Data and Code for: Healthcare Rationing in Public Insurance Programs: Evidence from Medicaid

We study two mechanisms used by public health insurance programs for rationing healthcare: outsourcing to private managed care plans and quantity limits for prescription drugs. Leveraging a natural experiment in Texas's Medicaid program, we find that the shift to managed care and the relaxation of a strict drug cap increased access to high-value drugs and outpatient services and reduced avoidable hospitalizations. Program costs increased significantly, indicating a trade-off between cost and quality. We provide suggestive evidence attributing the reduction in hospitalizations to the relaxation of the drug cap and much of the spending increase to the shift to managed care.本研究针对公共健康保险计划用于医疗资源配给的两类机制展开分析：一是外包至私人管理式医疗计划（managed care plans），二是处方药配给量限制。本研究借助德克萨斯州医疗补助计划（Medicaid）中的自然实验开展实证分析，结果显示，转向管理式医疗模式以及放松严格的药品额度限制，均提升了高价值处方药与门诊服务的可及性，并减少了可避免的住院治疗人次。与此同时，该计划的总成本显著上升，表明医疗资源成本与服务质量之间存在权衡关系。本研究还提供了佐证性证据，显示住院治疗人次的减少可归因于药品额度限制的放松，而支出增长的大部分则源于向管理式医疗计划的转型。