Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
BMC Health Serv Res. 2022 Oct 18;22(1):1260. doi: 10.1186/s12913-022-08613-y.
Consumer moral hazard refers to an increase in demand for health services or a decrease in preventive care due to insurance coverage. This phenomenon as one of the most evident forms of moral hazard must be reduced and prevented because of its important role in increasing health costs. This study aimed to determine and analyze the strategies used to control consumer moral hazards in health systems.
In this systematic review. Web of Sciences, PubMed, Scopus, Embase, ProQuest, Iranian databases(Magiran and SID), and Google Scholar engine were searched using search terms related to moral hazard and healthcare utilization without time limitation. Eligible English and Persian studies on consumer moral hazard in health were included, and papers outside the health and in other languages were excluded. Thematic content analysis was used for data analysis.
Content analysis of 68 studies included in the study was presented in the form of two group, six themes, and 11 categories. Two group included "changing behavior at the time of receiving health services" and "changing behavior before needing health services." The first group included four themes: demand-side cost sharing, health savings accounts, drug price regulation, and rationing of health services. The second approach consisted of two themes Development of incentive insurance programs and community empowerment.
Strategies to control consumer moral hazards focus on changing consumer consumptive and health-related behaviors, which are designed according to the structure of health and financing systems. Since "changing consumptive behavior" strategies are the most commonly used strategies; therefore, it is necessary to strengthen strategies to control health-related behaviors and develop new strategies in future studies. In addition, in the application of existing strategies, the adaptation to the structure of the health and financing system, and the pattern of consumption of health services in society should be considered.
消费者道德风险是指由于保险覆盖而导致对医疗服务需求的增加或预防性护理的减少。这种道德风险最明显的形式之一，必须加以减少和防范，因为它在增加医疗费用方面起着重要作用。本研究旨在确定和分析用于控制医疗保健系统中消费者道德风险的策略。
在这项系统评价中，我们无时间限制地使用与道德风险和医疗保健利用相关的搜索词，在 Web of Sciences、PubMed、Scopus、Embase、ProQuest、伊朗数据库（Magiran 和 SID）和 Google Scholar 引擎上进行了搜索。纳入了有关医疗保健中消费者道德风险的英文和波斯语合格研究，排除了非医疗保健和其他语言的论文。采用主题内容分析法进行数据分析。
对纳入研究的 68 项研究进行内容分析，以两组、六个主题和 11 个类别呈现。两组包括“在接受医疗服务时改变行为”和“在需要医疗服务之前改变行为”。第一组包括四个主题：需求方成本分担、健康储蓄账户、药品价格管制和医疗服务配给。第二种方法包括两个主题：激励保险计划的发展和社区赋权。
控制消费者道德风险的策略侧重于改变消费者的消费和与健康相关的行为，这些策略是根据卫生和融资系统的结构设计的。由于“改变消费行为”策略是最常用的策略；因此，在未来的研究中，有必要加强控制与健康相关的行为的策略，并开发新的策略。此外，在应用现有策略时，应考虑适应卫生和融资系统的结构以及社会对卫生服务的消费模式。
