The Spillover Effects of Health Insurance Coverage and Generosity

说明（由申请人提供）：对健康保险对获得护理和健康结果的影响进行了广泛研究。一个人的健康保险覆盖范围对其他患者的医疗保健利用和健康结果的溢出效应知之甚少。本项目不仅探讨了医疗保险覆盖对被保险人的影响，还探讨了整个医疗保健系统所提供的医疗服务的数量和质量。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，是评估医疗保险和医疗补助等政府医疗保险计划的更广泛影响的关键组成部分。如果扩大覆盖范围的许多好处都给了没有直接受到覆盖范围影响的患者，那么，不考虑这些溢出效应的私人和公共政策分析可能会得出关于健康保险覆盖的最佳范围、来源和结构的错误结论。首先，该项目将确定健康保险覆盖的溢出效应是否存在及其程度。为此，我们将通过非比例共享医院（DSH）计划检查医疗补助慷慨增加对医院人员和资本设备支出的影响，包括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，本项目将探索这些卫生和支出溢出效应发生的渠道，如不同人群之间的卫生联合生产、提供者保险状况的不完全区分、提供者偏好和直接卫生溢出效应。我们将通过研究溢出效应集中的不同人群、疾病和治疗方法来区分这些溢出机制。我们将探讨这些不同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.