Feldman R, Dowd B
Division of Health Services Research and Policy, University of Minnesota, Minneapolis 55455, USA.
J Health Econ. 2000 Jul;19(4):499-512. doi: 10.1016/s0167-6296(00)00051-5.
This paper traces the evolution of economists' views about risk segmentation in health insurance markets. Originally seen as a desirable goal, risk segmentation has come to be viewed as leading to abnormal profits, wasted resources, and inefficient limitations on coverage and services. We suggest that risk segmentation may be efficient if one takes an ex post view (i.e., after consumers' risks are known). From this perspective, managed care may be a much better method for achieving risk segmentation than limitations on coverage. The most serious objection to risk segmentation is the ex ante concern that it undermines long-term insurance contracts that would protect consumers against changes in lifetime risk.
本文追溯了经济学家对健康保险市场风险细分观点的演变。风险细分最初被视为一个理想目标，如今却被视为会导致超额利润、资源浪费以及保险范围和服务的低效限制。我们认为，如果从事后角度（即消费者风险已知之后）来看，风险细分可能是有效的。从这个角度看，管理式医疗可能是实现风险细分比限制保险范围更好的方法。对风险细分最严重的反对意见是事前担忧它会破坏旨在保护消费者抵御终身风险变化的长期保险合同。
