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%-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.

中文翻译：

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健康计划有何不同？来自医疗补助随机计划分配的证据。


利用医疗补助受益人对管理式医疗计划的随机分配，我们发现尽管计划具有相同的成本分摊，但特定计划的支出效果却相当大。相对于加入最高支出计划，加入最低支出计划可减少至少 25% 的支出（主要是通过数量减少）。低支出计划并没有减少“浪费”的支出，而是广泛减少了医疗服务的提供——包括提供低成本、高价值的护理——并恶化了受益人的满意度和健康状况。消费者需求跟随支出：计划特定支出增加 10% 与市场份额增加 40% 相关。这些事实对政府的承包问题和项目成本增长具有影响。