Adverse Selection and the Challenges to Stand-Alone Prescription Drug Insurance
AbstractThis paper investigates a possible predictor of adverse selection problems in unsubsidized stand-alone' prescription drug insurance: the persistence of an individual's high spending over multiple years. Using MEDSTAT claims data and data from the Medicare Survey of Current Beneficiaries, we find that persistence is much higher for outpatient drug expenses than for other categories of medical expenses. We then use these estimates to develop a simple and intuitive model of adverse selection in competitive insurance markets and show that this high relative persistence makes it unlikely that unsubsidized drug insurance can be offered for sale, even with premiums partially risk adjusted, without a probable adverse selection death spiral. We show that this outcome can be avoided if drug coverage is bundled with other coverage, and briefly discuss the need either for comprehensive coverage or generous subsidies if adverse selection is to be avoided in private and Medicare insurance markets.
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Bibliographic InfoPaper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 9919.
Date of creation: Aug 2003
Date of revision:
Publication status: published as Pauly, Mark V. and Yuhui Zeng. "Adverse Selection And The Challenges To Stand-Alone Prescription Drug Insurance," Forum for Health Economics and Policy, 2004, v7, Article 3.
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Find related papers by JEL classification:
- G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
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- Martin Gaynor & Jian Li & William B. Vogt, 2006.
"Is Drug Coverage a Free Lunch? Cross-Price Elasticities and the Design of Prescription Drug Benefits,"
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