Collaborative Research: Equilibria in Health Exchanges: Adverse Selection, Reclassification Risk, and Dynamic Contracting

合作研究：健康交换中的均衡：逆向选择、重新分类风险和动态契约

• 批准号: 1260949
• 负责人: Igal Hendel
• 金额: $ 33.77万
• 依托单位: Northwestern University
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1260949&HistoricalAwards=false
• 关键词: Collaborative; Research; Equilibria; Health; Exchanges

Health insurance markets are subject to a variety of regulations driven by efficiency and equity provision. The Patient Protection and Affordable Care Act (PPACA) proposes the use of exchanges; markets where insurers offer yearly policies subject to several pricing rules. Despite the substantial public discussion of health exchanges, there has been little formal analysis of the likely outcomes and welfare impact of alternative designs. The goal of this project is model of insurer competition in a regulated marketplace in order to investigate both theoretically and empirically the functioning of exchanges.The PIs develop a model of an insurance exchange building on the models of Rothschild and Stiglitz (1976), Wilson (1977), Miyazaki (1977) and Riley (1985). They propose to investigate the properties of equilibria in exchanges and present an algorithm to find equilibria using a population and their estimated distributions of health risk and preferences. The PIs use detailed information on individual-level health plan choices and health claims from a large firm to simulate an exchange. Preferences are recovered from a structural choice model, while the distribution of health risk is quantified with a professional risk assessment software program.Preliminary results reveal lot of unraveling due to asymmetric information/adverse selection. One way to potentially reduce this unraveling is by allowing pricing based on pre-existing conditions, which the PPACA bans. However, in the longer run, pricing pre-existing conditions can subject consumers to re-classification risk. The PIs will examine the effects of this rule. Preliminary results suggest the losses from reclassification risk may far outweigh the adverse selection losses. In addition, absent subsidies, around 20% of the population would opt out of the exchange in the absence of a mandate compelling participation. The PIs also propose to examine the impact of a number of possible alternative designs of an exchange. One of these is the current suggestions for risk adjustment, which has recently been proposed by HHS.

健康保险市场受到各种法规的影响，这些法规是由效率和公平规定驱动的。《患者保护和平价医疗法案》（PPACA）建议使用交易所;保险公司根据几项定价规则提供年度保单的市场。尽管公众对健康交换进行了大量讨论，但很少有对替代设计的可能结果和福利影响进行正式分析。本研究的目标是建立一个在管制市场中的保险公司竞争模型，以便从理论和经验上研究保险交易所的功能。本研究以Rothschild和Stiglitz（1976）、Wilson（1977）、宫崎（1977）和Riley（1985）的模型为基础，建立了一个保险交易所模型。他们建议研究交易所中均衡的性质，并提出一种算法，使用人口及其健康风险和偏好的估计分布来找到均衡。PI使用个人层面的健康计划选择和健康索赔的详细信息，从一个大公司模拟交换。偏好是从结构选择模型中恢复的，而健康风险的分布是用专业的风险评估软件程序量化的。初步结果显示，由于信息不对称/逆向选择，很多解开。一种可能减少这种混乱的方法是允许根据预先存在的条件定价，而PPACA禁止这种情况。然而，从长远来看，定价预先存在的条件可能会使消费者面临重新分类的风险。PI将检查此规则的效果。初步结果表明，重新分类风险的损失可能远远超过逆向选择损失。此外，如果没有补贴，大约20%的人口将在没有强制参与的情况下选择退出交易所。研究报告还建议研究一些可能的交易所替代设计的影响。其中之一是HHS最近提出的风险调整建议。