Pardo Cristian, Schott Whitney
Department of Economics, Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131, USA. E-mail:
Health Policy Plan. 2014 May;29(3):302-12. doi: 10.1093/heapol/czt017. Epub 2013 Apr 4.
In Chile, workers are mandated to choose either public or private health insurance coverage. Although private insurance premiums depend on health risk, public insurance premiums are solely linked to income. This structure implies that individuals with higher health risks may tend to avoid private insurance, leaving the public insurance system responsible for their care. This article attempts to explore the determinants of health insurance selection (private vs public) by individuals in Chile and to test empirically whether adverse selection indeed exists. We use panel data from Chile's 'Encuesta de Proteccion Social' survey, which allows us to control for a rich set of individual observed and unobserved characteristics using both a cross-sectional analysis and fixed-effect methods. Results suggest that age, sex, job type, income quintile and self-reported health are the most important factors in explaining the type of insurance selected by individuals. Asymmetry in insurance mobility caused by restrictions on pre-existing conditions may explain why specific illnesses have an unambiguous relationship with insurance selection. Empirical evidence tends to indicate that some sorting by health risk and income levels takes place in Chile. In addition, by covering a less healthy population with higher utilization of general health consultations, the public insurance system may be incurring disproportionate expenses. Results suggest that if decreasing segmentation and unequal access to health services are important policy objectives, special emphasis should be placed on asymmetries in the premium structure and inter-system mobility within the health care system. Preliminary analysis of the impact of the 'Garantias Explicitas de Salud' plan (explicit guarantees on health care plan) on insurance selection is also considered.
在智利，工人被要求选择公共或私人医疗保险覆盖范围。虽然私人保险费取决于健康风险，但公共保险费仅与收入相关。这种结构意味着健康风险较高的个人可能倾向于避开私人保险，而让公共保险系统负责他们的医疗护理。本文试图探讨智利个人选择医疗保险（私人保险还是公共保险）的决定因素，并通过实证检验逆向选择是否确实存在。我们使用智利“社会保护调查”的面板数据，这使我们能够通过横断面分析和固定效应方法来控制一系列丰富的个人观察到的和未观察到的特征。结果表明，年龄、性别、工作类型、收入五分位数和自我报告的健康状况是解释个人选择保险类型的最重要因素。对已有疾病的限制所导致的保险流动性不对称，可能解释了为什么特定疾病与保险选择有着明确的关系。实证证据倾向于表明，在智利存在一些按健康风险和收入水平进行的分类。此外，由于公共保险系统覆盖了健康状况较差、一般健康咨询利用率较高的人群，可能会产生不成比例的费用。结果表明，如果减少医疗服务的分割和不平等获取是重要的政策目标，那么应特别强调保险费结构的不对称以及医疗保健系统内的系统间流动性。本文还考虑了对“健康明确保障”计划（医疗保健计划的明确保障）对保险选择影响的初步分析。
