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Medical Savings Accounts als Instrument zur Reduktion von moral hazard Verlusten bei der Absicherung des Krankheitsrisikos

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  • Schreyögg, Jonas

Abstract

Krankenversicherungssysteme induzieren häufig Wohlfahrtsverluste aufgrund asymetrischer Informationen. Neben einem Anstieg der Gesundheitsausgaben bewirken diese eine ineffiziente Allokation von Ressourcen. Einige empirische Studien schätzen den Wohlfahrtsverlust sogar so gross, dass er den aus dem Pooling von Risiken resultierenden Nutzen einer Krankenversicherung überkompensiert. Da die Höhe des Wohlfahrtsverlustes von der Preiselastizität der Nachfrage abhängt, erscheint es sinnvoll, den Versicherungsumfang auf preisunelastische Gebiete der Nachfrage zu beschränken. Eine Differenzierung der Absicherung des Krankheitsrisikos nach der Preiselastizität verschiedener Nachfragebereiche könnte demnach die Wohlfahrtsverluste reduzieren. Singapur hat diesen Ansatz erfolgreich umgesetzt. Das dortige Finanzierungssystem setzt sich zusammen aus einer Hochrisikoversicherung, die unelastische Bereiche der Nachfrage abdeckt, out-of-pocket Zahlungen für elastische Bereiche und Gesundheitssparkonten (Medical Savings Accounts) für den Zwischenbereich. -- Health insurance often results in moral hazard welfare loss. If large enough this causes significant growth of health expenditure and at the same time an inefficient allocation of resources. Some empirical studies estimate the welfare loss of moral hazard so large that it could offset the benefits of risk-pooling in health insurance. If demand price elasticity is used as an indicator of the potential for moral hazard, theory suggests to provide insurance mainly for inelastic parts of the demand for health services. Therefore different health financing schemes, according to demand price elasticity, might reduce losses caused by moral hazard. Singapore has incorporated this approach successfully. Its health care system consists of three different health financing schemes including catastropic health insurance for inelastic demand, out-of-pocket payment for elastic demand and medical savings accounts for the demand in between.

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Paper provided by Technische Universität Berlin, School of Economics and Management in its series Discussion Papers with number 2002/5.

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Date of creation: 2002
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Handle: RePEc:zbw:tubsem:20025

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  1. Nyman, John A., 1999. "The economics of moral hazard revisited," Journal of Health Economics, Elsevier, Elsevier, vol. 18(6), pages 811-824, December.
  2. William C. Hsiao, 2000. "What Should Macroeconomists Know About Health Care Policy: A Primer," IMF Working Papers 00/136, International Monetary Fund.
  3. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, American Economic Association, vol. 77(3), pages 251-77, June.
  4. Manning, Willard G. & Marquis, M. Susan, 1996. "Health insurance: The tradeoff between risk pooling and moral hazard," Journal of Health Economics, Elsevier, Elsevier, vol. 15(5), pages 609-639, October.
  5. Feldman, Roger & Dowd, Bryan, 1991. "A New Estimate of the Welfare Loss of Excess Health Insurance," American Economic Review, American Economic Association, American Economic Association, vol. 81(1), pages 297-301, March.
  6. Manning, Willard G. & Marquis, M. Susan, 2001. "Health insurance: tradeoffs revisited," Journal of Health Economics, Elsevier, Elsevier, vol. 20(2), pages 289-293, March.
  7. Cassel, Dieter & Oberdieck, Veit, 2002. "Kapitaldeckung in der gesetzlichen Krankenversicherung," Wirtschaftsdienst – Zeitschrift für Wirtschaftspolitik (1998 - 2007), ZBW – German National Library of Economics / Leibniz Information Centre for Economics, vol. 82(1), pages 15-22.
  8. Keeler, Emmett B. & Rolph, John E., 1988. "The demand for episodes of treatment in the health insurance experiment," Journal of Health Economics, Elsevier, Elsevier, vol. 7(4), pages 337-367, December.
  9. Hurley, Jeremiah, 2000. "An overview of the normative economics of the health sector," Handbook of Health Economics, Elsevier, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 2, pages 55-118 Elsevier.
  10. Francesco Squintani, 1999. "Moral Hazard," Discussion Papers, Northwestern University, Center for Mathematical Studies in Economics and Management Science 1269, Northwestern University, Center for Mathematical Studies in Economics and Management Science.
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