Subsidy Design in Privately Provided Social Insurance: Lessons from Medicare Part D

• 成果类型: Article
• 署名作者: Decarolis, Francesco; Polyakova, Maria; Ryan, Stephen P.
• 署名单位: Bocconi University; Stanford University; Leibniz Association; Ifo Institut; National Bureau of Economic Research; Washington University (WUSTL)
• 刊物名称: JOURNAL OF POLITICAL ECONOMY
• ISSN/ISSBN: 0022-3808
• DOI: 10.1086/705550
• 发表日期: 2020
• 页码: 1712-1752
• 关键词: health-insurance; choice inconsistencies; plan choice; selection

摘要

The efficiency of publicly subsidized, privately provisioned social insurance programs depends on the interaction between strategic insurers and the subsidy mechanism. We study this interaction in the context of Medicare's prescription drug coverage program. We find that the observed mechanism is successful in keeping raise-the-subsidy incentives relatively low, acts much like a flat voucher, and obtains a level of welfare close to that for the optimal voucher. Across a range of counterfactuals, we find that more efficient subsidy mechanisms share three features: they retain the marginal elasticity of demand, limit the exercise of market power, and preserve the link between prices and marginal costs.