The Spillover Effects of Health Insurance Coverage and Generosity

描述（由申请人提供）：健康保险对获得护理和健康结果的影响已得到广泛研究。关于一个人的健康保险对其他患者的医疗保健利用和健康结果的溢出效应，人们知之甚少。该项目探讨了健康保险覆盖范围的后果，不仅对那些谁被覆盖，但对整个医疗保健系统提供的护理的数量和质量。了解特定患者群体的医疗保险覆盖范围变化的更广泛后果是评估政府医疗保险计划（如Medicare和Medicaid）更广泛影响的关键组成部分：如果覆盖范围扩大的许多益处增加到不直接受覆盖范围影响的患者，那么，对私人和公共政策的分析如果不考虑这些溢出效应，就可能得出关于健康保险覆盖范围、来源和结构的最佳结论。首先，本项目将确定健康保险覆盖范围的溢出效应的存在和程度。我们将通过研究医疗补助慷慨增加的影响，通过不成比例的份额医院（DSH）计划对医院的人员和资本设备支出，无论是医疗补助患者和非医疗补助患者。然后，我们将追踪这些支出变化对患者健康结果的影响。其次，本项目将探讨这些健康和支出溢出的发生渠道，如不同人群之间的健康联合生产，提供者的保险状态的不完全区分，提供者偏好和直接健康溢出。我们将通过研究溢出效应集中的不同人群、疾病和治疗来区分这些溢出机制。我们将探讨这些不同的机制对卫生政策的影响，如医疗保险购买补贴的相对效率，直接提供护理，技术采用补贴，医疗保险和医疗补助的资格和报销结构。

DESCRIPTION (provided by applicant): The impact of health insurance on access to care and health outcomes has been studied extensively. Much less is known about the spillover effects of one person's health insurance coverage on the health care utilization and health outcomes of other patients. This project explores the consequences of health insurance coverage not just for those who are covered, but for the quantity and quality of care provided throughout the health care system. Understanding the wider consequences of changes in the scope of health insurance coverage for particular patient groups is a key component in evaluating the broader effects of government health insurance programs such as Medicare and Medicaid: if many of the benefits of coverage expansions accrue to patients not directly affected by the coverage, then analyses of both private and public policies that do not take these spillovers into account may come to incorrect conclusions about the optimal scope, source and structure of health insurance coverage. First, this project will identify the existence and magnitude of the spillover effects of health insurance coverage. We will do this by examining the effects of increases in Medicaid generosity through the Disproportionate Share Hospital (DSH) program on hospital spending for personnel and capital equipment, both for Medicaid patients and non-Medicaid patients. We will then trace out the effects of those spending changes on patient health outcomes. Second, this project will explore the channels through which these health and spending spillovers occur, such as joint production of health across different populations, imperfect differentiation of insurance status by providers, provider preferences, and direct health spillovers. We will distinguish among these spillover mechanisms by examining the different populations, diseases, and treatments in which spillovers are concentrated. We will explore the implications of these different mechanisms for health policy, such as the relative efficiency of subsidies for health insurance purchase, direct provision of care, subsidies for technology adoption, and Medicare and Medicaid eligibility and reimbursement structures.