare's rates to address this question. Although Medicare's rates are influential, 25 percent of physician services in our data, representing 45 percent of covered spending, deviate from the benchmark. Heterogeneity in the pervasiveness and direction of deviations suggests that the private market coordinates around Medicare's pricing for simplicity but abandons it when sufficient value is at stake. (C) 2017 Elsevier B.V. All rights reserved.