Externalities and Benefit Design in Health Insurance
Externalities and Benefit Design in Health Insurance
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DOI：
10.1093/restud/rdz052
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发表时间：
2020-11-01
影响因子：
5.8
通讯作者：
Town, Robert J.
中科院分区：
文献类型：
--
作者：
Starc, Amanda;Town, Robert J.
保险福利设计对消费者福利具有重要意义。在本文中，我们对保险公司在医疗保险处方药覆盖市场中的行为进行了建模，并表明私营保险公司的战略激励对传统医疗保险计划施加了财政外部性。我们的文件表明，涵盖医疗费用的计划比只负责处方药支出的计划有更慷慨的药物覆盖范围，这转化为参保者更高的药物利用率。这种效应是由减少医疗支出和治疗慢性病的药物推动的。我们的效益设计均衡模型内化了规划特征并考虑了信息不对称；该模型估计证实，内化医疗补偿的不同激励可以解释计划之间的差异。反事实表明，在决定福利设计时，保险公司的战略激励与信息不对称同样重要。
Insurance benefit design has important implications for consumer welfare. In this article, we model insurer behaviour in the Medicare prescription drug coverage market and show that strategic private insurer incentives impose a fiscal externality on the traditional Medicare program. We document that plans covering medical expenses have more generous drug coverage than plans that are only responsible for prescription drug spending, which translates into higher drug utilization by enrolees. The effect is driven by drugs that reduce medical expenditure and treat chronic conditions. Our equilibrium model of benefit design endogenizes plan characteristics and accounts for asymmetric information; the model estimates confirm that differential incentives to internalize medical care offsets can explain disparities across plans. Counterfactuals show that strategic insurer incentives are as important as asymmetric information in determining benefit design.