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Health Insurance and the Welfare Economics of Organ Transplants

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Ce texte analyse les conséquences redistributives et allocatives du passage à un système de marché pour la gestion des organes prélevés sur des personnes décédées, par opposition au système actuel qui repose sur l'altruisme des donneurs et le rationnement médical des candidats à une greffe. Dans un système de marché, les individus bien portant pourraient vendre à terme le droit de prélèvement de leurs organes en cas de décès prématuré, mais le coût d'une greffe inclurait le prix au comptant des organes, ce coût pouvant être pris en compte dans les couvertures d'assurance maladie souscrites au préalable par les individus. Je montre qu'un tel changement de régime n'a pas pour effet de redistribuer le bien-être des pauvres vers les riches, mais qu'il a plutôt un effet redistributif au profit des donneurs altruistes du système actuel (qu'ils soient pauvres ou riches) et aux dépens des non-donneurs. Ce résultat repose sur la possibilité de souscrire des contrats d'assurance élaborés spécifiant de façon détaillée les contingences dans lesquelles une greffe sera indemnisée. Lorsque les contrats d'assurance sont incomplets, tous les individus, riches et pauvres, pourraient voir leur bien-être diminuer par suite du passage à un système de marché. This paper analyzes the redistributive and efficiency implications of switching from the current cadaveric organ procurement and allocation system, based on rationing and altruistic donorship, to a pure market based system. In the latter, individuals could sell forward the right to the removal of their organs at death, but potential recipients would need to pay the going market price of organs for a transplant, a cost that could be covered by their health insurance policy. I show that the effect of the change in regime is not to redistribute welfare from poor to rich individuals, but from current non-donnors to current donors. That is, current altruistic donnors, whether poor or rich, are strictly better off from the change and the only individuals who could be made worse off are the current non-donors. This result rests on the availability of sophisticated insurance contracts specifying in detail the contingencies under which an individual is to receive a transplant if he becomes ill. When insurance contracts are incomplete, both rich and poor alike can be made worse off by the change in regime.

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Paper provided by Université du Québec à Montréal, Département des sciences économiques in its series Cahiers de recherche du Département des sciences économiques, UQAM with number 9507.

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Date of creation: Jul 1995
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Handle: RePEc:cre:uqamwp:9507

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