Health Care Rationing in Public Insurance Programs: Evidence from Medicaid
研究了公共保险计划通过外包给管理式医疗计划和处方药数量限制来配给医疗的两种机制，发现放松药物上限增加了高价值药物和门诊服务的可及性，减少了可避免的住院，但显著增加了项目成本。
We study two mechanisms used by public health insurance programs for rationing health care: outsourcing to private managed care plans and quantity limits for prescription drugs. Leveraging a natural experiment in Texas’s Medicaid program, we find that the shift to managed care and the relaxation of a strict drug cap increased access to high-value drugs and outpatient services and reduced avoidable hospitalizations. Program costs increased significantly, indicating a trade-off between cost and quality. We provide suggestive evidence attributing the reduction in hospitalizations to the relaxation of the drug cap and much of the spending increase to the shift to managed care.