Stanford University School of Medicine, CHP/PCOR, 117 Encina Commons, Stanford, CA 94305-6019, United States.
J Health Econ. 2012 Jan;31(1):135-46. doi: 10.1016/j.jhealeco.2011.09.001. Epub 2011 Sep 16.
It is well-known that pooled insurance coverage can induce people to make inefficiently low investments in self-protective activities. We identify another ex ante moral hazard that runs in the opposite direction. Lower levels of self-protection and the associated chronic conditions and behavioral patterns such as obesity, smoking, and malnutrition increase the incidence of many diseases and consumption of treatments to those diseases. This increases the reward for innovation and thus benefits the innovator. It also increases treatment innovation which benefits all consumers. As individuals do not take these positive externalities into account, their investments in self-protection are inefficiently high. We quantify the lower bound of this externality for obesity. The lower bound is independent of how much additional innovation is generated. The results show that the externality we identify offsets the negative Medicare-induced insurance externality of obesity. The Medicare-induced obesity subsidy is thus not a sufficient rationale for "soda taxes", "fat taxes" or other penalties on obesity. The quantitative finding also implies that the other ex ante moral hazard that we identify can be as important as the ex ante moral hazard that has been a central concept in health economics for decades.
众所周知,集合保险覆盖范围可能会诱使人们在自我保护活动上进行低效的低投资。我们发现了另一种事前道德风险,其方向相反。较低水平的自我保护以及相关的慢性疾病和行为模式,如肥胖、吸烟和营养不良,会增加许多疾病的发病率,并增加对这些疾病的治疗消费。这增加了创新的回报,从而使创新者受益。它还增加了治疗创新,使所有消费者受益。由于个人没有考虑到这些正外部性,他们在自我保护方面的投资效率低下。我们对肥胖的这种外部性的下限进行了量化。下限与产生多少额外创新无关。结果表明,我们确定的这种外部性抵消了肥胖对医疗保险的负保险外部性。因此,肥胖引起的医疗保险补贴并不是“苏打税”、“脂肪税”或其他针对肥胖的惩罚的充分理由。这一定量发现还意味着,我们所确定的另一种事前道德风险可能与几十年来一直是健康经济学核心概念的事前道德风险一样重要。