Ellis Randall P, McGuire Thomas G
Economics Department, Boston University, 270 Bay State Road, Boston, MA 02215, USA.
J Health Econ. 2007 Jan;26(1):25-48. doi: 10.1016/j.jhealeco.2006.06.004. Epub 2006 Aug 14.
This paper re-examines the relation between the predictability of health care spending and incentives due to adverse selection. Within an explicit model of health plan decisions about service levels, we show that predictability (how well spending on certain services can be anticipated), predictiveness (how well the predicted levels of certain services contemporaneously co-vary with total health care spending), and demand responsiveness all matter for adverse selection incentives. The product of terms involving these three measures of predictability, predictiveness, and demand responsiveness define an empirical index of the direction and magnitude of selection incentives. We quantify the relative magnitude of adverse selection incentives bearing on various types of health care services in Medicare. Our results are consistent with other research on service-level selection. The index of incentives can readily be applied to data from other payers.
本文重新审视了医疗保健支出的可预测性与逆向选择所产生的激励之间的关系。在一个关于健康计划服务水平决策的明确模型中，我们表明，可预测性（特定服务支出的可预测程度）、预测性（某些服务的预测水平与总医疗保健支出同时变动的程度）以及需求响应性对于逆向选择激励均至关重要。涉及可预测性、预测性和需求响应性这三种度量的各项乘积定义了选择激励的方向和大小的一个实证指标。我们对医疗保险中影响各类医疗保健服务的逆向选择激励的相对大小进行了量化。我们的结果与关于服务水平选择的其他研究一致。激励指标可以很容易地应用于来自其他支付方的数据。
