IDEAS home Printed from https://ideas.repec.org/a/oup/restud/v84y2017i1p1-44..html
   My bibliography  Save this article

Claim Timing and Ex Post Adverse Selection

Author

Listed:
  • Marika Cabral

Abstract

Many health care treatments are not urgent and may be delayed if patients so choose. Because insurance coverage is typically determined by the treatment date, individuals may have incentives to strategically delay treatments to minimize out-of-pocket costs. The strategic delay of treatment—a particular form of moral hazard—can be an important source of subsequent adverse selection, in which ex ante identical individuals select insurance coverage based on their differing accumulation of previously delayed treatments. This article investigates these forces empirically in the context of the missing market for dental insurance. Using rich claim-level data, my analysis reveals that approximately 40% of individuals strategically delay dental treatments when incentivized to do so, and this flexibility in delaying treatment can explain why the market for dental insurance has largely unraveled. More generally, the counterfactual analysis suggests features such as open enrolment periods and contracting on pre-existing conditions may be helpful tools in overcoming adverse selection in insurance contexts where the timing of uncertainty is not contractible.

Suggested Citation

  • Marika Cabral, 2017. "Claim Timing and Ex Post Adverse Selection," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 84(1), pages 1-44.
  • Handle: RePEc:oup:restud:v:84:y:2017:i:1:p:1-44.
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1093/restud/rdw022
    Download Restriction: Access to full text is restricted to subscribers.
    ---><---

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

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Nathaniel Hendren, 2015. "Knowledge of Future Job Loss and Implications for Unemployment Insurance," NBER Working Papers 21819, National Bureau of Economic Research, Inc.
    2. Kevin Devereux & Mona Balesh Abadi & Farah Omran, 2019. "Correcting for Transitory Effects in RCTs: Application to the RAND Health Insurance Experiment," Working Papers 201910, School of Economics, University College Dublin.
    3. Minke Remmerswaal & Jan Boone & Michiel Bijlsma & Rudy Douven, 2017. "Cost-Sharing Design Matters: A Comparison of the Rebate and Deductible in Healthcare," CPB Discussion Paper 367, CPB Netherlands Bureau for Economic Policy Analysis.
    4. Hayen, Arthur P. & Klein, Tobias J. & Salm, Martin, 2021. "Does the framing of patient cost-sharing incentives matter? the effects of deductibles vs. no-claim refunds," Journal of Health Economics, Elsevier, vol. 80(C).
    5. Boone, Jan & Remmerswaal, Minke & Bijlsma, Michiel & Douven, Rudy, 2017. "Cost-Sharing Design Matters: A Comparison of the Rebate and Deductible in Healthcare," CEPR Discussion Papers 12507, C.E.P.R. Discussion Papers.
    6. Toshiaki Iizuka & Hitoshi Shigeoka, 2020. "Asymmetric Demand Response when Prices Increase and Decrease: The Case of Child Healthcare," NBER Working Papers 28057, National Bureau of Economic Research, Inc.
    7. Alex Hoagland & David M. Anderson & Ed Zhu, 2022. "Medical Bill Shock and Imperfect Moral Hazard," Papers 2211.01116, arXiv.org, revised Mar 2024.
    8. Christina M Dalton & Gautam Gowrisankaran & Robert J Town, 2020. "Salience, Myopia, and Complex Dynamic Incentives: Evidence from Medicare Part D," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 87(2), pages 822-869.
    9. Zarek C. Brot-Goldberg & Amitabh Chandra & Benjamin R. Handel & Jonathan T. Kolstad, 2017. "What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 132(3), pages 1261-1318.
    10. David Autor & Mark Duggan & Jonathan Gruber, 2014. "Moral Hazard and Claims Deterrence in Private Disability Insurance," American Economic Journal: Applied Economics, American Economic Association, vol. 6(4), pages 110-141, October.
    11. Toshiaki Iizuka & Hitoshi Shigeoka, 2018. "Free for Children? Patient Cost-sharing and Healthcare Utilization," NBER Working Papers 25306, National Bureau of Economic Research, Inc.
    12. Remmerswaal, Minke & Boone, Jan & Bijlsma, Michiel & Douven, R.C.M.H., 2017. "Cost-Sharing Design Matters : A Comparison of the Rebate and Deductible in Healthcare," Discussion Paper 2017-049, Tilburg University, Center for Economic Research.
    13. Simonsen, Marianne & Skipper, Lars & Skipper, Niels & Christensen, Anne Illemann, 2021. "Spot price biases in non-linear health insurance contracts," Journal of Public Economics, Elsevier, vol. 203(C).
    14. Haizhen Lin & Daniel W. Sacks, 2016. "Intertemporal Substitution in Health Care Demand: Evidence from the RAND Health Insurance Experiment," NBER Working Papers 22802, National Bureau of Economic Research, Inc.
    15. Francetic, I.N.;, 2022. "Selection on moral hazard in the Swiss market for mandatory health insurance: Empirical evidence from Swiss Household Panel data," Health, Econometrics and Data Group (HEDG) Working Papers 22/24, HEDG, c/o Department of Economics, University of York.
    16. Anja Sautmann & Samuel Brown & Mark Dean, 2016. "Subsidies, Information, and the Timing of Childrenís Health Care in Mali," Working Papers 2016-2, Brown University, Department of Economics.
    17. Lin, Haizhen & Sacks, Daniel W., 2019. "Intertemporal substitution in health care demand: Evidence from the RAND Health Insurance Experiment," Journal of Public Economics, Elsevier, vol. 175(C), pages 29-43.
    18. Avdic, Daniel & Decker, Simon & Karlsson, Martin & Salm, Martin, 2024. "No-claim refunds and healthcare use," Journal of Public Economics, Elsevier, vol. 230(C).
    19. Marianne Simonsen & Lars Skipper & Niels Skipper, 2017. "Piling Pills? Forward-Looking Behavior and Stockpiling of Prescription Drugs," Economics Working Papers 2017-08, Department of Economics and Business Economics, Aarhus University.
    20. Wiseman, Thomas, 2018. "Competitive long-term health insurance," Journal of Health Economics, Elsevier, vol. 58(C), pages 144-150.
    21. Besanko, David & Dranove, David & Garthwaite, Craig, 2020. "Insurance access and demand response: Pricing and welfare implications," Journal of Health Economics, Elsevier, vol. 73(C).
    22. Robin McKnight & Jonathan Reuter & Eric Zitzewitz, 2012. "Insurance as Delegated Purchasing: Theory and Evidence from Health Care," NBER Working Papers 17857, National Bureau of Economic Research, Inc.
    23. Nathaniel Hendren, 2017. "Knowledge of Future Job Loss and Implications for Unemployment Insurance," American Economic Review, American Economic Association, vol. 107(7), pages 1778-1823, July.

    More about this item

    Keywords

    Insurance; Asymmetric information; Moral hazard; Adverse selection; Sub-Saharan Africa;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

    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:oup:restud:v:84:y:2017:i:1:p:1-44.. See general information about how to correct material in RePEc.

    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.

    We have no bibliographic references for this item. You can help adding them by using 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.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Oxford University Press (email available below). General contact details of provider: https://academic.oup.com/restud .

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

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.