What Difference Does a Health Plan Make? Evidence from Random Plan Assignment in Medicaid
利用医疗补助受益人随机分配到不同管理式医疗计划的数据，研究发现即使成本分摊相同，不同计划的支出差异显著，低支出计划减少医疗服务数量，但降低了受益人的满意度和健康水平，且消费者需求随计划支出增加而上升。
Exploiting the random assignment of Medicaid beneficiaries to managed care plans, we find substantial plan-specific spending effects despite plans having identical cost sharing. Enrollment in the lowest-spending plan reduces spending by at least 25 percent—primarily through quantity reductions—relative to enrollment in the highest-spending plan. Rather than reducing “wasteful” spending, lower-spending plans broadly reduce medical service provision—including the provision of low-cost, high-value care—and worsen beneficiary satisfaction and health. Consumer demand follows spending: a 10 percent increase in plan-specific spending is associated with a 40 percent increase in market share. These facts have implications for the government’s contracting problem and program cost growth.