Zheng Yan, Vukina Tomislav, Zheng Xiaoyong
JP Morgan Chase, 201 N Walnut St, Wilmington, DE, 19801, USA.
Department of Agricultural and Resource Economics, North Carolina State University, 2801 Founders Dr, Raleigh, NC, 27695, USA.
Int J Health Econ Manag. 2018 Jul 14. doi: 10.1007/s10754-018-9246-z.
We use a structural approach to separately estimate moral hazard and adverse selection effects in health care utilization using hospital invoices data. Our model explicitly accounts for the heterogeneity in the non-insurable transactions costs associated with hospital visits which increase the individuals' total cost of health care and dampen the moral hazard effect. A measure of moral hazard is derived as the difference between the observed and the counterfactual health care consumption. In the population of patients with non life-threatening diagnoses, our results indicate statistically significant and economically meaningful moral hazard. We also test for the presence of adverse selection by investigating whether patients with different health status sort themselves into different health insurance plans. Adverse selection is confirmed in the data because patients with estimated worse health tend to buy the insurance coverage and patients with estimated better health choose not to buy the insurance coverage.
我们采用一种结构化方法，利用医院发票数据分别估算医疗保健利用中的道德风险和逆向选择效应。我们的模型明确考虑了与医院就诊相关的不可保险交易成本的异质性，这些成本会增加个人的医疗保健总成本，并抑制道德风险效应。道德风险的一种衡量方法是观察到的医疗保健消费与反事实医疗保健消费之间的差异。在非危及生命诊断的患者群体中，我们的结果表明存在具有统计学显著性和经济意义的道德风险。我们还通过调查不同健康状况的患者是否会选择不同的健康保险计划来检验逆向选择的存在。数据证实了逆向选择的存在，因为健康状况估计较差的患者倾向于购买保险，而健康状况估计较好的患者则选择不购买保险。
