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The design of insurance coverage for medical products under imperfect competition

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  • Bardey, David
  • Cremer, Helmuth
  • Lozachmeur, Jean-Marie

Abstract

This paper studies the design of health insurance with ex post moral hazard, when there is imperfect competition in the market for the medical product. Various scenarios, such as monopoly pricing or horizontal differentiation are considered. Insurers (or their regulator) can commit to a reimbursement policy which specifies two types of copayments: an ad valoremcoinsurance rate and a specific (per unit) copayment. By combining both copayment rates in an adequate way the insurer can effectively control the producer price, which is then set so that the producer's revenue just covers fixed costs. Consequently, a suitable regulation of the copayment instruments leads to the same reimbursement rule as under perfect competition for medical products. Additional rationing of coverage because of imperfect competition is notnecessary. The optimal policy involves the smallest possible copayment combined with the largest possible coinsurance rate such that the participation constraint of health providers is binding.

Suggested Citation

  • Bardey, David & Cremer, Helmuth & Lozachmeur, Jean-Marie, 2016. "The design of insurance coverage for medical products under imperfect competition," Journal of Public Economics, Elsevier, vol. 137(C), pages 28-37.
  • Handle: RePEc:eee:pubeco:v:137:y:2016:i:c:p:28-37
    DOI: 10.1016/j.jpubeco.2016.03.006
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    Cited by:

    1. Bardey, David & Harker, Arturo & Zuluaga, Daniela, 2021. "Price cap regulation in the Colombian pharmaceutical market: An impact evaluation," TSE Working Papers 21-1195, Toulouse School of Economics (TSE).
    2. Catalina Gutiérrez S. & Nicolás Gómez, 2018. "El sistema de salud colombiano en las próximas décadas: cómo avanzar hacia la sostenibilidad y la calidad en la atención," Cuadernos de Fedesarrollo 16251, Fedesarrollo.
    3. Cremer, Helmuth & Lozachmeur, Jean-Marie, 2022. "Coinsurance vs. co-payments: Reimbursement rules for a monopolistic medical product with competitive health insurers," Journal of Health Economics, Elsevier, vol. 84(C).
    4. Mak, Henry Y., 2018. "Managing imperfect competition by pay for performance and reference pricing," Journal of Health Economics, Elsevier, vol. 57(C), pages 131-146.
    5. Bardey, David & Li, Sanxi & Wu, Yaping, 2015. "Health Care Insurance Payment Policy when the Physician and Patient May Collude," TSE Working Papers 15-572, Toulouse School of Economics (TSE).
    6. Gilad Sorek & Randolph T. Beard, 2016. "Regulating from the Demand Side: Public Health Insurance with Monopolistically Competitive Providers and Optional Spot Sales," Auburn Economics Working Paper Series auwp2016-06, Department of Economics, Auburn University.

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    More about this item

    Keywords

    ex post moral hazard; Health insurance contracts; Copayments; Imperfect competition;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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