Health Insurance Competition and Healthcare Costs

在美国，受监管的健康保险市场越来越重要。本项目的目标是调查这些市场的运作效率，以及私营保险公司之间的竞争如何。我们专注于美国医疗保险计划。几乎三分之一的医疗保险受益人现在通过医疗保险优势参加私人保险计划，医疗保险和最近的私人保险公司提供了详细的行政数据。事实上，医疗保险私人计划与公共收费医疗保险并行运作，并与之竞争，这使得私人和公共管理的医疗保险之间可以进行比较。医疗保险计划的庞大规模-联邦政府每年在医疗保险私人计划上花费超过1300亿美元-也使其产生了重大影响。 该项目将解决三个具体问题：（1）目前的医疗保险管理竞争制度的效率如何？(2)是否有计划的变化，将减少纳税人的成本，而不会使受益人更糟？(3)相对于公共保险，私人计划是否实现了成本节约？如果是，它们是如何做到的？为了回答这些问题，PI将使用医疗索赔数据来比较私人和公共保险计划提供的服务和相关成本。他们还将估计健康计划选择和保险公司之间的竞争模型，并使用这些模型来分析私人计划对参保人，保险公司和纳税人的福利影响。关于私人保险计划和公共保险之间的业务和成本差异以及市场竞争如何运作的调查结果将引起经济学家和更广泛受众的兴趣。

Regulated markets for health insurance are increasingly important in the United States. The goal of this project is to investigate how efficiently these markets can operate, and how well competition between private insurers can work. We focus on the U.S. Medicare program. Almost a third of Medicare beneficiaries now enroll in private insurance plans through Medicare Advantage, and there is detailed administrative data available from Medicare, and recently from private insurers. The fact Medicare private plans operate in parallel to, and in competition with public fee-for-service Medicare, allows for a comparison between private and publicly administered health insurance. The large size of the Medicare program --- the federal government spends over $130 billion annually on Medicare private plans --- also makes it consequential. The project will address three specific questions: (1) How efficient is the current Medicare managed competition system? (2) Are there program changes that would reduce taxpayer costs without making beneficiaries worse off? (3) Do private plans achieve cost savings relative to public insurance, and if so, how do they do it? To answer these questions, the PIs will use medical claims data to compare the services provided and costs associated with private and public insurance plans. They will also estimate models of health plan choice and competition between insurers, and use these models to analyze the welfare effects of private plans for enrollees, insurers and taxpayers. Findings on the operational and cost differences between private insurance plans and public insurance, and on how well market competition is functioning, will be of interest both to economists and a wider audience.