Separating Selection and Incentive Effects in Health Insurance
Separating Selection and Incentive Effects in Health Insurance
复制标题
健康保险中的选择效应和激励效应分离
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
C. Grandchamp
中科院分区：
文献类型：
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作者：
P. Geoffard;L. Gardiol;C. Grandchamp
本文对健康保险和医疗保健消费进行了分析。利用瑞士 60 000 多名成年人的保险索赔数据，采用完全最大似然法开发和估计了健康保险和医疗保健联合需求的结构性微观经济模型。估算策略依赖于瑞士体系的制度特征，其中每个人都在相同的合同菜单中进行选择，并按免赔额的大小排名。实证分析显示了选择效应的有力证据。然而，一旦控制了选择效应，重要的激励效应（“事后道德风险”）仍然存在。共付率从 100% 降低到 10% 会使医疗保健的边际需求增加约 90%，从 100% 降低到 0% 则增加约 150%。保险覆盖范围和医疗保健支出之间的相关性可以分解为两种效应：75%可能归因于选择效应，25%可能归因于激励效应。
This paper provides an analysis of the health insurance and health care consumption. A structural microeconomic model of joint demand for health insurance and health care is developed and estimated using full maximum likelihood method using Swiss insurance claims data for over 60 000 adult individuals. The estimation strategy relies on the institutional features of the Swiss system, in which each individual chooses among the same menu of contracts, ranked by the size of their deductible. The empirical analysis shows strong and robust evidence of selection effects. Nevertheless, once selection effects are controlled for, an important incentive effect ("ex-post moral hazard") remains. A decrease in the copayment rate from 100% to 10% increases the marginal demand for health care by about 90% and from 100% to 0% by about 150%. The correlation between insurance coverage and health care expenditures may be decomposed into the two effects: 75% may be attributed to selection, and 25 % to incentive effects.