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Mechanism design of multi-strategy health insurance plans under asymmetric information

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  • Sun, Huan
  • Wang, Haiyan
  • Steffensen, Sonja

Abstract

In health insurance services, the health system is often unable to obtain people’s private genetic information. This knowledge can reflect individuals’ future health, which leads to their information advantage. People with information advantages can hide their true private information and obtain insurance, which leads to service inefficiency for insurance providers. To reduce this inefficiency, we design a mechanism for the health system to build a set of multi-strategy combination insurance plans for heterogeneous probabilistic individuals, where the prices and the price difference of plans guide their choice and prevention strategy. First, after analysing the utility of the individuals and the health system when the individuals use true/false information, we propose a reasonable goal of this mechanism: When the people use true information to make decisions, the individuals and the health system can obtain maximum utility. Second, we provide the conditions for the individuals and the health system to participate in health insurance, and the conditions for achieving the rationality goal of the mechanism. Finally, we obtain the optimal result for the individuals and the health system. On one hand, some new theories on mechanism design are produced in health insurance transactions. On the other hand, the insurance scheme design effectively eliminates the individual’s motive for concealing information and improves the efficiency of health services.

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  • Sun, Huan & Wang, Haiyan & Steffensen, Sonja, 2022. "Mechanism design of multi-strategy health insurance plans under asymmetric information," Omega, Elsevier, vol. 107(C).
    • Handle: RePEc:eee:jomega:v:107:y:2022:i:c:s0305048321001638
    DOI: 10.1016/j.omega.2021.102554
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    as
    1. Mehmet Ulvi Saygi Ayvaci & Oguzhan Alagoz & Mehmet Eren Ahsen & Elizabeth S. Burnside, 2018. "Preference‐Sensitive Management of Post‐Mammography Decisions in Breast Cancer Diagnosis," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2313-2338, December.
    2. Zhou, Wenhui & Wan, Qiang & Zhang, Ren-Qian, 2017. "Choosing among hospitals in the subsidized health insurance system of China: A sequential game approach," European Journal of Operational Research, Elsevier, vol. 257(2), pages 568-585.
    3. Zweifel, Peter, 2020. "Innovation in long-term care insurance: Joint contracts for mitigating relational moral hazard," Insurance: Mathematics and Economics, Elsevier, vol. 93(C), pages 116-124.
    4. Lu (Lucy) Yan & Xiangbin Yan & Yong Tan & Sherry X. Sun, 2019. "Shared Minds: How Patients Use Collaborative Information Sharing via Social Media Platforms," Production and Operations Management, Production and Operations Management Society, vol. 28(1), pages 9-26, January.
    5. Margret Bjarnadottir & David Anderson & Leila Zia & Kim Rhoads, 2018. "Predicting Colorectal Cancer Mortality: Models to Facilitate Patient‐Physician Conversations and Inform Operational Decision Making," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2162-2183, December.
    6. Sarah Zheng & Anita L. Tucker & Z. Justin Ren & Janelle Heineke & Amy McLaughlin & Aubrey L. Podell, 2018. "The Impact of Internal Service Quality on Preventable Adverse Events in Hospitals," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2201-2212, December.
    7. Vera-Hernandez, Marcos, 2003. "Structural Estimation of a Principal-Agent Model: Moral Hazard in Medical Insurance," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 670-693, Winter.
    8. Manaf Zargoush & Mehmet Gümüş & Vedat Verter & Stella S. Daskalopoulou, 2018. "Designing Risk‐Adjusted Therapy for Patients with Hypertension," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2291-2312, December.
    9. Pierre Martinon & Pierre Picard & Anasuya Raj, 2018. "On the design of optimal health insurance contracts under ex post moral hazard," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 43(2), pages 137-185, September.
    10. Ching‐To Albert Ma & Michael H. Riordan, 2002. "Health Insurance, Moral Hazard, and Managed Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 11(1), pages 81-107, March.
    11. Lauren F. Laker & Craig M. Froehle & Jaime B. Windeler & Christopher John Lindsell, 2018. "Quality and Efficiency of the Clinical Decision‐Making Process: Information Overload and Emphasis Framing," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2213-2225, December.
    12. Ma, Peng & Shang, Jennifer & Wang, Haiyan, 2017. "Enhancing corporate social responsibility: Contract design under information asymmetry," Omega, Elsevier, vol. 67(C), pages 19-30.
    13. Dhaval Dave & Robert Kaestner, 2009. "Health insurance and ex ante moral hazard: evidence from Medicare," International Journal of Health Economics and Management, Springer, vol. 9(4), pages 367-390, December.
    14. Georges Dionne (ed.), 2013. "Handbook of Insurance," Springer Books, Springer, edition 2, number 978-1-4614-0155-1, January.
    15. Kurt M. Bretthauer & Sergei Savin, 2018. "Introduction to the Special Issue on Patient‐Centric Healthcare Management in the Age of Analytics," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2101-2102, December.
    16. Tan, Ken Seng & Wei, Pengyu & Wei, Wei & Zhuang, Sheng Chao, 2020. "Optimal dynamic reinsurance policies under a generalized Denneberg’s absolute deviation principle," European Journal of Operational Research, Elsevier, vol. 282(1), pages 345-362.
    17. Teymourifar, Aydin & Kaya, Onur & Ozturk, Gurkan, 2021. "Contracting models for pricing and capacity decisions in healthcare systems," Omega, Elsevier, vol. 100(C).
    18. Xiang Liu & Michael Hu & Jonathan E. Helm & Mariel S. Lavieri & Ted A. Skolarus, 2018. "Missed Opportunities in Preventing Hospital Readmissions: Redesigning Post‐Discharge Checkup Policies," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2226-2250, December.
    19. Nitin Mehta & Jian Ni & Kannan Srinivasan & Baohong Sun, 2017. "A Dynamic Model of Health Insurance Choices and Healthcare Consumption Decisions," Marketing Science, INFORMS, vol. 36(3), pages 338-360, May.
    20. Wang, Jian-Jun & Li, Zhong-Ping & Shi, Jim (Junmin) & Chang, Ai-Chih (Jasmine), 2021. "Hospital referral and capacity strategies in the two-tier healthcare systems," Omega, Elsevier, vol. 100(C).
    21. Corina Birghila & Tim J. Boonen & Mario Ghossoub, 2020. "Optimal Insurance under Maxmin Expected Utility," Papers 2010.07383, arXiv.org.
    22. Eric M. Webb & Alex F. Mills, 2019. "Incentive–Compatible Prehospital Triage in Emergency Medical Services," Production and Operations Management, Production and Operations Management Society, vol. 28(9), pages 2221-2241, September.
    23. Ghossoub, Mario, 2019. "Budget-constrained optimal insurance with belief heterogeneity," Insurance: Mathematics and Economics, Elsevier, vol. 89(C), pages 79-91.
    24. Schumacher, Heiner, 2016. "Insurance, self-control, and contract flexibility," European Economic Review, Elsevier, vol. 83(C), pages 220-232.
    25. Ghossoub, Mario, 2019. "Budget-constrained optimal insurance without the nonnegativity constraint on indemnities," Insurance: Mathematics and Economics, Elsevier, vol. 84(C), pages 22-39.
    26. Salar Ghamat & Gregory S. Zaric & Hubert Pun, 2018. "Contracts to Promote Optimal Use of Optional Diagnostic Tests in Cancer Treatment," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2184-2200, December.
    27. Yichun Chi & Wei Wei, 2020. "Optimal insurance with background risk: An analysis of general dependence structures," Finance and Stochastics, Springer, vol. 24(4), pages 903-937, October.
    28. Bayerstadler, Andreas & van Dijk, Linda & Winter, Fabian, 2016. "Bayesian multinomial latent variable modeling for fraud and abuse detection in health insurance," Insurance: Mathematics and Economics, Elsevier, vol. 71(C), pages 244-252.
    29. Charles E. Phelps, 1978. "Illness Prevention and Medical Insurance," NBER Chapters, in: The Economics of Physician and Patient Behavior, pages 183-207, National Bureau of Economic Research, Inc.
    30. Caballini, Claudia & Paolucci, Massimo, 2020. "A rostering approach to minimize health risks for workers: An application to a container terminal in the Italian port of Genoa," Omega, Elsevier, vol. 95(C).
    31. Zhang, Yu & Wang, Yu & Tang, Jiafu & Lim, Andrew, 2020. "Mitigating overtime risk in tactical surgical scheduling," Omega, Elsevier, vol. 93(C).
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