Department of Economics, Santa Clara University, United States.
Department of Economics, Stanford University, United States.
J Health Econ. 2019 Sep;67:102216. doi: 10.1016/j.jhealeco.2019.06.003. Epub 2019 Jul 17.
A fundamental question in health insurance markets is how do health care consumers dynamically optimize their medical utilization under non-linear insurance contracts? Our paper tests the neoclassical prediction that a fully forward-looking agent only responds to their expected end-of-year price. Our unique identification strategy studies families during the year of childbirth who will likely satisfy their annual deductible, thereby knowing their expected end-of-year price. We find that during the year of a childbirth, fathers increase medical spending by 11% per month after their deductible is satisfied, rejecting the null of fully forward-looking consumers. This behavior cannot be explained by fathers increasing utilization in response to the childbirth itself. Furthermore, this myopia translates to a 21-24% decrease in total annual medical spending, relative to the counterfactual of fully forward-looking behavior, and is concentrated in elective procedures; we find no response in low value or urgent care. Our findings suggest the need for modeling non-linear incentives while accounting for myopic behavior when studying the medical utilization responses to health insurance.
医疗保险市场中的一个基本问题是，医疗保健消费者如何在非线性保险合同下动态优化他们的医疗利用？我们的论文检验了新古典主义的预测，即完全前瞻性的代理人只会对他们的年末预期价格做出反应。我们独特的识别策略研究了在分娩年度的家庭，这些家庭很可能满足他们的年度免赔额，从而了解他们的年末预期价格。我们发现，在分娩年度，父亲在满足免赔额后每月的医疗支出增加了 11%，这拒绝了完全前瞻性消费者的零假设。这种行为不能用父亲为应对分娩本身而增加利用来解释。此外，这种近视导致总年度医疗支出减少 21-24%，相对于完全前瞻性行为的反事实情况，并且集中在选择性程序上；我们在低价值或紧急护理方面没有发现反应。我们的研究结果表明，在研究医疗保险对医疗利用的反应时，需要在考虑近视行为的同时对非线性激励进行建模。
