MH AND ADVERSE SELECTION 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，心理健康服务的提供不足将是管理式护理计划将采取的一种策略，以阻止失败者注册，但这种论点从未受到实证审查。在管理式护理中，心理健康服务是否比其他疾病的治疗更有可能提供不足？拟议的研究将通过确定其治疗最受管理式医疗中选择激励影响的条件来解决这个问题。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措施与提供其他服务的激励措施有关。这项建议提出了一种新的方法，根据经济理论，得出一个措施的计划严格的配给服务。我们展示了如何可以使用这种措施作为一个计算上简单的激励指标，以提供各种条件下的服务。我们打算在本研究中实证实施这一概念，并根据研究结果，提出具体的建议，政策的风险调整和“分割”，以处理与选择相关的激励措施的标记管理式医疗计划。服务扭曲产生的选择相关的激励影响计划的选择登记。通过将精神卫生保健从健康计划的竞争战略中去除，开拓计划可能会削弱这种激励。我们测试了这种效应的经验重要性。逆向选择是一个持久的威胁，在保险市场提供精神卫生保健的效率。了解逆向选择如何在管理式医疗中发挥作用，以及可以对此做些什么，应该是研究的一个高度优先事项。

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.