具有私人合同的健康服务提供者网络:狭窄网络中存在治疗不足吗?

Health provider networks with private contracts: Is there under-treatment in narrow networks?

Journal of Health Economics · 2019
被引 9
人大 AABS 3

中文导读

通过建模健康保险公司与提供者之间的私人合同,发现网络越大,提供者收费越高,治疗概率和医疗成本也越高;福利最大化的网络可能包含多个提供者,而提高价格透明度仅在消费者能处理所有治疗价格时才能提升福利。

Abstract

Contracts between health insurers and providers are private. By modelling this explicitly, we find the following. Insurers with bigger provider networks, pay providers higher fee-for-service rates. This makes it more likely that a patient is treated and hence health care costs and utilization increase with provider network size. Although providers are homogeneous, the welfare maximizing provider network can consist of two or more providers. Provider profits are positive whereas they would be zero with public contracts. Increasing transparency of provider prices increases welfare only if consumers can "mentally process" the prices of all treatments involved in an insurance contract. If not, it tends to reduce welfare.

健康保险医疗服务提供者网络私人合同治疗不足