全球智库信息集成服务系统(G2TT): Do Insurers Risk-Select Against Each Other? Evidence from Medicaid and Implications for Health Reform

G2TT

来源类型	Working Paper
规范类型	报告
DOI	10.3386/w19198
来源ID	Working Paper 19198
	Do Insurers Risk-Select Against Each Other? Evidence from Medicaid and Implications for Health Reform
	Ilyana Kuziemko; Katherine Meckel; Maya Rossin-Slater
发表日期	2013-07-02
出版年	2013
语种	英语
摘要	Increasingly in U.S. public insurance programs, the state finances and regulates competing, capitated private health plans but does not itself directly insure beneficiaries through a public fee-for-service (FFS) plan. We develop a simple model of risk-selection in such settings. Capitation incentivizes insurers to retain low-cost clients and thus improve their care relative to high-cost clients, who they prefer would switch to a competitor. We test this prediction using county transitions from FFS Medicaid to capitated Medicaid managed care (MMC) for pregnant women and infants. We first document the large health disparities and corresponding cost differences between blacks and Hispanics (who make up the large majority of Medicaid enrollees in our data), with black births costing nearly double that of Hispanics. Consistent with the model, black-Hispanic infant health disparities widen under MMC (e.g., the black-Hispanic mortality gap grows by 42 percent) and black mothers' pre-natal care worsens relative to that of Hispanics. Remarkably, black birth rates fall (and abortions rise) significantly after MMC--consistent with mothers reacting to poor care by reducing fertility or plans discouraging births from high-cost groups. Implications for the ACA exchanges are discussed
主题	Public Economics ; Public Goods ; Health, Education, and Welfare ; Health ; Labor Economics ; Demography and Aging
URL	https://www.nber.org/papers/w19198
来源智库	National Bureau of Economic Research (United States)
引用统计
资源类型	智库出版物
条目标识符	http://119.78.100.153/handle/2XGU8XDN/576871
推荐引用方式 GB/T 7714	Ilyana Kuziemko,Katherine Meckel,Maya Rossin-Slater. Do Insurers Risk-Select Against Each Other? Evidence from Medicaid and Implications for Health Reform. 2013.