일시: 2025년 6월 2일 (월) 16시 - 17시30분

장소: 59-1동 301호

발표자: 황우남 교수님 (KAIST 산업및시스템공학과)

Problem definition: Following recent legislation, private insurers who participate in Medicare Advantage (MA) have been allowed to expand their set of supplementary services to include benefits that are not primarily health related. This policy change is meant to lead to lower costs and better care but questions have been raised about how this affects the incentives of private insurers. We analytically investigate the implications of the policy for MA offerings, beneficiary enrollment, and social welfare.

Methodology/results: We develop a game-theoretical model of the interactions between a social planner, an MA insurer, and beneficiaries. We posit that — owing to the broadened remit from the new legislation — the insurer can introduce either targeted supplementary services that primarily benefit unhealthy beneficiaries or uniform supplementary services that entail the same level of non-health-related utility for all beneficiaries. We demonstrate that the policy change incentivizes the insurer to provide targeted supplementary services — which have the largest health impact — if and only if it receives high capitation payments for enrolled beneficiaries. Otherwise, the insurer offers uniform supplementary services aimed at attracting healthier beneficiaries. Moreover, for intermediate values of the capitation payment, the insurer enrolls fewer beneficiaries than under status quo policies — highlighting how the policy change can backfire by exacerbating favorable beneficiary selection (cream skimming) issues inherent in capitation payment systems. Partially efficient insurance plans with low treatment costs but high cost of targeted supplementary services are least likely to offer targeted supplementary services. Finally, we characterize the capitation payment that optimizes social welfare and mitigates the aforementioned selection issue; however, the cost of circumventing the selection issue may be so high as to undermine the health benefits of the policy.

Managerial implications: While increasing the flexibility of private insurers to offer a wider range of supplementary services has the potential to result in more targeted offerings (thereby lowering treatment costs), policymakers should be aware of the conditions under which the policy might, instead, increase cream skimming and reduce social welfare. Avoiding this outcome may be costly.