Estimating Efficient Moral Hazard: Spending Where Willingness-to-Pay Exceeds Cost

描述（由申请人提供）：道德风险是由于保险而消耗的额外医疗费用。传统理论认为道德风险是福利的减少，但这并没有解释由于收入从购买保险并保持健康的人转移到购买保险并生病的人而购买的额外医疗保健。对这种收入效应的认识表明，一部分是福利减少，另一部分是福利增加。福利增加的部分可以通过投保消费者购买的额外医疗保健来估算，如果保险公司不支付任何医疗保健费用，而是向他支付与标准保险单下保险公司支付的他或她的医疗保健费用相等的金额的本票。本研究没有进行昂贵的rand类型的健康保险实验，而是建议使用1996-2008年医疗支出小组调查来估计由于保险而增加的额外医疗保健的福利增加部分，并针对(a)美国普通人口，(b)分别具有15种优先健康状况中的9种的美国人，以及(c)所有15种优先健康状况组合。它将使用7个步骤的过程：(1)使用工具变量方法来估计医疗保健支出，以纠正私人和公共医疗保险的内生性，考虑到公共保险的可能选择；(2)对于每个未投保的人，从步骤1中的收入系数估计需求的收入弹性；(3)对于私人投保的人，估计总支出中由保险公司支付的部分（不包括费用分摊）。(4)对于每一个保险,使用来自步骤3的系数估计的开支由保险人支付如果他们已经投保,(5)对于每一个保险,从第2步使用收入系数估计的变化没有保险医疗保险支出,如果他们有一支索赔保险政策,还清了相同的支出在步骤4,(6)对于每一个保险,使用步骤1的系数估计道德风险支出是否已经投保,(7)对于每一个没有保险的人，如果个人从步骤5中获得了或有索赔合同的保险，则医疗保健支出的变化乘以在没有保险的状态下的估计支出，以确定额外医疗保健支出的有效部分。然后，将这种带有或有索赔政策的有效支出与步骤6中估计的总体道德风险支出进行比较，以确定无效道德风险的数量。对被保险人和整个样品重复类似的程序。这项研究首次估算了道德风险中有效的部分。这些信息将用于推断美国医疗保健支出总额中代表有效道德风险的比例，也将用于评估对具有各种优先健康状况的被保险人施加费用分摊的适当性。

DESCRIPTION (provided by applicant): Moral hazard is the additional health care that is consumed because of insurance. Conventional theory regards moral hazard as being welfare decreasing, but this does not account for the additional health care that is purchased because of the transfer of income from those who purchase insurance and remain healthy, to those who purchase insurance and become ill. Recognition of this income effect suggests that a portion is welfare decreasing but another portion is welfare increasing. The welfare-increasing portion can be estimated by the additional health care that an insured consumer would have purchased if, instead of paying for any care, the insurer had paid him a cashier's check in an amount equal to the portion of his or her health care expenditures covered by the insurer under the standard insurance policy. Rather than conducting an expensive RAND-type of health insurance experiment, this study proposes to estimate the welfare-increasing portion of the additional health care due to insurance using the 1996-2008 Medical Expenditure Panel Survey, and to do so for (a) the general population of Americans, (b) those Americans with 9 of the 15 priority health conditions separately, and (c) all 15 priority health conditions combined. It will use a 7-step process to (1) estimate health care spending using an instrumental variables approach to correct for the endogeneity of private and public health insurance, taking into account the possible choice of public insurance, (2) for each uninsured, estimate the income elasticity of demand from the income coefficients in step 1, (3) for the privately insured, estimate the portion of total spending that would have been paid for by the insurer (excluding cost sharing), (4) for each uninsured, use the coefficients from step 3 to estimate the amount of spending paid for by the insurer if they had been insured, (5) for each uninsured, use the income coefficients from step 2 to estimate the change in uninsured health care spending if they were insured with a contingent claims insurance policy that paid off with the same spending as in step 4, (6) for each uninsured, use the coefficients from step 1 to estimate the moral hazard spending if they had been insured, and (7) for each uninsured, the change in health care spending had the individual been insured by a contingent claims contract from step 5 is multiplied by the estimated spending in the uninsured state to determine the efficient portion of the additional health care spending. This efficient spending with a contingent claims policy is then compared to estimated overall moral hazard spending from step 6 to determine the amount of inefficient moral hazard. An analogous procedure will be repeated for the insured and for the entire sample. This study represents the first to estimate the portion of moral hazard that is efficient. This information wil be used to make inferences about the proportion of the total health care spending in the U.S. that represents efficient moral hazard, and also will be used to evaluate appropriateness of imposing cost sharing on insured persons with the various priority health conditions.