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Self-selection and moral hazard in Chilean health insurance

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  • Sapelli, Claudio
  • Vial, Bernardita

Abstract

In Chile, dependant workers are mandated to purchase health insurance and they can chose between one public provider and several private providers. Here, we analyze the relation between utilization and the choice of either private or public insurance. Independent workers, however, are not mandated. In this case, we analyze the relationship between utilization and the decision to purchase insurance. The results show adverse selection against insurance companies for independent workers and against FONASA for dependant workers. Moral hazard is negligible in the case of hospitalization. Regarding medical visits, over consumption is quantitatively important and statistically significant in all cases (against insurance for independents; against public and private insurance in the case of dependant workers).

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 22 (2003)
Issue (Month): 3 (May)
Pages: 459-476

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Handle: RePEc:eee:jhecon:v:22:y:2003:i:3:p:459-476

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Web page: http://www.elsevier.com/locate/inca/505560

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References

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  1. David M. Cutler & Sarah Reber, 1996. "Paying for Health Insurance: The Tradeoff between Competition and Adverse Selection," NBER Working Papers 5796, National Bureau of Economic Research, Inc.
  2. Claudio Sapelli & Arístides Torche, 1998. "El Seguro Previsional de Salud: Determinantes de la Elección entre Seguro Público y Privado, 1990-1994," Latin American Journal of Economics-formerly Cuadernos de Economía, Instituto de Economía. Pontificia Universidad Católica de Chile., vol. 35(106), pages 383-406.
  3. Claudio Sapelli & Bernardita Vial, 1998. "Utilización de Prestaciones de Salud en Chile: ¿Es Diferente entre Grupos de Ingreso?," Latin American Journal of Economics-formerly Cuadernos de Economía, Instituto de Economía. Pontificia Universidad Católica de Chile., vol. 35(106), pages 343-382.
  4. Cameron, A. Colin & Trivedi, Pravin K., 1991. "The role of income and health risk in the choice of health insurance : Evidence from Australia," Journal of Public Economics, Elsevier, vol. 45(1), pages 1-28, June.
  5. Cameron, A C & P. K. Trivedi & Frank Milne & J. Piggott, 1988. "A Microeconometric Model of the Demand for Health Care and Health Insurance in Australia," Review of Economic Studies, Wiley Blackwell, vol. 55(1), pages 85-106, January.
  6. David M. Cutler & Richard J. Zeckhauser, 1998. "Adverse Selection in Health Insurance," NBER Chapters, in: Frontiers in Health Policy Research, volume 1, pages 1-32 National Bureau of Economic Research, Inc.
  7. William H. Greene, 1997. "FIML Estimation of Sample Selection Models for Count Data," Working Papers 97-02, New York University, Leonard N. Stern School of Business, Department of Economics.
  8. David Cutler, 1994. "Market Failure in Small Group Health Insurance," NBER Working Papers 4879, National Bureau of Economic Research, Inc.
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Citations

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Cited by:
  1. Sosa-Rubí, Sandra G. & Galárraga, Omar & Harris, Jeffrey E., 2009. "Heterogeneous impact of the "Seguro Popular" program on the utilization of obstetrical services in Mexico, 2001-2006: A multinomial probit model with a discrete endogenous variable," Journal of Health Economics, Elsevier, vol. 28(1), pages 20-34, January.
  2. Goulão, Catarina, 2014. "Voluntary Public Health Insurance," TSE Working Papers 14-488, Toulouse School of Economics (TSE).
  3. Yilma, Zelalem & van Kempen, Luuk & de Hoop, Thomas, 2012. "A perverse ‘net’ effect? Health insurance and ex-ante moral hazard in Ghana," Social Science & Medicine, Elsevier, vol. 75(1), pages 138-147.
  4. Cuong Viet Nguyen, 2012. "The Impact Of Voluntary Health Insurance On Health Care Utilization And Out‐Of‐Pocket Payments: New Evidence For Vietnam," Health Economics, John Wiley & Sons, Ltd., vol. 21(8), pages 946-966, 08.
  5. Wong, Irene Oi Ling & Chan, Wai-Sum & Choi, Sarah & Lo, Su-Vui & Leung, Gabriel Matthew, 2006. "Moral hazard or realised access to care?: Empirical observations in Hong Kong," Health Policy, Elsevier, vol. 75(3), pages 251-261, February.
  6. Nguyen Viet Cuong, 2014. "Impact Evaluation of Health Insurance for Children: Evidence from a Developing Country," Working Papers 2014-180, Department of Research, Ipag Business School.
  7. Ghislando, S & Manachotphong, W & Perego, VME, 2013. "The impact of Universal Health Coverage on healthcare consumption and risky behaviours: evidence from Thailand," Working Papers 11200, Imperial College, London, Imperial College Business School.
  8. Nguyen Viet, Cuong, 2011. "The Impact of Health Insurance for Children: Evidence from Vietnam," MPRA Paper 36552, University Library of Munich, Germany.
  9. Lim, Jae-Young, 2010. "De-mystifying the Inconvenient Truth : Does Ex Post Moral Hazard Indeed Exist in Korean Private Health Insurance Market?," Hitotsubashi Journal of Economics, Hitotsubashi University, vol. 51(2), pages 74-92, December.
  10. Greg Brunner & Pablo Gottret & Birgit Hansl & Vijayasekar Kalavakonda & Somil Nagpal & Nicole Tapay, 2012. "Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation," World Bank Publications, The World Bank, number 13093, October.
  11. Wagstaff, Adam & Pradhan, Menno, 2005. "Health insurance impacts on health and nonmedical consumption in a developing country," Policy Research Working Paper Series 3563, The World Bank.
  12. Wong, Irene O.L. & Lindner, Michael J. & Cowling, Benjamin J. & Lau, Eric H.Y. & Lo, Su-Vui & Leung, Gabriel M., 2010. "Measuring moral hazard and adverse selection by propensity scoring in the mixed health care economy of Hong Kong," Health Policy, Elsevier, vol. 95(1), pages 24-35, April.
  13. Grönqvist, Erik, 2004. "Information Updating and Insurance Dropout: Evidence from Dental Insurance," Working Paper Series in Economics and Finance 576, Stockholm School of Economics.

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