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Adverse selection and network design under regulated plan prices: Evidence from Medicaid

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  • Kreider, Amanda R.
  • Layton, Timothy J.
  • Shepard, Mark
  • Wallace, Jacob

Abstract

Health plans for the poor increasingly limit access to specialty hospitals. We investigate the role of adverse selection in generating this equilibrium among private plans in Medicaid. Studying a network change, we find that covering a top cancer hospital causes severe adverse selection, increasing demand for a plan by 50% among enrollees with cancer versus no impact for others. Medicaid’s fixed insurer payments make offsetting this selection, and the contract distortions it induces, challenging, requiring either infeasibly high payment rates or near-perfect risk adjustment. By contrast, a small explicit bonus for covering the hospital is sufficient to make coverage profitable.

Suggested Citation

  • Kreider, Amanda R. & Layton, Timothy J. & Shepard, Mark & Wallace, Jacob, 2024. "Adverse selection and network design under regulated plan prices: Evidence from Medicaid," Journal of Health Economics, Elsevier, vol. 97(C).
    • Handle: RePEc:eee:jhecon:v:97:y:2024:i:c:s0167629624000468
    DOI: 10.1016/j.jhealeco.2024.102901
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    1. Michael Geruso & Timothy Layton & Daniel Prinz, 2019. "Screening in Contract Design: Evidence from the ACA Health Insurance Exchanges," American Economic Journal: Economic Policy, American Economic Association, vol. 11(2), pages 64-107, May.
    2. Kurt Lavetti & Kosali Simon, 2018. "Strategic Formulary Design in Medicare Part D Plans," American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 154-192, August.
    3. Nathaniel Hendren, 2013. "Private Information and Insurance Rejections," Econometrica, Econometric Society, vol. 81(5), pages 1713-1762, September.
    4. Nicholas Tilipman, 2022. "Employer Incentives and Distortions in Health Insurance Design: Implications for Welfare and Costs," American Economic Review, American Economic Association, vol. 112(3), pages 998-1037, March.
    5. Liran Einav & Amy Finkelstein & Mark R. Cullen, 2010. "Estimating Welfare in Insurance Markets Using Variation in Prices," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(3), pages 877-921.
    6. Michael Geruso & Timothy J. Layton, 2017. "Selection in Health Insurance Markets and Its Policy Remedies," Journal of Economic Perspectives, American Economic Association, vol. 31(4), pages 23-50, Fall.
    7. Mark Shepard, 2022. "Hospital Network Competition and Adverse Selection: Evidence from the Massachusetts Health Insurance Exchange," American Economic Review, American Economic Association, vol. 112(2), pages 578-615, February.
    8. Danil Agafiev Macambira & Michael Geruso & Anthony Lollo & Chima D. Ndumele & Jacob Wallace, 2022. "The Private Provision of Public Services: Evidence from Random Assignment in Medicaid," NBER Working Papers 30390, National Bureau of Economic Research, Inc.
    9. Colleen Carey, 2017. "Technological Change and Risk Adjustment: Benefit Design Incentives in Medicare Part D," American Economic Journal: Economic Policy, American Economic Association, vol. 9(1), pages 38-73, February.
    10. Newhouse, Joseph P, 1970. "Toward a Theory of Nonprofit Institutions: An Economic Model of a Hospital," American Economic Review, American Economic Association, vol. 60(1), pages 64-74, March.
    11. Jacob Wallace, 2023. "What Does a Provider Network Do? Evidence from Random Assignment in Medicaid Managed Care," American Economic Journal: Economic Policy, American Economic Association, vol. 15(1), pages 473-509, February.
    12. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 90(4), pages 629-649.
    13. Ilyana Kuziemko & Katherine Meckel & Maya Rossin-Slater, 2018. "Does Managed Care Widen Infant Health Disparities? Evidence from Texas Medicaid," American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 255-283, August.
    14. David M. Cutler & Sarah J. Reber, 1998. "Paying for Health Insurance: The Trade-Off between Competition and Adverse Selection," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 113(2), pages 433-466.
    15. André Veiga & E. Glen Weyl, 2016. "Product Design in Selection Markets," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(2), pages 1007-1056.
    16. Ben Handel & Igal Hendel & Michael D. Whinston, 2015. "Equilibria in Health Exchanges: Adverse Selection versus Reclassification Risk," Econometrica, Econometric Society, vol. 83(4), pages 1261-1313, July.
    17. Timothy Layton & Alice K. Ndikumana & Mark Shepard, 2017. "Health Plan Payment in Medicaid Managed Care: A Hybrid Model of Regulated Competition," NBER Working Papers 23518, National Bureau of Economic Research, Inc.
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    More about this item

    Keywords

    Adverse selection; Medicaid; Cancer hospitals;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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