Feldman R, Escribano C, Pellisé L
Division of Health Services Research, University of Minnesota, Minneapolis 55455, USA.
Health Econ. 1998 Dec;7(8):659-70. doi: 10.1002/(sici)1099-1050(199812)7:8<659::aid-hec384>3.0.co;2-1.
This paper analyzes the welfare economics of three arrangements for purchasing health insurance: competitive markets in which consumers are free to choose among options with different levels of coverage and prices; systems with compulsory partial pooling which permit private firms to sell supplementary coverage; and government-run pools that purchase comprehensive coverage at a single price for all consumers. Competitive insurance markets are assumed to face the problem of 'adverse selection'. This refers to a situation in which the insurer cannot observe characteristics of individuals that affect the cost of insurance and that are known to the individuals. Competitive markets with adverse selection are not efficient because low risks cannot purchase comprehensive insurance coverage. However, government-run pools with comprehensive coverage are an inefficient solution to the problem of adverse selection. Compulsory partial coverage may represent an attractive alternative to both competitive markets and comprehensive pools. We discover two situations when government intervention of this type will succeed: when there are not many high risks in the population, and when the risk types are similar. We discuss the implications of these results for health insurance programs in several countries. Our results also have implications for the allocation of public funds for disease-prevention projects. A project targeted at high risks will produce external benefits for low risks, even though they are not directly affected by the program. However, a successful project might eliminate the market for private insurance; in this case the government should consider mandating partial insurance coverage.
消费者可在具有不同保险范围和价格的选项中自由选择的竞争性市场；允许私人公司销售补充保险的强制性部分统筹制度；以及以单一价格为所有消费者购买全面保险的政府运营保险池。假设竞争性保险市场面临“逆向选择”问题。这是指保险人无法观察到影响保险成本且个人已知的个人特征的情况。存在逆向选择的竞争性市场是无效率的，因为低风险人群无法购买全面的保险。然而，提供全面保险的政府运营保险池对于逆向选择问题而言是一种无效率的解决方案。强制性部分保险可能是竞争性市场和全面保险池的一种有吸引力的替代方案。我们发现这种类型的政府干预在两种情况下会成功：当人群中高风险人群不多时，以及当风险类型相似时。我们讨论了这些结果对若干国家医疗保险计划的影响。我们的结果也对疾病预防项目的公共资金分配有影响。针对高风险人群的项目会为低风险人群带来外部收益，即使他们并未直接受到该项目影响。然而，一个成功的项目可能会消除私人保险市场；在这种情况下，政府应考虑强制要求部分保险覆盖。
