Pardo Cristian, Schott Whitney
Department of Economics, Saint Joseph's University, Philadelphia, PA 19131, USA.
Int J Health Care Finance Econ. 2012 Mar;12(1):39-61. doi: 10.1007/s10754-012-9105-2. Epub 2012 Feb 29.
This paper models health insurance choice in Chile (public versus private) as a dynamic, stochastic process, where individuals consider premiums, expected out-of pocket costs, personal characteristics and preferences. Insurance amenities and restrictions against pre-existing conditions among private insurers introduce asymmetry to the model. We confirm that the public system services a less healthy and wealthy population (adverse selection for public insurance). Simulation of choices over time predicts a slight crowding out of private insurance only for the most pessimistic scenario in terms of population aging and the evolution of education. Eliminating the restrictions on pre-existing conditions would slightly ameliorate the level (but not the trend) of the disproportionate accumulation of less healthy individuals in the public insurance program over time.
本文将智利的医疗保险选择（公共保险与私人保险）建模为一个动态随机过程，在此过程中，个人会考虑保费、预期自付费用、个人特征和偏好。私人保险公司的保险福利以及对已有疾病的限制给该模型引入了不对称性。我们证实，公共保险体系服务于健康状况较差且较为富裕的人群（公共保险存在逆向选择）。对随时间变化的选择进行模拟预测，只有在人口老龄化和教育发展最悲观的情况下，私人保险才会出现轻微的挤出效应。消除对已有疾病的限制会在一定程度上缓解随着时间推移公共保险项目中健康状况较差的个人不成比例积累的程度（但不会改变趋势）。
