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Advantageous selection in private health insurance: The case of Australia

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Author Info

  • Thomas Buchmueller

    (University of Michigan)

  • Denzil Fiebig

    (University of NSW)

  • Glenn Jones

    (Macquarie University)

  • Elizabeth Savage

    () (CHERE, University of Technology, Sydney)

Abstract

When consumers have private information about risk of suffering a loss, or equivalently, if insurers are prohibited from using observable information on risk in underwriting, theoretical models of insurance predict adverse selection. Yet the most common finding in empirical studies is that of no positive correlation between risk and insurance coverage. This is found for different types of insurance (e.g. car, health, life) and in different countries (e.g. France, US, UK, Israel) suggesting a fundamental relationship involving private information and consumer preferences. In this paper, we investigate the nature of risk selection in the Australian market for private health insurance in which community rated private health insurance complements a universal public health care system. We use National Health Survey data on hospital utilisation and individual characteristics to construct an empirical analogue for the risk variable in the Rothschild and Stiglitz model. Estimating the relationship between insurance and risk semi-parametrically, we find robust evidence of favourable selection. To explore the extent to which underlying risk preferences rather than risk drives the decision to purchase health insurance, we use Household Expenditure Survey data to model decisions to purchase a range of insurance products (health, life, accident, home, car) and to engage in risky behaviours (smoking and various forms of gambling). Correlations between residuals in the model suggest that advantageous selection is driven by risk aversion, which theoretical models do not typically capture.

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File URL: http://www.chere.uts.edu.au/pdf/wp2008_2.pdf
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Bibliographic Info

Paper provided by CHERE, University of Technology, Sydney in its series Working Papers with number 2008/2.

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Date of creation: May 2008
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Handle: RePEc:her:chewps:2008/2

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Keywords: health insurance; adverse selection; Australia;

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References

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  1. Pierre‐André Chiappori & Bruno Jullien & Bernard Salanié & François Salanié, 2006. "Asymmetric information in insurance: general testable implications," RAND Journal of Economics, RAND Corporation, vol. 37(4), pages 783-798, December.
  2. Joshua S. Gans & Stephen P. King, 2003. "Anti-Insurance: Analysing the Health Insurance System in Australia," Melbourne Institute Working Paper Series wp2003n10, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
  3. Cao, Zhun & McGuire, Thomas G., 2003. "Service-level selection by HMOs in Medicare," Journal of Health Economics, Elsevier, vol. 22(6), pages 915-931, November.
  4. Pierre-Andre Chiappori & Bernard Salanie, 2000. "Testing for Asymmetric Information in Insurance Markets," Journal of Political Economy, University of Chicago Press, vol. 108(1), pages 56-78, February.
  5. Jane Hall & Richard De Abreu Lourenco & Rosalie Viney, 1999. "Carrots and sticks-the fall and fall of private health insurance in Australia," Health Economics, John Wiley & Sons, Ltd., vol. 8(8), pages 653-660.
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Citations

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Cited by:
  1. Damien Eldridge & Catagay Koc & Ilke Onur & Malathi Velamuri, 2011. "The Impact of Private Hospital Insurance on Utilization of Hospital Care in Australia: Evidence from the National Health Survey," Working Papers 2011.01, School of Economics, La Trobe University, revised Jan 2011.
  2. Bolhaar, Jonneke & Lindeboom, Maarten & van der Klaauw, Bas, 2008. "A Dynamic Analysis of the Demand for Health Insurance and Health Care," IZA Discussion Papers 3698, Institute for the Study of Labor (IZA).
  3. Carine Franc & Marc Perronnin & Aurélie Pierre, 2010. "Subscribing to Supplemental Health Insurance in France: A Dynamic Analysis of Adverse Selection," Working Papers DT35, IRDES institut for research and information in health economics, revised Dec 2010.
  4. Janko Gorter & Paul Schilp, 2012. "Risk preferences over small stakes: Evidence from deductible choice," DNB Working Papers 338, Netherlands Central Bank, Research Department.
  5. Meliyanni Johar & Glenn Jones & Michael Keane & Elizabeth Savage & Olena Stavrunova, 2010. "Waiting times and the decision to buy private health insurance. CHERE Working Paper 2010/9," Working Papers 2010/9, CHERE, University of Technology, Sydney.
  6. Jonneke Bolhaar & Maarten Lindeboom & Bas van der Klaauw, . "A Dynamic Analysis of the Demand for Health Insurance and Health Care," Tinbergen Institute Discussion Papers 08-084/3, Tinbergen Institute.

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