Competition in health insurance markets may fail to improve health outcomes if consumers are not able to identify high-quality plans. We develop and apply a novel instrumental variables framework to quantify the variation in causal mortality effects across plans and measure how much consumers attend to this variation. We first document large differences in the observed mortality rates of Medicare Advantage plans in local markets. We then show that when plans with high mortality rates exit these markets, enrollees tend to switch to more typical plans and subsequently experience lower mortality. We derive and validate a novel “fallback condition” governing the subsequent choices of those affected by plan exits. When the fallback condition is satisfied, plan terminations can be used to estimate the relationship between observed plan mortality rates and causal mortality effects. Applying the framework, we find that mortality rates unbiasedly predict causal mortality effects. We then extend our framework to study other predictors of plan mortality effects and estimate consumer willingness to pay. Higher-spending plans tend to reduce enrollee mortality, but existing quality ratings are uncorrelated with plan mortality effects. Consumers place little weight on mortality effects when choosing plans. Good insurance plans dramatically reduce mortality, and redirecting consumers to such plans could improve beneficiary health.

中文翻译：

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死亡率影响和私人健康保险计划的选择


如果消费者无法识别高质量的计划，健康保险市场的竞争可能无法改善健康结果。我们开发并应用了一种新颖的工具变量框架来量化不同计划之间因果死亡率影响的变化，并衡量消费者对这种变化的关注程度。我们首先记录了当地市场中 Medicare Advantage 计划观察到的死亡率的巨大差异。然后我们表明，当死亡率高的计划退出这些市场时，参保者往往会转向更典型的计划，从而经历较低的死亡率。我们推导并验证了一种新颖的“后备条件”，用于管理受计划退出影响的人的后续选择。当满足回退条件时，计划终止可用于估计观察到的计划死亡率与因果死亡率效应之间的关系。应用该框架，我们发现死亡率可以公正地预测因果死亡率影响。然后，我们扩展我们的框架来研究计划死亡率影响的其他预测因素并估计消费者的支付意愿。较高支出的计划往往会降低参与者死亡率，但现有的质量评级与计划死亡率影响不相关。消费者在选择计划时很少考虑死亡率的影响。良好的保险计划可以显着降低死亡率，而将消费者重新定向到此类计划可以改善受益人的健康状况。