Competition in Insurance Markets

The goal for today is to examine the role of competition in health insurance, including “managed competition”. Focus areas and selected papers are listed below.

Competition and Health Insurance Premiums

As in just about any market, increased competition will tend to reduce prices. But examining this question empirically is challenging in health insurance, and there are reasons that this typical relationship may reverse in health insurance. We’ll discuss Dafny, Duggan, and Ramanarayanan (2012) and Ho and Lee (2017) as an exellent examples of research in this area.

Managed Competition

The U.S. health insurance model increasingly relies on private insurance even for government-sponsored programs like Medicare and Medicaid. This model is based on the idea of “managed competition”, which relies on market forces to improve the efficiency of health insurance markets. We’ll discuss Cabral, Geruso, and Mahoney (2018) and Curto et al. (2021) as examples of papers in this area. Cabral, Geruso, and Mahoney (2018) cautions against the assumption that increased subsidies will directly benefit consumers, emphasizing the need for careful design and regulation of subsidy mechanisms, and Curto et al. (2021) examines the potential for competition to improve consumer outcomes in these markets. Both papers underscore the importance of balancing market forces with effective regulation to achieve the goals of managed competition in government-sponsored health insurance programs.

References

Cabral, Marika, Michael Geruso, and Neale Mahoney. 2018. “Do Larger Health Insurance Subsidies Benefit Patients or Producers? Evidence from Medicare Advantage.” American Economic Review 108 (8): 2048–87.
Curto, Vilsa, Liran Einav, Jonathan Levin, and Jay Bhattacharya. 2021. “Can Health Insurance Competition Work? Evidence from Medicare Advantage.” Journal of Political Economy 129 (2): 570–606.
Dafny, Leemore, Mark Duggan, and Subramaniam Ramanarayanan. 2012. “Paying a Premium on Your Premium? Consolidation in the US Health Insurance Industry.” American Economic Review 102 (2): 1161–85.
Ho, Kate, and Robin S Lee. 2017. “Insurer Competition in Health Care Markets.” Econometrica 85 (2): 379–417.