Decomposition of Moral Hazard

道德风险分解

• 批准号: 8189501
• 负责人: John A Nyman
• 金额: $ 17.21万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189501
• 关键词: Decomposition; Moral; Hazard

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.

描述（由申请人提供）：道德风险是因为保险而消费的额外医疗保健。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，而另一部分是福利增加。福利增加部分是被保险消费者本应购买的额外医疗保健，如果保险人不支付任何医疗费用，而是向他支付一张银行本票，金额等于保险人根据标准保险单支付的他或她的医疗保健支出部分。从理论上讲，道德风险的福利增加部分是对包含在保险价格下降中的收入转移的反应。本研究提出将道德风险分解为福利增加的部分和福利减少的部分，分别针对15种优先健康状况中的9种和所有15种优先健康状况的美国人。使用1996-2008年医疗支出小组调查，它将使用一个7步过程来：（1）使用工具变量方法估计医疗保健支出，以纠正私人和公共医疗保险的内生性，同时考虑到公共保险的可能选择，（2）对于每个未投保的人，从第1步中的收入系数估计需求的收入弹性，（3）对于私人投保人，估计保险公司将支付的总支出部分（不包括费用分摊），（4）对于每个未投保的人，使用步骤3中的系数来估计如果他们已经投保，保险公司支付的支出金额，（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，如果他们用或有索赔保险单投保，该保险单用与步骤4中相同的支出支付，（6）对于每个未投保的人，使用步骤1中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，如果个人通过步骤5中的或有索赔合同投保，则医疗保健支出的变化乘以未投保状态下的估计支出，以确定额外医疗保健支出的有效部分。然后，将这种有效率的支出与第6步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本重复类似的程序。这项研究首次估计了有效的道德风险部分。这些信息将用于对美国医疗保健总支出中代表有效道德风险的比例进行推断，并用于评估对具有各种优先健康状况的被保险人实施费用分担的适当性。 公共卫生关系：传统的经济理论认为，投保会激励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成本。这项提案旨在确定额外保健的哪一部分值得为全体人口和患有某些健康状况的人支付费用。