Mortality Effects and Choice Across Private Health Insurance Plans.
Mortality Effects and Choice Across Private Health Insurance Plans.
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DOI：
10.1093/qje/qjab017
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Starc A
中科院分区：
文献类型：
--
作者：
Abaluck J;Bravo MC;Hull P;Starc A
如果消费者不能确定高质量的计划，健康保险市场的竞争可能无法改善健康结果。我们开发并应用了一个新的工具变量框架来量化计划中因果死亡率影响的变化，以及消费者对这种变化的关注程度。我们首先记录了医疗保险优势计划在当地市场中观察到的死亡率的巨大差异。然后我们表明，当高(低)死亡率的计划退出这些市场时，参与者往往会转向更典型的计划，随后经历更低(更高)的死亡率。我们推导并验证了一个新的“后备条件”，该条件支配着那些受计划退出影响的人随后的选择。当后备条件满足时，可以使用计划终止来估计观察到的计划死亡率和因果死亡率之间的关系。应用该框架，我们发现死亡率不带偏见地预测因果死亡效应。然后，我们将我们的框架扩展到研究计划死亡率影响的其他预测因素，并估计消费者的支付意愿。更高的支出计划往往会降低参保者的死亡率，但现有的质量评级与计划死亡率的影响无关。消费者在选择计划时很少考虑死亡率的影响。好的保险计划极大地降低了死亡率，而将消费者重新引导到此类计划可能会改善受益人的健康。
Competition in health insurance markets may fail to improve health outcomes if consumers are not able to identify high quality plans. We develop and apply a novel instrumental variables framework to quantify the variation in causal mortality effects across plans and how much consumers attend to this variation. We first document large differences in the observed mortality rates of Medicare Advantage plans within local markets. We then show that when plans with high (low) mortality rates exit these markets, enrollees tend to switch to more typical plans and subsequently experience lower (higher) mortality. We derive and validate a novel “fallback condition” governing the subsequent choices of those affected by plan exits. When the fallback condition is satisfied, plan terminations can be used to estimate the relationship between observed plan mortality rates and causal mortality effects. Applying the framework, we find that mortality rates unbiasedly predict causal mortality effects. We then extend our framework to study other predictors of plan mortality effects and estimate consumer willingness to pay. Higher spending plans tend to reduce enrollee mortality, but existing quality ratings are uncorrelated with plan mortality effects. Consumers place little weight on mortality effects when choosing plans. Good insurance plans dramatically reduce mortality, and redirecting consumers to such plans could improve beneficiary health.
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