Decomposition of Moral Hazard

描述(由投保人提供)：道德风险是指因投保而产生的额外医疗费用。传统理论认为道德风险是福利递减。另一种理论认为，一部分是福利减少，另一部分是福利增加。福利增加部分是指如果保险公司向投保消费者支付了一张本票，金额等于保险公司根据标准保险单支付的医疗保健支出的部分，而不是支付任何护理费用，则该消费者将购买的额外医疗保健。从理论上讲，道德风险中福利增加的部分是对保险降价中包含的收入转移的反应。这项研究建议将道德风险分解为普通美国人福利增加的部分和福利减少的部分，分别针对那些15种优先健康状况中有9种的美国人，以及所有15种优先健康状况的总和。使用1996-2008年医疗支出小组调查，它将使用7个步骤的过程来(1)使用工具变量方法来估计卫生保健支出，以校正私人和公共健康保险的内生性，考虑到公共保险的可能选择，(2)对于每个未参保的人，根据步骤1中的收入系数估计需求的收入弹性，(3)对于私人参保的人，估计总支出中本应由保险公司支付的部分(不包括成本分担)，(4)对于每个未参保的人，使用步骤3中的系数来估计保险公司支付的支出金额(如果他们已经投保)，(5)对于每个未投保的人，使用步骤2中的收入系数来估计未投保的医疗保健支出的变化，如果他们是用与步骤4中的相同支出支付的或有索赔保险单投保的，(6)对于每个未投保的人，使用步骤1的系数来估计道德风险支出，如果他们已经投保，以及(7)对于每个未投保的人，如果个人从步骤5开始通过或有索赔合同投保，则医疗保健支出的变化乘以未投保州的估计支出，以确定额外医疗保健支出的有效部分。然后，将这种具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，以确定低效道德风险的数量。对于被保险人和整个样本，将重复类似的程序。这项研究首次估计了道德风险中有效的部分。这些信息将被用来推断美国医疗保健总支出中代表有效道德风险的比例，并将被用来评估对不同优先健康状况的参保人实施费用分担的适当性。 与公共健康相关：传统经济学理论认为，参保会刺激人们购买不值得的额外医疗保健。另一种理论认为，一些医疗保健是浪费的，但很大一部分是值得的。这项建议旨在确定为全体人口和有某些健康状况的人提供的额外保健费用所值的部分。

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. An alternative theory suggests that a portion is welfare decreasing but another portion is welfare increasing. The welfare-increasing portion is 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. In theoretical terms, the welfare-increasing portion of moral hazard is the response to income transfers that are contained within the insurance price reduction. This study proposes to decompose moral hazard into a welfare-increasing portion and a portion that is welfare decreasing for the general population of Americans, for those Americans with 9 of the 15 priority health conditions separately, and for all 15 priority health conditions combined. Using the 1996-2008 Medical Expenditure Panel Survey, 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 will 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. PUBLIC HEALTH RELEVANCE: Conventional economic theory suggests that being insured creates incentives for people to purchase additional healthcare that is not worth the costs. An alternative theory suggests that some healthcare is wasteful, but a large portion is worth the costs. This proposal seeks to identify the portion of the additional health care that is worth the costs for the entire population and for those who are ill with certain health conditions.