Department of Economics, University of Paderborn, Warburger Straße 100, 33098, Paderborn, Germany.
Eur J Health Econ. 2019 Dec;20(9):1317-1333. doi: 10.1007/s10198-019-01091-w. Epub 2019 Aug 12.
In this paper, I analyze whether premium refunds can reduce ex-post moral hazard behavior in the health insurance market. I do so by estimating the effect of these refunds on different measures of medical demand. I use panel data from German sickness funds that cover the years 2006-2010 and I estimate effects for the year 2010. Applying regression adjusted matching, I find that choosing a tariff that contains a premium refund is associated with a significant reduction in the probability of visiting a general practitioner. Furthermore, the probability of visiting a doctor due to a trivial ailment such as a common cold is reduced. Effects are mainly driven by younger (and, therefore, healthier) individuals, and they are stronger for men than for women. Medical expenditures for doctor visits are also reduced. I conclude that there is evidence that premium refunds are associated with a reduction in ex-post moral hazard. Robustness checks support these findings. Yet, using observable characteristics for matching and regression, it is never possible to completely eliminate a potentially remaining selection bias and results may not be interpreted in a causal manner.
在本文中，我分析了保费退款是否可以减少医疗保险市场中的事后道德风险行为。我通过估计这些退款对不同医疗需求衡量指标的影响来做到这一点。我使用了涵盖 2006-2010 年的德国疾病基金的面板数据，并对 2010 年的影响进行了估计。通过应用回归调整匹配，我发现选择包含保费退款的关税与普通医生就诊概率的显著降低有关。此外，由于普通感冒等琐碎疾病而看医生的概率也降低了。这些影响主要是由年轻（因此更健康）的个体驱动的，并且对男性的影响比对女性的影响更大。医生就诊的医疗支出也减少了。我得出的结论是，有证据表明保费退款与事后道德风险的降低有关。稳健性检验支持这些发现。然而，使用可观察的特征进行匹配和回归，永远不可能完全消除潜在的剩余选择偏差，并且结果不能以因果关系的方式进行解释。
