Antonini M, van Kleef R C, Henriquez J, Paolucci F
School of Medicine and Public Health, The University of Newcastle, Newcastle, 2300 Australia.
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3000 Rotterdam, The Netherlands.
Geneva Pap Risk Insur Issues Pract. 2023;48(1):130-156. doi: 10.1057/s41288-021-00253-3. Epub 2021 Nov 2.
Several regulated health insurance markets include the option for consumers to choose a voluntary deductible. An important motive for this option is to reduce moral hazard. In return for a voluntary deductible, consumers receive a premium rebate, which is typically community rated. Under community rating, voluntary deductibles are particularly attractive for low-risk consumers. Since these people use relatively little medical care, the total moral hazard reduction might be relatively small compared to the total healthcare spending. This paper examines the potential moral hazard reduction under risk-rated premiums. We use Chile as a case study due to institutional features that make it a valid benchmark for other countries. Our simulations show that in the presence of self-selection and under a uniform percentage moral hazard reduction across risk types, the absolute moral hazard reduction from a voluntary deductible is indeed expected to be larger in a system with risk-rated premiums than in a system with community-rated premiums. Nevertheless, sensitivity checks show that this conclusion might no longer hold as the percentage moral hazard reduction is lower for high-risk individuals compared to low-risk individuals.
几个受监管的健康保险市场为消费者提供了选择自愿免赔额的选项。这一选项的一个重要动机是降低道德风险。作为对自愿免赔额的回报，消费者会获得保费回扣，保费回扣通常采用社区费率。在社区费率制度下，自愿免赔额对低风险消费者特别有吸引力。由于这些人使用的医疗服务相对较少，与总的医疗支出相比，降低道德风险的总体效果可能相对较小。本文研究了风险评级保费制度下潜在的道德风险降低情况。由于智利的制度特征使其成为其他国家的有效基准，我们将智利作为案例进行研究。我们的模拟结果表明，在存在自我选择且不同风险类型的道德风险降低比例统一的情况下，与社区费率保费制度相比，在风险评级保费制度下，自愿免赔额带来的绝对道德风险降低幅度确实预计会更大。然而，敏感性检验表明，当高风险个体的道德风险降低比例低于低风险个体时，这一结论可能不再成立。
