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The Political Economy of Rationing in Social Health Insurance

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  • Breyer, Friedrich

Abstract

Due to the rapid progress in medical technology social insurance systems will soon no longer be able to grant health services without limits but must employ non-price rationing devices. This raises the question how these limits will be determined. Here we consider a direct democracy where the size of the social health insurance plan is determined in a popular referendum using simple majority rule. Moreover, two different kinds of rationing are distinguished according to whether additional private purchases of health care are allowed. For both systems we examine the size of the social insurance system in a political equilibrium, and we compare the results in particular with respect to their distributional effects.

Suggested Citation

  • Breyer, Friedrich, 1995. "The Political Economy of Rationing in Social Health Insurance," Journal of Population Economics, Springer;European Society for Population Economics, vol. 8(2), pages 137-148, May.
    • Handle: RePEc:spr:jopoec:v:8:y:1995:i:2:p:137-48
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    Cited by:

    1. Potrafke, Niklas, 2010. "The growth of public health expenditures in OECD countries: Do government ideology and electoral motives matter?," Journal of Health Economics, Elsevier, vol. 29(6), pages 797-810, December.
    2. Roger D. Congleton & Alberto Batinti & Rinaldo Pietratonio, 2017. "The Electoral Politics and the Evolution of Complex Healthcare Systems," Kyklos, Wiley Blackwell, vol. 70(4), pages 483-510, November.
    3. Jacob, Johanna & Lundin, Douglas, 2005. "A median voter model of health insurance with ex post moral hazard," Journal of Health Economics, Elsevier, vol. 24(2), pages 407-426, March.
    4. Pfarr, Christian & Schmid, Andreas, 2013. "The political economics of social health insurance: the tricky case of individuals’ preferences," MPRA Paper 44534, University Library of Munich, Germany.
    5. Niklas Potrafke, 2012. "Political cycles and economic performance in OECD countries: empirical evidence from 1951–2006," Public Choice, Springer, vol. 150(1), pages 155-179, January.
    6. Mathias Kifmann, 2005. "Health insurance in a democracy: Why is it public and why are premiums income related?," Public Choice, Springer, vol. 124(3), pages 283-308, September.
    7. Grepperud, Sverre & Pedersen, Pål Andreas, 2020. "Positioning and negotiations: The case of pharmaceutical pricing," European Journal of Political Economy, Elsevier, vol. 62(C).
    8. Anderberg, Dan, 1999. "Determining the mix of public and private provision of insurance by majority rule," European Journal of Political Economy, Elsevier, vol. 15(3), pages 417-440, September.
    9. Friedrich Breyer, 2001. "Income Redistribution and the Political Economy of Social Health Insurance: Comparing Germany and Switzerland," Discussion Papers of DIW Berlin 253, DIW Berlin, German Institute for Economic Research.
    10. Jacob, Johanna & Lundin, Douglas, 2001. "A Median Voter Model of Health Insurance with Ex Post Moral Hazard," Working Paper Series 2001:7, Uppsala University, Department of Economics.

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