Code for: Adverse Selection and Network Design Under Regulated Plan Prices: Evidence From Medicaid

Principal Investigator(s):  View help for Principal Investigator(s) Amanda R. Kreider, University of Pittsburgh; Timothy J. Layton, University of Virginia; Mark Shepard, Harvard University; Jacob Wallace, Yale University

Version:  View help for Version V1

Version Title:  View help for Version Title Initial release

Name File Type Size Last Modified
  analysis 04/07/2025 07:05:PM
  analysis_files 04/07/2025 07:05:PM
  figs 04/07/2025 07:05:PM
  networks 04/07/2025 07:05:PM
  spend_util 04/07/2025 07:05:PM
  tables 04/07/2025 07:05:PM
cr_analysis_file.do text/plain 1.1 KB 04/07/2025 03:05:PM
cr_network_files.do text/plain 275 bytes 04/07/2025 03:05:PM
cr_spend_util_measures.do text/plain 346 bytes 04/07/2025 03:05:PM
cr_tables_figs.do text/plain 847 bytes 04/07/2025 03:05:PM

Project Description

Summary:  View help for Summary Health plans for the poor increasingly limit access to specialty hospitals. We investigate the role of adverse selection in generating this equilibrium among private plans in Medicaid. Studying a network change, we find that covering a top cancer hospital causes severe adverse selection, increasing demand for a plan by 50% among enrollees with cancer versus no impact for others. Medicaid’s fixed insurer payments make offsetting this selection, and the contract distortions it induces, challenging, requiring either infeasibly high payment rates or near-perfect risk adjustment. By contrast, a small explicit bonus for covering the hospital is sufficient to make coverage profitable.

Scope of Project

Subject Terms:  View help for Subject Terms Medicaid; adverse selection; cancer care; managed care; health economics; risk adjustment; provider networks
Geographic Coverage:  View help for Geographic Coverage New York, USA


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Published Versions

V1 [2025-04-07]

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