Tel Aviv University, Israel, USA.
J Health Econ. 2011 Sep;30(5):1011-9. doi: 10.1016/j.jhealeco.2011.05.018. Epub 2011 Jun 28.
New regulation of health insurance markets creates multiple levels of health plans, with designations like "Gold" and "Silver." The underlying rationale for the heavy-metal approach to insurance regulation is that heterogeneity in demand for health care is not only due to health status (sick demand more than the healthy) but also to other, "taste" related factors (rich demand more than the poor). This paper models managed competition with demand heterogeneity to consider plan payment and enrollee premium policies in relation to efficiency (net consumer benefit) and fairness (the European concept of "solidarity"). Specifically, this paper studies how to implement a "Silver" and "Gold" health plan efficiently and fairly in a managed competition context. We show that there are sharp tradeoffs between efficiency and fairness. When health plans cannot or may not (because of regulation) base premiums on any factors affecting demand, enrollees do not choose the efficient plan. When taste (e.g., income) can be used as a basis of payment, a simple tax can achieve both efficiency and fairness. When only health status (and not taste) can be used as a basis of payment, health status-based taxes and subsidies are required and efficiency can only be achieved with a modified version of fairness we refer to as "weak solidarity." An overriding conclusion is that the regulation of premiums for both the basic and the higher level plans is necessary for efficiency.
新的医疗保险市场监管规定设立了多个层次的医疗保险计划，包括“金”级和“银”级等。医疗保险监管的重金属方法的基本原理是，对医疗保健的需求异质性不仅归因于健康状况（病人比健康人需求更多），还归因于其他与“口味”相关的因素（富人比穷人需求更多）。本文通过对需求异质性的管理竞争进行建模，以考虑计划支付和参保人保费政策与效率（净消费者收益）和公平（欧洲的“团结”概念）之间的关系。具体来说，本文研究了在管理竞争环境下如何有效地、公平地实施“银”级和“金”级医疗保险计划。我们表明，效率和公平之间存在明显的权衡。当医疗保险计划不能或可能不会（由于监管）根据任何影响需求的因素来确定保费时，参保人不会选择有效的计划。当口味（如收入）可以作为支付的基础时，简单的税收可以同时实现效率和公平。当只能根据健康状况（而不是口味）作为支付基础时，就需要进行基于健康状况的税收和补贴，并且只有通过我们称之为“弱团结”的公平的修改版本才能实现效率。一个压倒性的结论是，对基本计划和更高层次计划的保费进行监管对于提高效率是必要的。
