Assessing incentives for service-level selection in private health insurance exchanges |
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| Affiliation: | 1. West China School of Public Health, Sichuan University, Chengdu 610041, China;2. West China Research Center for Rural Health Development, Sichuan University, China;3. School of Economics, Peking University, Beijing 100871, China;4. College of Social Sciences, Michigan State University, 203A Berkey Hall, East Lansing, MI 48824, USA;5. Department of Geography and Geoinformation Science, George Mason University, 4400 University Drive, MS 6C3, Fairfax, VA 22030, USA;1. Princeton University, Princeton, NJ 08544, USA;2. Dept. of Applied Economics, Guanghua School of Management, Peking University, Rm. 325, Hall 2, Beijing 100871, China;3. Dept. of Applied Economics, Guanghua School of Management, Peking University, Rm. 320, Hall 2, Beijing 100871, China |
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| Abstract: | Even with open enrollment and mandated purchase, incentives created by adverse selection may undermine the efficiency of service offerings by plans in the new health insurance Exchanges created by the Affordable Care Act. Using data on persons likely to participate in Exchanges drawn from five waves of the Medical Expenditure Panel Survey, we measure plan incentives in two ways. First, we construct predictive ratios, improving on current methods by taking into account the role of premiums in financing plans. Second, relying on an explicit model of plan profit maximization, we measure incentives based on the predictability and predictiveness of various medical diagnoses. Among the chronic diseases studied, plans have the greatest incentive to skimp on care for cancer, and mental health and substance abuse. |
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| Keywords: | Health insurance Exchanges Adverse selection |
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