IDEAS home Printed from https://ideas.repec.org/a/eee/jeborg/v131y2016ipbp62-77.html
   My bibliography  Save this article

Should I stay or should I go? Exit options within mixed systems of public and private health care finance

Author

Listed:
  • Buckley, Neil
  • Cuff, Katherine
  • Hurley, Jeremiah
  • Mestelman, Stuart
  • Thomas, Stephanie
  • Cameron, David

Abstract

Mixed public–private finance is widespread in health care systems internationally. In one variant of mixed finance, some countries (e.g., Germany) allow eligible beneficiaries to fully exit from the public (social insurance) system and purchase private insurance. Using a controlled laboratory experiment, we empirically investigate the predictions of a political economy model of mixed systems of public and private finance with two types of exit: universal-exit, when all individuals can choose to exit the public system, and conditional-exit, when only individuals with an income at or above a threshold income level can choose to exit. We find that high-income individuals are less likely to exit under universal-exit than under conditional-exit, despite having the same incentive to exit in both treatments. Sensitivity treatments suggests that a number of factors may be at play in explaining this result, including learning effects, a priming effect and a framing effect, but that other-regarding preferences do not appear to be an important factor.

Suggested Citation

  • Buckley, Neil & Cuff, Katherine & Hurley, Jeremiah & Mestelman, Stuart & Thomas, Stephanie & Cameron, David, 2016. "Should I stay or should I go? Exit options within mixed systems of public and private health care finance," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 62-77.
  • Handle: RePEc:eee:jeborg:v:131:y:2016:i:pb:p:62-77
    DOI: 10.1016/j.jebo.2016.05.013
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0167268116300920
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Kesternich, Iris & Schumacher, Heiner & Winter, Joachim, 2015. "Professional norms and physician behavior: Homo oeconomicus or homo hippocraticus?," Journal of Public Economics, Elsevier, vol. 131(C), pages 1-11.
    2. Hennig-Schmidt, Heike & Selten, Reinhard & Wiesen, Daniel, 2011. "How payment systems affect physicians' provision behaviour--An experimental investigation," Journal of Health Economics, Elsevier, vol. 30(4), pages 637-646, July.
    3. Dufwenberg, Martin & Gächter, Simon & Hennig-Schmidt, Heike, 2011. "The framing of games and the psychology of play," Games and Economic Behavior, Elsevier, vol. 73(2), pages 459-478.
    4. Glomm, Gerhard & Ravikumar, B. & Schiopu, Ioana C., 2011. "The Political Economy of Education Funding," Handbook of the Economics of Education, Elsevier.
    5. Stephan Kroll & Todd L. Cherry & Jason F. Shogren, 2007. "Voting, Punishment, And Public Goods," Economic Inquiry, Western Economic Association International, vol. 45(3), pages 557-570, July.
    6. Glenn W. Harrison & John A. List, 2004. "Field Experiments," Journal of Economic Literature, American Economic Association, vol. 42(4), pages 1009-1055, December.
    7. Bearse, Peter & Cardak, Buly A. & Glomm, Gerhard & Ravikumar, B., 2013. "Why do education vouchers fail at the ballot box?," European Journal of Political Economy, Elsevier, vol. 32(C), pages 26-37.
    8. Glenn W. Harrison & Morten I. Lau & E. Elisabet Rutström, 2007. "Estimating Risk Attitudes in Denmark: A Field Experiment," Scandinavian Journal of Economics, Wiley Blackwell, vol. 109(2), pages 341-368, June.
    9. Marlies Ahlert & Stefan Felder & Bodo Vogt, 2012. "Which patients do I treat? An experimental study with economists and physicians," Health Economics Review, Springer, vol. 2(1), pages 1-11, December.
    10. Stiglitz, J. E., 1974. "The demand for education in public and private school systems," Journal of Public Economics, Elsevier, vol. 3(4), pages 349-385, November.
    11. Epple, Dennis & Romano, Richard E, 1996. "Public Provision of Private Goods," Journal of Political Economy, University of Chicago Press, vol. 104(1), pages 57-84, February.
    12. Gerhard Glomm & B. Ravikumar, 1998. "Opting out of publicly provided services: A majority voting result," Social Choice and Welfare, Springer;The Society for Social Choice and Welfare, vol. 15(2), pages 187-199.
    13. Sutter, Matthias & Weck-Hannemann, Hannelore, 2003. "On the effects of asymmetric and endogenous taxation in experimental public goods games," Economics Letters, Elsevier, vol. 79(1), pages 59-67, April.
    14. Magdalena Margreiter & Matthias Sutter & Dennis Dittrich, 2005. "Individual and Collective Choice and Voting in Common Pool Resource Problem with Heterogeneous Actors," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 32(2), pages 241-271, October.
    15. Hennig-Schmidt, Heike & Selten, Reinhard & Wiesen, Daniel, 2011. "How payment systems affect physicians' provision behaviour--An experimental investigation," Journal of Health Economics, Elsevier, vol. 30(4), pages 637-646, July.
    16. Urs Fischbacher, 2007. "z-Tree: Zurich toolbox for ready-made economic experiments," Experimental Economics, Springer;Economic Science Association, vol. 10(2), pages 171-178, June.
    17. Buckley, Neil & Cuff, Katherine & Hurley, Jeremiah & Mestelman, Stuart & Thomas, Stephanie & Cameron, David, 2015. "Support for public provision of a private good with top-up and opt-out: A controlled laboratory experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 111(C), pages 177-196.
    18. Robert Moir, 1998. "A Monte Carlo Analysis of the Fisher Randomization Technique: Reviving Randomization for Experimental Economists," Experimental Economics, Springer;Economic Science Association, vol. 1(1), pages 87-100, June.
    19. Epple, Dennis & Romano, Richard E., 1996. "Ends against the middle: Determining public service provision when there are private alternatives," Journal of Public Economics, Elsevier, vol. 62(3), pages 297-325, November.
    20. Alm, James & Jacobson, Sarah, 2007. "Using Laboratory Experimentsin Public Economics," National Tax Journal, National Tax Association;National Tax Journal, vol. 60(1), pages 129-152, March.
    21. repec:cup:apsrev:v:72:y:1978:i:02:p:575-598_15 is not listed on IDEAS
    22. Mentzakis, Emmanouil & Mestelman, Stuart, 2013. "Hypothetical bias in value orientations ring games," Economics Letters, Elsevier, vol. 120(3), pages 562-565.
    23. Cohen-Zada, Danny & Justman, Moshe, 2003. "The political economy of school choice: linking theory and evidence," Journal of Urban Economics, Elsevier, vol. 54(2), pages 277-308, September.
    24. Miguel Gouveia, 1997. "Majority rule and the public provision of a private good," Public Choice, Springer, vol. 93(3), pages 221-244, December.
    Full references (including those not matched with items on IDEAS)

    More about this item

    Keywords

    Health care financing; Publicly provided private good; Mixed financing; Voting experiment; Framing effect;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • H44 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Goods: Mixed Markets
    • C91 - Mathematical and Quantitative Methods - - Design of Experiments - - - Laboratory, Individual Behavior
    • D7 - Microeconomics - - Analysis of Collective Decision-Making

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:jeborg:v:131:y:2016:i:pb:p:62-77. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: http://www.elsevier.com/locate/jebo .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.