Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany St, Boston, MA 02118. Email:
Am J Manag Care. 2021 Aug;27(8):323-328. doi: 10.37765/ajmc.2021.88723.
The Trump administration ended television advertising for the Health Insurance Marketplace prior to the 2018 open enrollment period, leaving insurers as the predominant source of health insurance advertising. Prior research findings are mixed on the effectiveness of private advertising on Marketplace enrollment, but no work to date has examined how competitive changes in health insurance markets are related to marketing patterns. This study provides the first evidence on how insurers are altering their marketing in response to changes in competition.
This study links data capturing Marketplace participation (CMS Qualified Health Plan Landscape files) by county and health insurance advertising (Kantar Media/Campaign Media Analysis Group) by media market for the 2014 through 2018 open enrollment periods.
We used population-weighted county fixed effects models to estimate the relationship between year-over-year changes in Marketplace competition and changes in (1) total private advertising and (2) advertising per insurer.
Going from multiple insurers to a single insurer resulted in 465 fewer private ads aired within a county during open enrollment (P < .01), a 17% to 38% reduction. Losing monopoly status is associated with a drop in advertising of 452 airings per insurer (P < .01), and becoming a monopolist is associated with 293 more airings per insurer (P < .01).
Insurers are not replacing the decline in government-sponsored advertising. We find that insurers behave as if they are responding to strategic incentives, advertising more when they become a monopolist but not filling the hole left by their former competitor, which has implications for the volume of messages seen by consumers.
特朗普政府在 2018 年开放注册期前停止了医疗保险市场的电视广告，使保险公司成为健康保险广告的主要来源。先前的研究结果对私人广告在市场注册中的有效性存在分歧，但迄今为止尚无研究考察医疗保险市场的竞争变化与营销模式之间的关系。本研究首次提供了有关保险公司如何根据竞争变化调整营销的证据。
本研究通过县的市场参与数据（CMS 合格健康计划景观文件）和媒体市场的健康保险广告（Kantar Media/Campaign Media Analysis Group），将 2014 年至 2018 年开放注册期间的数据联系起来。
我们使用人口加权县固定效应模型来估计市场竞争的年际变化与（1）私人广告总量和（2）每个保险公司广告之间的关系。
从多个保险公司到单一保险公司，导致一个县在开放注册期间播出的私人广告减少了 465 条（P<.01），减少了 17%至 38%。失去垄断地位与广告投放量减少 452 条有关（P<.01），成为垄断者与每条广告增加 293 条有关（P<.01）。
保险公司并没有取代政府赞助广告的下降。我们发现，保险公司的行为似乎是在对战略激励做出反应，当它们成为垄断者时会增加广告投放，但不会填补其前竞争对手留下的空白，这对消费者看到的信息量有影响。
