Centre for Applied Health Economics, Griffith University, Queensland, Nathan, Australia.
Menzies Health Institute Queensland, Griffith University, Queensland, Southport, Australia.
Health Econ. 2023 Jan;32(1):3-24. doi: 10.1002/hec.4605. Epub 2022 Sep 13.
Separating selection bias from moral hazard in private health insurance (PHI) markets has been a challenging task. We estimate selection bias and moral hazard in Australia's mixed public-private health system, where PHI premiums are community-rated rather than risk-rated. Using longitudinal cohort data, with fine-grained measures for medical services predominantly funded by PHI providers, we find consistent and robust estimates of advantageous selection among hospitalized cardiovascular disease (CVD) patients. Specifically, we show that in addition to their risk-averse attributes, CVD patients who purchase PHI use fewer services that are not covered by PHI providers (e.g., general practitioners and emergency departments) and have fewer comorbidities. Finally, unlike previous studies, we show that ex-post moral hazard exists in the use of specific "in-hospital" medical services such as specialist and physician services, miscellaneous diagnostic procedures, and therapeutic treatments. From the perspective of PHI providers, the annual cost of moral hazard translates to a lower bound estimate of $707 per patient, equivalent to a 3.03% reduction in their annual profits.
在私人医疗保险（PHI）市场中，将选择偏差与道德风险区分开来一直是一项具有挑战性的任务。我们在澳大利亚公私混合的医疗体系中对选择偏差和道德风险进行了评估，该体系中的 PHI 保费是按社区定价而不是按风险定价。我们使用纵向队列数据，对主要由 PHI 提供者资助的医疗服务进行了细粒度的衡量，发现住院心血管疾病（CVD）患者中存在有利的选择偏倚。具体来说，我们表明，除了风险规避属性外，购买 PHI 的 CVD 患者还会减少使用不受 PHI 提供者覆盖的服务（例如全科医生和急诊部），并且合并症更少。最后，与先前的研究不同，我们表明在特定的“住院”医疗服务（如专科医生和医师服务、各种诊断程序和治疗）的使用中存在事后道德风险。从 PHI 提供者的角度来看，道德风险的年度成本相当于每位患者 707 美元的下限估计，相当于其年度利润减少 3.03%。
