UCSD, USA; NBER, USA.
NBER, USA; UBC, Canada.
J Health Econ. 2017 Sep;55:153-167. doi: 10.1016/j.jhealeco.2017.07.001. Epub 2017 Jul 13.
One of private health insurers' main roles in the United States is to negotiate physician payment rates on their beneficiaries' behalf. We show that these rates are often set in reference to a government benchmark, and ask how often private insurers customize their fee schedules away from this default. We exploit changes in Medicare's payments and dramatic bunching in markups over Medicare's rates to address this question. Although Medicare's rates are influential, 25 percent of physician services in our data, representing 45 percent of covered spending, deviate from the benchmark. Heterogeneity in the pervasiveness and direction of deviations suggests that the private market coordinates around Medicare's pricing for simplicity but abandons it when sufficient value is at stake.
在美国，私人健康保险公司的主要角色之一是代表其受益人与医生协商支付费率。我们发现这些费率通常是参照政府基准设定的，那么私人保险公司会在多大程度上偏离这一基准来定制自己的收费表呢？我们利用医疗保险支付的变化和医疗保险费率的大幅溢价来解决这个问题。尽管医疗保险的费率具有影响力，但我们数据中有 25%的医生服务，占已覆盖支出的 45%，偏离了基准。偏差的普遍程度和方向的异质性表明，私人市场为了简单起见围绕着医疗保险的定价进行协调，但在涉及到足够的价值时，就会放弃它。
