Department of Economics, Stanford University, Stanford, CA 94305.
National Bureau of Economic Research, Cambridge, MA 02138.
Proc Natl Acad Sci U S A. 2020 Aug 11;117(32):18939-18947. doi: 10.1073/pnas.2004759117. Epub 2020 Jul 27.
Changes in the way health insurers pay healthcare providers may not only directly affect the insurer's patients but may also affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform that was implemented in some areas of the country but not in others, via random assignment. We estimate that the payment reform-which targeted traditional Medicare patients-had effects of similar magnitude on the healthcare experience of nontargeted, privately insured Medicare Advantage patients. We discuss the implications of these findings for estimates of the impact of healthcare payment reforms and more generally for the design of healthcare policy.
医疗保险机构向医疗服务提供者支付方式的变化不仅可能直接影响到保险公司的患者，还可能影响到其他保险公司承保的患者。我们在全国范围内通过随机分组实施的医疗保险捆绑支付改革的背景下提供了这种溢出效应的证据。我们估计，这项针对传统医疗保险患者的支付改革对非目标私人医疗保险优势患者的医疗体验产生了类似程度的影响。我们讨论了这些发现对医疗保健支付改革影响的估计以及更普遍的医疗保健政策设计的意义。
