Health Care Rationing in Public Insurance Programs: Evidence from Medicaidt

• 成果类型: Article
• 署名作者: Layton, Timothy J.; Maestas, Nicole; Prinz, Daniel; Vabson, Boris
• 署名单位: Harvard University; National Bureau of Economic Research; The World Bank; University of London; London School Economics & Political Science
• 刊物名称: AMERICAN ECONOMIC JOURNAL-ECONOMIC POLICY
• ISSN/ISSBN: 1945-7731
• DOI: 10.1257/pol.20190628
• 发表日期: 2022
• 页码: 397-431
• 关键词: quality-of-care; Managed care; COMPETITION

摘要

We study two mechanisms used by public health insurance programs for rationing health care: outsourcing to private managed care plans and quantity limits for prescription drugs. Leveraging a natural experiment in Texas's Medicaid program, we find that the shift to managed care and the relaxation of a strict drug cap increased access to high-value drugs and outpatient services and reduced avoidable hospitalizations. Program costs increased significantly, indicating a trade-off between cost and quality. We provide suggestive evidence attributing the reduction in hospitalizations to the relaxation of the drug cap and much of the spending increase to the shift to managed care. (JEL G22, H75, I13, I18, I38)