Barros Pedro Pita, Machado Matilde P, Sanz-de-Galdeano Anna
Universidad Nova de Lisboa, Portugal.
Universidad Carlos III de Madrid, Spain and CEPR.
J Health Econ. 2008 Jul;27(4):1006-1025. doi: 10.1016/j.jhealeco.2008.02.007. Epub 2008 Feb 29.
We estimate the impact of extra health insurance coverage beyond a National Health System on the demand for several health services. Traditionally, the literature has tried to deal with the endogeneity of the private (extra) insurance decision by finding instrumental variables. Since a priori instrumental variables are hard to find we take a different approach. We focus on the most common health insurance plan in Portugal, ADSE, which is given to all civil servants and their dependents. We argue that this insurance is exogenous, i.e., not correlated with the beneficiaries' health status. This identifying assumption allows us to estimate the impact of having ADSE coverage on the demand for three different health services using a matching estimator technique. The health services used are number of visits, number of blood and urine tests, and the probability of visiting a dentist. Results show large positive effects of ADSE coverage for number of visits and tests among the young (18-30 years old) but only the latter is statistically significantly different from zero. The effects represent 21.8% and 30% of the average number of visits and tests for the young. On the contrary, we find no evidence of moral hazard on the probability of visiting a dentist.
我们估计了国家医疗系统之外的额外医疗保险覆盖范围对几种医疗服务需求的影响。传统上，文献试图通过寻找工具变量来处理私人（额外）保险决策的内生性问题。由于先验的工具变量很难找到，我们采用了一种不同的方法。我们关注葡萄牙最常见的医疗保险计划ADSE，该计划覆盖所有公务员及其家属。我们认为这种保险是外生的，即与受益人的健康状况无关。这一识别假设使我们能够使用匹配估计技术来估计拥有ADSE保险对三种不同医疗服务需求的影响。所使用的医疗服务包括就诊次数、血液和尿液检测次数以及看牙医的概率。结果表明，ADSE保险覆盖范围对年轻人（18 - 30岁）的就诊次数和检测次数有很大的正向影响，但只有后者在统计上显著不同于零。这些影响分别占年轻人平均就诊次数和检测次数的21.8%和30%。相反，我们没有发现看牙医概率存在道德风险的证据。
