Insurer-Provider Networks in the Medical Care Market

I use data on the hospital networks offered by managed care health insurers to estimate the expected division of profits between insurers and providers. I include a simple profit-maximization framework and an additional effect: hospitals that can secure demand without contracting with all insurers (e.g., those most attractive to consumers and those that are capacity constrained) may demand high prices that some insurers refuse to pay. Hospital mergers may also affect price bargaining. I estimate that all three types of hospitals capture higher markups than other providers. These results provide information on the hospital investment incentives generated by bargaining. (JEL G22, G34, I11, L25)

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Population-based incidence and prevalence of nontuberculous mycobacterial lung disease in a large US managed care health plan, 2008 – 2015

Pneumologie ◽

10.1055/s-0037-1619373 ◽

2018 ◽

Vol 72 (S 01) ◽

pp. S95-S95

Author(s):

K Winthrop ◽

G Eagle ◽

R Van der Laan ◽

R Zhang ◽

Q Zhang

Keyword(s):

Managed Care ◽

Lung Disease ◽

Health Plan ◽

Population Based ◽

Nontuberculous Mycobacterial Lung Disease ◽

Care Health

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Timing of Chemoradiation in Newly Diagnosed Glioblastoma: Comparative Analysis Between County and Managed Care Health Care Models

World Neurosurgery ◽

10.1016/j.wneu.2021.01.023 ◽

2021 ◽

Author(s):

Harjyot Toor ◽

Paras Savla ◽

Stacey Podkovik ◽

Tye Patchana ◽

Hammad Ghanchi ◽

...

Keyword(s):

Health Care ◽

Comparative Analysis ◽

Managed Care ◽

Newly Diagnosed ◽

Health Care Models ◽

Care Models ◽

Newly Diagnosed Glioblastoma ◽

Care Health

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Managed Care

PEDIATRICS ◽

10.1542/peds.90.2.278b ◽

1992 ◽

Vol 90 (2) ◽

pp. 278-279

Author(s):

JENIFER D. C. CARTLAND ◽

BETH K. YUDKOWSKY

Keyword(s):

Managed Care ◽

Medical Care ◽

Care Program ◽

Kaiser Permanente ◽

Care Plans

In Reply.— Doctors Sapin and Laws raise fundamental concerns about our article that was recently published in Pediatrics.1 We feel that these concerns are addressed adequately in the paper, but we would like to take this opportunity to clarify our findings. Dr Sapin argues that our study characterizes all managed care plans, such as the Kaiser Permanente Medical Care Program in which he practices, as having ineffective referral mechanisms. He holds that pediatricians at Kaiser experience "no barriers to appropriate referrals" and indicates that we did not stress this finding adequately.

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Equilibrium Provider Networks: Bargaining and Exclusion in Health Care Markets

The American Economic Review ◽

10.1257/aer.20171288 ◽

2019 ◽

Vol 109 (2) ◽

pp. 473-522 ◽

Cited By ~ 15

Author(s):

Kate Ho ◽

Robin S. Lee

Keyword(s):

Health Care ◽

Consumer Welfare ◽

Bargaining Solution ◽

Health Care Markets ◽

Social Incentives ◽

Provider Networks ◽

Hospital Networks ◽

Private Incentives ◽

Social Surplus ◽

Optimal Networks

We evaluate the consequences of narrow hospital networks in commercial health care markets. We develop a bargaining solution, “Nash-in-Nash with Threat of Replacement,” that captures insurers’ incentives to exclude, and combine it with California data and estimates from Ho and Lee (2017) to simulate equilibrium outcomes under social, consumer, and insurer-optimal networks. Private incentives to exclude generally exceed social incentives, as the insurer benefits from substantially lower negotiated hospital rates. Regulation prohibiting exclusion increases prices and premiums and lowers consumer welfare without significantly affecting social surplus. However, regulation may prevent harm to consumers living close to excluded hospitals. (JEL C78, D85, G22, H75, I11, I13, I18)

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