Department of Economics, Princeton University, Julis Romo Rabinowitz Building, Princeton, NJ 08544.
Department of Economics, Harvard University, Littauer Center, Cambridge, MA 02138.
Am Econ Rev. 2019 Feb;109(2):473-522.
We evaluate the consequences of narrow hospital networks in commercial health care markets. We develop a bargaining solution, "Nash- in-Nash with Threat of Replacement," that captures insurers' incentives to exclude, and combine it with California data and estimates from Ho and Lee (2017) to simulate equilibrium outcomes under social, consumer, and insurer- optimal networks. Private incentives to exclude generally exceed social incentives, as the insurer benefits from substantially lower negotiated hospital rates. Regulation prohibiting exclusion increases prices and premiums and lowers consumer welfare without significantly affecting social surplus. However, regulation may prevent harm to consumers living close to excluded hospitals.
我们评估了商业医疗保健市场中医院网络狭窄的后果。我们开发了一种讨价还价的解决方案，“纳什威胁替换”，它捕捉了保险公司排除的动机，并将其与加利福尼亚的数据和 Ho 和 Lee（2017）的估计结合起来，以模拟社会、消费者和保险公司最优网络下的均衡结果。排除的私人动机通常超过社会动机，因为保险公司从大幅降低的谈判医院费率中受益。禁止排除的规定会提高价格和保费，降低消费者福利，而不会显著影响社会盈余。然而，监管可能会防止对靠近被排除医院的消费者造成伤害。
