Health insurance and ex ante moral hazard: evidence from Medicare
Health insurance and ex ante moral hazard: evidence from Medicare
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DOI：
10.1007/s10754-009-9056-4
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发表时间：
2009-12-01
期刊：
影响因子：
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通讯作者：
Kaestner, Robert
中科院分区：
文献类型：
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作者：
Dave, Dhaval;Kaestner, Robert
基本经济学理论表明，医疗保险覆盖范围可能会导致预防活动的减少，但实证研究尚未提供太多证据来支持这一预测。然而，在涉及不良健康事件的其他保险环境中，事前道德风险的证据更一致。在本文中，我们扩展了健康保险对健康行为的影响的分析，允许健康保险对健康行为具有直接(事前道德风险)和间接影响的可能性。间接影响通过健康促进信息和患病概率的变化发挥作用，这可能是保险导致与医疗专业人员更多接触的副产品。我们确定了这两个影响，并在这样做的过程中确定了纯粹的事前道德风险影响。这项研究利用了健康保险中看似合理的外生变异，作为在65岁获得医疗保险覆盖的结果。我们发现，有证据表明，获得医疗保险减少了老年男性的预防，增加了不健康行为。我们还发现，医生咨询在改变健康行为方面是成功的。
Basic economic theory suggests that health insurance coverage may cause a reduction in prevention activities, but empirical studies have yet to provide much evidence to support this prediction. However, in other insurance contexts that involve adverse health events, evidence of ex ante moral hazard is more consistent. In this paper, we extend the analysis of the effect of health insurance on health behaviors by allowing for the possibility that health insurance has a direct (ex ante moral hazard) and indirect effect on health behaviors. The indirect effect works through changes in health promotion information and the probability of illness that may be a byproduct of insurance-induced greater contact with medical professionals. We identify these two effects and in doing so identify the pure ex ante moral hazard effect. This study exploits the plausibly exogenous variation in health insurance as a result of obtaining Medicare coverage at age 65. We find evidence that obtaining health insurance reduces prevention and increases unhealthy behaviors among elderly men. We also find evidence that physician counseling is successful in changing health behaviors.