MENTAL HEALTH & ADVERSE SELECTIOIN IN MANAGED CARE

许多人认为，由于心理健康成本与其他服务成本的相关性，管理保健计划将采取一种策略来阻止失败的参保者，但这种说法从未受到过实证审查。与其他疾病的治疗相比，管理型医疗中的精神健康服务更有可能提供不足吗？拟议的研究将通过确定哪些疾病的治疗最受管理医疗中的选择激励影响来解决这个问题。我们对精神健康特别感兴趣，但我们认为提供精神健康护理的激励与其他服务的激励相关联。这一建议引入了一种基于经济学理论的新方法，以推导出服务配给中计划严格性的衡量标准。我们展示了如何将这一衡量标准用作在不同条件下过度和不足提供服务的激励因素的计算简单指数。我们打算在这项研究中经验性地实施这一概念，并根据研究结果，为风险调整和“开拓”政策提出具体建议，以处理管理保健计划标记物中与选择相关的激励。与选择相关的激励所产生的服务扭曲影响了投保人的计划选择。开拓计划可能会通过将精神卫生保健从健康计划的竞争战略中移除来削弱这种激励。我们检验了这一效应的经验重要性。逆向选择是对保险市场提供精神卫生保健的效率的持久威胁。了解逆向选择在管理性医疗中是如何发挥作用的，以及对此可以做些什么，应该是研究的一个非常高的优先事项。

Many believe that underprovision of mental health services will be one strategy managed care plans will adopt to discourage loser enrollees because of the correlation of mental health costs with costs of other services, but this contention has never been subject to empirical scrutiny. Are mental health services any more likely to be under-provided in managed care than treatments for other conditions? The proposed research would address this question by identifying the conditions whose treatments are most affected by selection incentives in managed care. We are particularly interested in mental health, but we consider the incentives to provide care for mental health in relation to the incentives for other services. This proposal introduces a new approach, based on economic theory, to derive a measure of plan strictness in rationing of services. We show how this measure can be used as a computationally straightforward index of incentives to over and under-provide services for various conditions. We intend to empirically implement this concept in this research, and based on the results, make concrete recommendations for policies of risk adjustment and "carve outs" for dealing with selection-related incentives in markers for managed care plans. Service distortions generated by selection-related incentives affect the plan choices of enrollees. Carve out programs may attenuate such incentives by removing the mental health care from the competitive strategy of health plans. We test the empirical importance of this effect. Adverse selection is a enduring threat to the efficiency of provision of mental health care in insurance markets. Understanding how adverse selection works in managed care and what can be done about it should be a very high priority for research.