Department of Economics, Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131, United States.
J Health Econ. 2019 Sep;67:102221. doi: 10.1016/j.jhealeco.2019.07.001. Epub 2019 Jul 8.
This paper builds and estimates a dynamic choice model to examine the impact on health insurance selection of Chile's GES health care reform. This program provides guarantees in coverage and benefits to several health conditions in the context of a market where public and private health insurers co-exist. Structural differences in premiums, benefits and out-of-pocket medical costs across systems may have caused adverse selection problems. Restrictions on pre-existing conditions in the private system mean that insurance selection could be a dynamic process in which current choices can affect future health insurance selection. In fact, estimation results suggest there is willingness to pay to have access to private insurance to those affected by pre-existing conditions. The GES reform may have also altered health insurance choices, as it seems to have significantly reduced out-of-pocket medical costs to people affected by the covered illnesses. Simulations show an increase in participation in the public system of about 3.8 percentage points due to the reform, which is stronger for younger, healthier and more educated individuals. Therefore, the reform may have eased adverse selection problems in Chile's health care system by drawing low-risk individuals towards the public system.
本文构建并估计了一个动态选择模型，以检验智利 GES 医疗改革对健康保险选择的影响。该计划在公私医疗保险机构并存的市场环境下，为若干健康状况提供了保障和福利。不同体系之间保费、福利和自付医疗费用的结构性差异可能导致了逆向选择问题。在私人体系中对既往病症的限制意味着，保险选择可能是一个动态过程，当前的选择会影响未来的健康保险选择。事实上，估计结果表明，对于受既往病症影响的人来说，获得私人保险的意愿是有代价的。GES 改革也可能改变了健康保险的选择，因为它似乎显著降低了受保疾病患者的自付医疗费用。模拟结果显示，由于改革，公共体系的参与率增加了约 3.8 个百分点，对于年轻、健康和受教育程度较高的人来说，这种影响更为明显。因此，该改革可能通过将低风险个体吸引到公共体系，缓解了智利医疗体系中的逆向选择问题。
