Bargaining in Markets with Exclusion: An Analysis of Health Insurance Networks
Bargaining in Markets with Exclusion: An Analysis of Health Insurance Networks
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排除市场中的讨价还价：健康保险网络分析
DOI：
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
E. Liebman
中科院分区：
文献类型：
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作者：
E. Liebman
本文探讨了保险公司将医院排除在其网络之外以在合同谈判中获得议价杠杆的常见故事。我提出了一个新的双边寡头垄断环境下价格形成的模型，其中网络是内生的。其网络的内生性使得保险公司可以威胁将医院排除在外。排斥是一种平衡结果；保险公司通过减少对医院的补偿来抵消来自价值较低的网络的保费损失。我使用科罗拉多所有付款人索赔数据库的数据来估计这个模型。我发现，使用反事实分析，限制保险公司的排除能力将导致医院和保险公司之间谈判的价格上涨50%，而医院-保险公司讨价还价文献中使用的纳什-纳什框架发现价格将下降36%。
This paper explores the common story that insurance companies exclude hospitals from their networks to gain bargaining leverage in contract negotiations. I propose a novel model of price formation in a bilateral oligopoly setting where the networks are endogenous. The endogeneity of its network allows the insurer to threaten to exclude hospitals. Exclusion is an equilibrium outcome; the insurer offsets the loss of premiums from a less valuable network by reimbursing hospitals less. I estimate this model using data from the Colorado All-Payer Claims Database. I find, using a counterfactual analysis, that restricting insurers’ ability to exclude would lead to 50 percent higher prices negotiated between hospitals and insurers, while the Nash-in-Nash framework used in the hospital-insurer bargaining literature finds prices would fall by 36 percent.
平价医疗法案的早期影响（各州）
影响因子：
5.9
作者：
Kowalski, Amanda E.
通讯作者：
Kowalski, Amanda E.