Richman Barak D
Cornell Law Rev. 2005 Mar;90(3):705-68.
This Article employs a behavioral economic analysis to understand why Medicaid has failed to improve the health outcomes of its beneficiaries. It begins with a formal economic model of health care consumption and then systematically incorporates a survey of psychosocial variables to formulate explanations for persistent health disparities. This methodology suggests that consulting the literature in health psychology and intertemporal decision theory--empirical sources generally excluded from orthodox economic analysis--provides valuable material to explain certain findings in health econometrics. More significantly, the lessons from this behavioral economic approach generate useful policy considerations for Medicaid policymakers, who largely have neglected psychosocial variables in implementing a health insurance program that rests chiefly on orthodox economic assumptions. The Article's chief contributions include an expansion of the behavioral economic approach to include a host of variables in health psychology, a behavioral refinement of empirical health economics, a behavioral critique of Medicaid policy, and a menu of suggested Medicaid reforms.
本文运用行为经济学分析来理解为何医疗补助计划未能改善其受益人的健康状况。文章首先构建了一个医疗保健消费的正式经济模型，然后系统地纳入了对心理社会变量的调查，以阐述持续存在的健康差距。这种方法表明，参考健康心理学和跨期决策理论的文献——这些实证来源通常被正统经济分析所排除——能为解释健康计量经济学中的某些发现提供有价值的素材。更重要的是，这种行为经济学方法得出的经验教训为医疗补助计划的政策制定者带来了有用的政策考量，这些政策制定者在实施主要基于正统经济假设的医疗保险计划时，很大程度上忽视了心理社会变量。本文的主要贡献包括将行为经济学方法进行扩展，纳入健康心理学中的一系列变量，对实证健康经济学进行行为学细化，对医疗补助政策进行行为学批判，以及提供一系列建议的医疗补助改革措施。
