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

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下降，但这并没有考虑到由于购买保险并保持健康的人的收入转移到购买保险并生病的人而购买的额外医疗保健。这种收入效应的确认表明，一部分是福利下降，但另一部分是福利增加。福利增加部分可以通过被保险消费者购买的额外医疗保健来估计，如果保险人没有支付任何医疗费用，而是向他支付了一张银行本票，其金额等于他或她根据标准保险单由保险人支付的医疗保健支出部分。这项研究不是进行昂贵的RAND类型的健康保险实验，而是提出使用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，并且针对（a）美国普通人群，（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种优先健康状况的总和。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隐性，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）对于私人保险，估计总支出中保险公司将支付的部分（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，使用来自步骤2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中相同的支出来支付，（6）对于每个未投保的人，使用来自步骤1的系数来估计道德风险支出，如果他们已经投保，以及（7）对于每个未被保险的人，如果该个人通过来自步骤5的或有索赔合同被保险，则健康护理支出的变化乘以未被保险状态下的估计支出，以确定额外健康护理支出的有效部分。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。这项研究是第一次估计的道德风险是有效的。这些信息将用于推断美国医疗保健总支出中代表有效道德风险的比例，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摊的适当性。 公共卫生相关性：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，但这并没有考虑到保险的收入影响。这项建议旨在确定值得为全体人口和 那些患有某些健康状况的人。

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. PUBLIC HEALTH RELEVANCE: Conventional economic theory suggests that being insured creates incentives for people to purchase additional healthcare that is not worth the costs, but this does not take into account the income effects of insurance. 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.