A perverse ‘net’ effect? Health insurance and ex-ante moral hazard in Ghana
Incentive problems in insurance markets are well-established in economic theory. One of these incentive problems is related to reduced prevention efforts following insurance coverage (ex-ante moral hazard). This prediction is yet to be tested empirically with regard to health insurance, as the health domain is often considered relatively immune to perverse incentives, despite its validation in other insurance markets that entail adverse shocks. This paper tests for the presence of ex-ante moral hazard with reference to malaria prevention in Ghana. We investigate whether enrollment in the country's National Health Insurance Scheme (NHIS) negatively affects ownership and use of insecticide-treated bed nets (ITNs). We use a panel of 400 households in the Brong Ahafo region for this purpose and employ a propensity-adjusted household fixed effects model. Our results suggest that ex-ante moral hazard is present, especially when the level of effort and cost required for prevention is high. Implications of perverse incentive effects for the NHIS are briefly outlined.
Volume (Year): 75 (2012)
Issue (Month): 1 ()
|Contact details of provider:|| Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description|
|Order Information:|| Postal: http://www.elsevier.com/wps/find/supportfaq.cws_home/regional|
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-58, December.
- Cutler, David M. & Zeckhauser, Richard J., 2000.
"The anatomy of health insurance,"
Handbook of Health Economics,
in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 11, pages 563-643
- Alma Cohen & Rajeev Dehejia, 2003.
"The Effect of Automobile Insurance and Accident Liability Laws in Traffic Fatalities,"
NBER Working Papers
9602, National Bureau of Economic Research, Inc.
- Cohen, Alma & Dehejia, Rajeev, 2004. "The Effect of Automobile Insurance and Accident Liability Laws on Traffic Fatalities," Journal of Law and Economics, University of Chicago Press, vol. 47(2), pages 357-93, October.
- Jay Bhattacharya & Mikko Packalen, 2008.
"The Other Ex-Ante Moral Hazard in Health,"
NBER Working Papers
13863, National Bureau of Economic Research, Inc.
- Dhaval Dave & Robert Kaestner, 2009.
"Health insurance and ex ante moral hazard: evidence from Medicare,"
International Journal of Health Care Finance and Economics,
Springer, vol. 9(4), pages 367-390, December.
- Dhaval Dave & Robert Kaestner, 2006. "Health Insurance and Ex Ante Moral Hazard: Evidence from Medicare," NBER Working Papers 12764, National Bureau of Economic Research, Inc.
- Alessandro Tarozzi & Aprajit Mahajan, 2011. "Time Inconsistency, Expectations and Technology Adoption: The Case of Insecticide Treated Nets," Working Papers 11-14, Duke University, Department of Economics.
- Vincent H. Smith & Barry K. Goodwin, 1996. "Crop Insurance, Moral Hazard, and Agricultural Chemical Use," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 78(2), pages 428-438.
- Colm Harmon & Brian Nolan, 2001. "Health insurance and health services utilization in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 135-145.
- Jonathan Klick & Thomas Stratmann, 2007. "Diabetes Treatments and Moral Hazard," Journal of Law and Economics, University of Chicago Press, vol. 50, pages 519-538.
- Christophe Courbage & Augustin de Coulon, 2004.
"Prevention and Private Health Insurance in the U.K,"
The Geneva Papers on Risk and Insurance,
The International Association for the Study of Insurance Economics, vol. 29(4), pages 719-727, October.
- Christophe Courbage & Augustin de Coulon, 2004. "Prevention and Private Health Insurance in the U.K," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan, vol. 29(4), pages 719-727, October.
- Rajeev H. Dehejia & Sadek Wahba, 2002.
"Propensity Score-Matching Methods For Nonexperimental Causal Studies,"
The Review of Economics and Statistics,
MIT Press, vol. 84(1), pages 151-161, February.
- Dehejia, R.H. & Wahba, S., 1998. "Propensity Score Matching Methods for Non-Experimental Causal Studies," Discussion Papers 1998_02, Columbia University, Department of Economics.
- Rajeev H. Dehejia & Sadek Wahba, 2002. "Propensity score matching methods for non-experimental causal studies," Discussion Papers 0102-14, Columbia University, Department of Economics.
- Rajeev H. Dehejia & Sadek Wahba, 1998. "Propensity Score Matching Methods for Non-experimental Causal Studies," NBER Working Papers 6829, National Bureau of Economic Research, Inc.
- Joseph Mensah & Joseph R. Oppong & Christoph M. Schmidt, 2010.
"Ghana's national health insurance scheme in the context of the health MDGs: an empirical evaluation using propensity score matching,"
John Wiley & Sons, Ltd., vol. 19(S1), pages 95-106, September.
- Joseph Mensah & Joseph R. Oppong & Christoph M. Schmidt, 2009. "Ghana’s National Health Insurance Scheme in the Context of the Health MDGs – An Empirical Evaluation Using Propensity Score Matching," Ruhr Economic Papers 0157, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
- Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
- Sapelli, Claudio & Vial, Bernardita, 2003.
"Self-selection and moral hazard in Chilean health insurance,"
Journal of Health Economics,
Elsevier, vol. 22(3), pages 459-476, May.
- Claudio Sapelli & Bernardita Vial, 2001. "Self Selection and Moral Hazard in Chilean Health Insurance," Documentos de Trabajo 195, Instituto de Economia. Pontificia Universidad Católica de Chile..
- Marco Caliendo & Sabine Kopeinig, 2008.
"Some Practical Guidance For The Implementation Of Propensity Score Matching,"
Journal of Economic Surveys,
Wiley Blackwell, vol. 22(1), pages 31-72, 02.
- Marco Caliendo & Sabine Kopeinig, 2005. "Some Practical Guidance for the Implementation of Propensity Score Matching," Discussion Papers of DIW Berlin 485, DIW Berlin, German Institute for Economic Research.
- Caliendo, Marco & Kopeinig, Sabine, 2005. "Some Practical Guidance for the Implementation of Propensity Score Matching," IZA Discussion Papers 1588, Institute for the Study of Labor (IZA).
- Winnie Yip & Peter Berman, 2001. "Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance," Health Economics, John Wiley & Sons, Ltd., vol. 10(3), pages 207-220.
- Augurzky, Boris & Schmidt, Christoph M., 2001. "The Propensity Score: A Means to An End," IZA Discussion Papers 271, Institute for the Study of Labor (IZA).
- Koch, Steven & Alaba, Olufunke, 2010. "On health insurance and household decisions: A treatment effect analysis," Social Science & Medicine, Elsevier, vol. 70(2), pages 175-182, January.
- Thomas de HOOP & Luuk van KEMPEN, 2010. "Trust In Health Providers As A Catalyst For Malaria Prevention: Heterogeneous Impacts Of Health Education In Rural Ghana," The Developing Economies, Institute of Developing Economies, vol. 48(3), pages 376-404.
- Zweifel, Peter & Manning, Willard G., 2000. "Moral hazard and consumer incentives in health care," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 8, pages 409-459 Elsevier.
When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:75:y:2012:i:1:p:138-147. See general information about how to correct material in RePEc.
If references are entirely missing, you can add them using this form.