nach oben

The European Journal of Health Economics

Erschienen in:

01.08.2010 | Original Paper

Adverse selection in the health insurance market: some empirical evidence

verfasst von: Marcelo Resende, Rodrigo Zeidan

Erschienen in: The European Journal of Health Economics | Ausgabe 4/2010

Einloggen, um Zugang zu erhalten

Abstract

This paper tests for the existence of adverse selection in the Brazilian individual health insurance market in 2003. The testing approach adapts that conceived by Chiappori and Salanié (Eur Econ Rev 41, 943–950, 1997; J Polit Econ 108, 56–78, 2000). After controlling for sex, age, income, number of dependents, occupational groups and schooling levels, the evidence favors adverse selection as indicated by a positive correlation between the coverage of the contract and occurrence of illnesses (as approximated by hospitalization) was not strong. The consideration of complex sampling in the probit estimations led to empirical evidence that does not indicate the presence of adverse selection, but which highlighted some interesting features of the relationship between the selected variables.

The first group of studies considers specific segments of the market. Ettner [8] focused on Medicare supplementary (Medigap) insurance, Wolfe and Goddeeiris [20] focused only on the elderly segment, and Cutler [7] considered health plan choices by employees of Harvard University.

See, e.g., [11] for a useful introduction.

Institutional details on that market are discussed in [18].

Evidence provided by Bahia et al. [2] indicate that high-cost procedures are somewhat shared between the private and public. The former segment has a higher importance for cardiac bypass, cardiac angioplasty, hip arthroplasty, and morbid obesity surgery, whereas the latter has a more decisive role in terms of hepatic transplants and substitutive renal therapies.

The special supplement referred to had been previously available for 1998.

In general, applied economists ignore complex sampling in econometric estimation based on survey data, but the importance of sampling design has been outlined at least since 1965 [12].

In order to avoid the so-called dummy trap that would relate to perfect collinearity, the variable referring to individuals with no occupation is dropped in the econometric analysis.

Aoki, T.: Proposed modified probit model incorporating non-parametric density estimation: how to measure asymmetric information in the health insurance market? Appl. Econ. Lett. 12, 347–350 (2005). doi:10.1080/13504850500044104

Bahia, L., Simmer, E., Oliveira, D.C.: Cobertura de Planos Privados de Saúde e Doenças Crônicas: Notas sobre Utilização de Procedimentos de Alto Custo. Cien. Saude Colet. 9, 921–929 (2004). doi:10.1590/S1413-81232004000400013

Browne, M.: Evidence of adverse selection in the individual health insurance market. J. Risk Insur. 59, 13–33 (1992). doi:10.2307/253214

Cardon, J.H., Hendel, I.: Asymmetric information in health insurance: evidence from the national expenditure survey. Rand J. Econ. 32, 408–427 (2001). doi:10.2307/2696362

Chiappori, P.A., Salanié, B.: Empirical contract theory: the case of insurance data. Eur. Econ. Rev. 41, 943–950 (1997). doi:10.1016/S0014-2921(97)00052-4

Chiappori, P., Salanié, B.: Testing for asymmetric information in insurance markets. J. Polit. Econ. 108, 56–78 (2000). doi:10.1086/262111

Cutler, D.M., Reber, S.J. (1998) Paying for health insurance: the trade-off between competition and adverse selection. Q. J. Econ. 113, 433–466 doi:10.1162/003355398555649

Ettner, S.L.: Adverse selection and the purchase of medigap insurance by the elderly. J. Health Econ. 16, 543–562 (1997). doi:10.1016/S0167-6296(97)00011-8

Finkelstein, A., Poterba, J.: Adverse selection in insurance markets: policyholder evidence from the UK annuity market. J. Polit. Econ. 112, 183–208 (2004). doi:10.1086/379936

10.

Gouriéroux, C., Monfort, A., Renaut, E., Trognon, A.: Generalized residuals. J. Econom. 34, 5–32 (1987). doi:10.1016/0304-4076(87)90065-0

11.

Johnston, J., DiNardo, J.: Econometric methods. McGraw-Hill, New York (1997)

12.

Kish, L.: Survey sampling. Wiley, New York (1965)

13.

Neudeck, W., Podczeck, K.: Adverse selection and regulation in health insurance markets. J. Health Econ. 15, 387–408 (1996). doi:10.1016/S0167-6296(96)00488-2

14.

Pauly, M.V.: Is cream skimming a problem for the competitive medical market? J. Health Econ. 3, 88–95 (1984). doi:10.1016/0167-6296(84)90029-8

15.

Pauly, M.V.: Taxation, health insurance, and market failure in the medical economy. J. Econ. Lit. 24, 629–675 (1986)

16.

Saito, K.: Testing for asymmetric information in the automobile insurance market under rate regulation. J. Risk Insur. 73, 335–356 (2006). doi:10.1111/j.1539-6975.2006.00178.x

17.

Savage, E., Wright, D.J.: Moral hazard and adverse selection in Australian private hospitals: 1989–1990. J. Health Econ. 22, 331–359 (2003). doi:10.1016/S0167-6296(02)00104-2

18.

Wanick, A.T.S.: Risco Moral, Seleção Adversa e Regulação no Mercado de Saúde Suplementar, MSc dissertation, Instituto de Economia-Universidade Federal do Rio de Janeiro (2002)

19.

Wanick, A.T.S., Resende, M.: Testing for adverse selection in the Brazilian health plan market. Texto para Discussão no. 166, Universidade Federal Fluminense (2003)

20.

Wolfe, J.R., Goddeeris, J.H.: Adverse selection, moral hazard, and wealth effects in the Medigap insurance market. J. Health Econ. 10, 433–459 (1991). doi:10.1016/0167-6296(91)90024-H

Titel: Adverse selection in the health insurance market: some empirical evidence
verfasst von: Marcelo Resende
Rodrigo Zeidan
Publikationsdatum: 01.08.2010
Verlag: Springer-Verlag
Erschienen in: The European Journal of Health Economics / Ausgabe 4/2010
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-010-0219-5

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2010

Geographic distribution of physicians in Portugal

The challenge of corporatisation: the experience of Portuguese public hospitals

Optimal savings and health spending over the life cycle

Determinants of health care costs of HIV-positive patients in the Canary Islands, Spain

Modeling stroke management: a qualitative review of cost-effectiveness analyses

Substituting inpatient for outpatient care: what is the impact on hospital costs and efficiency?