Bargaining and Network Formation: Equilibrium Medical Provider Networks in Health Care Markets

讨价还价和网络形成：医疗保健市场中的均衡医疗提供者网络

• 批准号: 1730063
• 负责人: Robin Lee
• 金额: $ 26.11万
• 依托单位: Harvard University
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2021-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1730063&HistoricalAwards=false
• 关键词: Bargaining; Network; Formation; Equilibrium; Medical

This project combines economic theory and statistical methods to analyze the strategic interactions between health insurance firms and medical providers in the commercial U.S. health care market. The primary goal is to further our understanding of how rate negotiations between insurers and providers (hospital systems and physician groups) -- responsible for a substantial portion of the $1 trillion of spending in the private health care sector -- affect consumer welfare, utilization, and access to high-quality and cost-effective care. The analysis leverages detailed medical claims and enrollment data to estimate and quantify the effects of selective contracting, or "narrow network" offerings, by insurers, and of provider and insurer consolidation. The empirical findings and applied frameworks from this research will help inform the evaluation of network adequacy regulation, competition policy, and health marketplace design; furthermore, it will assist final payers for health care services -- particularly self-insured employers and government agencies -- in designing welfare-enhancing and cost-reducing plans.This research examines the formation of medical provider networks and determination of reimbursement rates in three projects. The first project develops a theoretical model of selective contracting and bargaining with exclusion; it then pairs the model with estimated parameters from prior work to evaluate the impact of insurance network regulation by simulating equilibrium networks, premiums, and reimbursement rates under different policies. The second project applies a dynamic model of network formation and bargaining among insurers and hospital systems to examine the price effects of hospital consolidation. The model used in this part differs from the first in that it considers competition among several insurers when forming networks, and admits for contracting frictions and dynamic considerations. It also departs from prior work on hospital mergers by explicitly accounting for potential network and rate adjustments. Finally, the third project studies the historic introduction of a narrow physician network plan by a large HMO provider in California, and examines both supply-side (including changes in physician capitation rates) and demand-side (consumer enrollment, utilization) responses.

该项目结合经济理论和统计方法，分析美国商业医疗保健市场中健康保险公司和医疗服务提供者之间的战略互动。主要目标是进一步了解保险公司和供应商（医院系统和医生团体）之间的费率谈判-负责私人医疗保健部门1万亿美元支出的很大一部分-影响消费者福利，利用率和获得高质量和具有成本效益的护理。 该分析利用详细的医疗索赔和登记数据来估计和量化保险公司选择性合同或“窄网络”产品以及供应商和保险公司合并的影响。本研究的实证结果和应用框架将有助于为网络充分性监管、竞争政策和健康市场设计的评估提供信息;此外，本发明还它将帮助医疗保健服务的最终支付者-特别是自我保险的雇主和政府机构-设计福利提高和成本降低方案，这项研究探讨了医疗提供者网络的形成和三个项目中报销率的确定。第一个项目开发了一个理论模型的选择性合同和讨价还价的排斥，然后配对模型与估计参数从以前的工作，以评估保险网络监管的影响，通过模拟平衡网络，保费和不同的政策下的报销率。第二个项目应用一个动态模型的网络形成和讨价还价的保险公司和医院系统，以检查医院合并的价格效应。与第一部分不同的是，本部分考虑了多个保险公司在形成网络时的竞争，并考虑了合同摩擦和动态因素。它还通过明确考虑潜在的网络和费率调整，偏离了以前关于医院合并的工作。 最后，第三个项目研究了加州的一家大型HMO提供商历史性地推出了一个狭窄的医生网络计划，并研究了供应方（包括医生人头率的变化）和需求方（消费者注册，利用）的反应。

项目成果

Equilibrium Provider Networks: Bargaining and Exclusion in Health Care Markets

均衡提供者网络：医疗保健市场中的讨价还价和排斥

• DOI: 10.1257/aer.20171288
• 发表时间: 2019
• 期刊: American Economic Review
• 影响因子: 10.7
• 作者: Ho, Kate;Lee, Robin S.
• 通讯作者: Lee, Robin S.