Economics Department, Columbia University, New York, NY.
Economics Department, Harvard University, Cambridge, MA.
Am Econ Rev. 2014 Dec;104(12):3841-84. doi: 10.1257/aer.104.12.3841.
We estimate an insurer-specific preference function which rationalizes hospital referrals for privately insured births in California. The function is additively separable in: a hospital price paid by the insurer, the distance traveled, and plan- and severity-specific hospital fixed effects (capturing hospital quality). We use an inequality estimator that allows for errors in price and detailed hospital-severity interactions and obtain markedly different results than those from a logit. The estimates indicate that insurers with more capitated physicians are more responsive to price. Capitated plans send patients further to utilize similar quality, lower-priced hospitals; but the cost-quality trade-off does not vary with capitation rates.
我们估计了一个特定于保险公司的偏好函数，该函数可以解释加利福尼亚私人保险分娩的医院转诊行为。该函数可加地分离为：保险公司支付的医院价格、旅行距离以及计划和严重程度特定的医院固定效应（捕捉医院质量）。我们使用一种不平等估计器，该估计器允许价格和详细的医院严重程度交互存在误差，并得到与逻辑回归明显不同的结果。这些估计表明，拥有更多人头医师的保险公司对价格的反应更为敏感。人头支付计划会让患者去更远的地方，以利用类似质量但价格更低的医院；但成本-质量的权衡并不随人头费率而变化。
