Koh Kanghyock, Park Sungchul
Department of Economics, Korea University, Seoul, Seongbuk-gu, Republic of Korea.
Department of Health Policy and Management, BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Seongbuk-gu, Republic of Korea.
Health Econ. 2025 Jan;34(1):105-153. doi: 10.1002/hec.4902. Epub 2024 Sep 28.
The Medicaid coverage "cliff" occurs when Medicare beneficiaries with household income exceeding 100% of the federal poverty level lose eligibility for supplemental Medicaid coverage. Using a regression discontinuity design with data from Medical Expenditure Panel Survey and National Health and Nutrition Examination Survey for 2007-2019, we demonstrate that the cliff increases out-of-pocket spending by 25% and the probability of experiencing problems paying medical bills by 44.4% without decreases in overall health care spending. However, there is evidence that near-poor Medicare beneficiaries changed behavior in response to the cliff, increasing the use of high-value diagnostic and preventive testing by 8.8% and enrollment in a more affordable plan by 12.2%. The cliff does not encourage healthy behavior.
当家庭收入超过联邦贫困水平100%的医疗保险受益人失去补充医疗补助覆盖资格时，就会出现医疗补助覆盖“悬崖”。利用2007年至2019年医疗支出面板调查和国家健康与营养检查调查的数据进行回归断点设计，我们证明，“悬崖”使自付费用增加了25%，支付医疗账单出现问题的概率增加了44.4%，而总体医疗保健支出并未减少。然而，有证据表明，接近贫困线的医疗保险受益人针对“悬崖”改变了行为，将高价值诊断和预防性检测的使用率提高了8.8%，并将参加更实惠计划的比例提高了12.2%。“悬崖”并未鼓励健康行为。
