Value Based Cost Sharing Meets the Theory of Moral Hazard

Value Based Cost Sharing Meets the Theory of Moral Hazard PDF

Author: Mark V. Pauly

Publisher:

Published: 2007

Total Pages: 26

ISBN-13:

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The conventional theory of optimal coinsurance rates in health insurance in the presence of moral hazard indicates that, in situations of equal risk characteristics, coinsurance should vary if the price-responsiveness or price-elasticity of demand for different medical services varies, and should be larger for the more price responsive services. An alternative theory called "value-based cost sharing" indicates that coinsurance should be lower for services with higher (marginal) benefits relative to costs. This paper reconciles the two views. It shows that, if patient demands are based on correct information on benefits and costs, the conclusion of the conventional view is identical to the conclusion from the value-based approach. If patient demands differ from correct demands, it is shown that optimal coinsurance depends both on the extent and direction of information imperfection and on price-responsiveness or price elasticity. The paper also shows, as an alternative to adjusting coinsurance to deal with information imperfection, that providing better information which affects patient demands can be superior if uninformed patient demands exceed informed patient demands, but value based cost sharing can be superior to providing information (even if the cost of information is minimal) when patient demands fall short of informed demands. An extended numerical example illustrates these points.

The Demand for Medical Care Services

The Demand for Medical Care Services PDF

Author: Joseph P. Newhouse

Publisher: RAND Corporation

Published: 1981

Total Pages: 44

ISBN-13:

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Surveys the literature on demand for medical care services and conjectures where the literature may go next. Although focus is on the response of demand to changes in cost sharing arrangements, several other determinants of demand are treated. Previous studies have used four sources of data: premium or claims information, natural experiments, comparison of demand of individuals with different insurance policies, and designed experiments. The advantages and drawbacks of using each of these sources are examined. Several frontiers of demand analysis are also discussed: specification of price, income, and health status variables; specification of the stochastic term and use of appropriate estimators; specification of the dependent variable; and the norms argument. The author concludes that whereas both conceptual and empirical knowledge are now much improved, the theory of both price and utilization at the market level is in need of further study.

A Review of the Rand Health Insurance Experiment. Statistics and Econometrics

A Review of the Rand Health Insurance Experiment. Statistics and Econometrics PDF

Author: Nina Schwenniger

Publisher: GRIN Verlag

Published: 2015-06-12

Total Pages: 25

ISBN-13: 3656978859

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Seminar paper from the year 2015 in the subject Economy - Health Economics, grade: 1,0, University of Paderborn, language: English, abstract: The famous RAND Health Insurance Experiment (RAND HIE) deals with the question how health insurance affects medical spending. The scientific essay The RAND Health Insurance Experiment, Three Decades Later (2013) by Aviva Aron-Dine, Liran Einav, and Amy Finkelstein, extracted from the Journal of Economic Perspective, forms the basis for this seminar paper. All facts regarding the primary experiment are taken from this essay. It features a reexamination of the core findings of the RAND HIE with a state of the art perspective regarding the analysis of randomized experiments and the economics of moral hazard. Between 1974 and 1981, more than 5,800 individuals from about 2,000 households in six different locations across the United States participated in the RAND HIE and thereby received health insurance. The experiment randomly assigned families to health insurance plans with different levels of cost sharing and was representative of families with adults under the age of 62. The plans ranged from full coverage (“free care”) to plans with little coverage (5 percent) for the first approximately $4,000 (in 2011 dollars) incurred during a year. The conduct and analysis of randomized experiments as well as the economic analysis of moral hazard in the context of health insurance were relatively novel fields of research back in the years of the RAND investigation. Nevertheless, the RAND results are highly esteemed when predicting the likely impact of health insurance reforms on medical spending or design-ing actual insurance policies. In the course of time, health spending has grown and the consequent pressure on the public sector confers additional significance to the RAND estimates. The RAND HIE was funded by the US Department of Health, Education, and Welfare and cost roughly $295 million (in 2011 dollars). From a cost perspective alone, a replication of such an experiment is highly improbable. In section two, the design of the RAND HIE is presented and complemented by a depiction of the key economic object of interest, namely the impact of health insurance on medical spending. Section three describes the experimental analysis, including the baseline regression. The core variable of interest, the treatment effect, is specified and validated. In section four, the price elasticity is derived and the application discussed. Section five emphasizes the raison d’être for a randomized experiment based on statistical evidence and additional literature.

Value Based Cost Sharing Meets the Theory of Moral Hazard

Value Based Cost Sharing Meets the Theory of Moral Hazard PDF

Author: Mark V. Pauly

Publisher:

Published: 2010

Total Pages: 26

ISBN-13:

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The conventional theory of optimal coinsurance rates in health insurance in the presence of moral hazard indicates that, in situations of equal risk characteristics, coinsurance should vary if the price-responsiveness or price-elasticity of demand for different medical services varies, and should be larger for the more price responsive services. An alternative theory called quot;value-based cost sharingquot; indicates that coinsurance should be lower for services with higher (marginal) benefits relative to costs. This paper reconciles the two views. It shows that, if patient demands are based on correct information on benefits and costs, the conclusion of the conventional view is identical to the conclusion from the value-based approach. If patient demands differ from correct demands, it is shown that optimal coinsurance depends both on the extent and direction of information imperfection and on price-responsiveness or price elasticity. The paper also shows, as an alternative to adjusting coinsurance to deal with information imperfection, that providing better information which affects patient demands can be superior if uninformed patient demands exceed informed patient demands, but value based cost sharing can be superior to providing information (even if the cost of information is minimal) when patient demands fall short of informed demands. An extended numerical example illustrates these points.

Moral Hazard in Health Insurance

Moral Hazard in Health Insurance PDF

Author: Amy Finkelstein

Publisher: Columbia University Press

Published: 2014-12-02

Total Pages: 161

ISBN-13: 0231538685

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Addressing the challenge of covering heath care expenses—while minimizing economic risks. Moral hazard—the tendency to change behavior when the cost of that behavior will be borne by others—is a particularly tricky question when considering health care. Kenneth J. Arrow’s seminal 1963 paper on this topic (included in this volume) was one of the first to explore the implication of moral hazard for health care, and Amy Finkelstein—recognized as one of the world’s foremost experts on the topic—here examines this issue in the context of contemporary American health care policy. Drawing on research from both the original RAND Health Insurance Experiment and her own research, including a 2008 Health Insurance Experiment in Oregon, Finkelstein presents compelling evidence that health insurance does indeed affect medical spending and encourages policy solutions that acknowledge and account for this. The volume also features commentaries and insights from other renowned economists, including an introduction by Joseph P. Newhouse that provides context for the discussion, a commentary from Jonathan Gruber that considers provider-side moral hazard, and reflections from Joseph E. Stiglitz and Kenneth J. Arrow. “Reads like a fireside chat among a group of distinguished, articulate health economists.” —Choice

The Microeconomics of Insurance

The Microeconomics of Insurance PDF

Author: Ray Rees

Publisher: Now Publishers Inc

Published: 2008

Total Pages: 178

ISBN-13: 1601981082

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In this relatively short survey, we present the core elements of the microeconomic analysis of insurance markets at a level suitable for senior undergraduate and graduate economics students. The aim of this analysis is to understand how insurance markets work, what their fundamental economic functions are, and how efficiently they may be expected to carry these out.

Insurance Economics

Insurance Economics PDF

Author: Peter Zweifel

Publisher: Springer Science & Business Media

Published: 2012-02-24

Total Pages: 461

ISBN-13: 364220547X

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Presenting theoretical foundations and empirical research, this text introduces the reader to the core issues and analytical tools of insurance economics, examining in detail a host of key factors including supply and demand, regulation and social insurance.