What Difference Does a Health Plan Make? Evidence from Random Plan Assignment in Medicaidt

• 成果类型: Article
• 署名作者: Geruso, Michael; Layton, Timothy J.; Wallace, Jacob
• 署名单位: University of Texas System; University of Texas Austin; National Bureau of Economic Research; Harvard University; Yale University
• 刊物名称: AMERICAN ECONOMIC JOURNAL-APPLIED ECONOMICS
• ISSN/ISSBN: 1945-7782
• DOI: 10.1257/app.20210843
• 发表日期: 2023
• 页码: 341-379
• 关键词: low-value care; insurance experiment; impacts; neighborhoods; CHOICE; exposure

摘要

Exploiting the random assignment of Medicaid beneficiaries to managed care plans, we find substantial plan-specific spending effects despite plans having identical cost sharing. Enrollment in the lowest-spending plan reduces spending by at least 25 percent -primarily through quantity reductions-relative to enrollment in the highest-spending plan. Rather than reducing wasteful spending, lower-spending plans broadly reduce medical service provision -including the provision of low-cost, high-value care-and worsen beneficiary satisfaction and health. Consumer demand follows spending: a 10 percent increase in plan-specific spending is asso-ciated with a 40 percent increase in market share. These facts have implications for the government's contracting problem and program cost growth. (JEL G22, H51, I13, I18, I38)