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De l'antisélection à la sélection en assurance santé : pour un changement de perspective

  • Agnès Couffinhal
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    [fre] Un des arguments couramment évoqués pour justifier l'intervention de l'État dans l'assurance maladie est la présence d' antisélection. Toutefois, l'analyse économique, dans la lignée du modèle de Rothschild et Stiglitz (1976), montre que les assureurs peuvent parvenir à surmonter l'asymétrie d'information dont ils sont victimes en différenciant les contrats. Rappeler les principaux résultats de cette recherche permet de dégager les conditions nécessaires à une validation empirique de l'antisélection et de présenter les tests visant à établir si elle est constituée sur les marchés d'assurance santé. Au terme de ce travail, on ne peut rejeter l'hypothèse selon laquelle l'antisélection est présente sur les marchés d'assurance santé ; en revanche, l'ampleur du phénomène ne semble pas très forte. Il apparaît de plus que l'antisélection n'est qu'une des limites au fonctionnement efficace des marchés d'assurance et la différenciation des contrats une des réponses possibles de l'assureur. La sélection des risques par les assureurs eux-mêmes est un autre phénomène, souvent confondu avec l'antisélection, lui aussi dommageable au fonctionnement du marché. Clarifier l'articulation entre antisélection et sélection conduit à souligner la nécessité de mieux prendre en compte ce second phénomène dans une analyse du fonctionnement du marché. [eng] From Adverse Selection to Selection in Health Insurance: for a Change in Perspective by Agnès Couffinhal One of the commonly raised arguments to justify government intervention in health insurance is the presence of adverse selection. However, an economic analysis based on the Rothschild and Stiglitz model (1976) shows that insurers can manage to overcome information asymmetry by differentiating contracts. A summary of the main findings of this research highlights the conditions required to empirically check for adverse selection and presents the tests to establish whether it is found on the health insurance markets. At the end of this work, we cannot reject the hypothesis that adverse selection is present on the health insurance markets. However, the phenomenon appears to be fairly minimal. Adverse selection would also seem to be just one of the hindrances to the efficient running of the insurance markets and contract differentiation one of the possible solutions open to the insurer. Risk selection by the insurers themselves is another phenomenon, often confused with adverse selection, which can also undermine market operations. A clarification of the link between adverse selection and selection highlights the need to better incorporate this second phenomenon into an analysis of market functioning.

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    Article provided by Programme National Persée in its journal Économie & prévision.

    Volume (Year): 142 (2000)
    Issue (Month): 1 ()
    Pages: 101-121

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    Handle: RePEc:prs:ecoprv:ecop_0249-4744_2000_num_142_1_5991
    Note: DOI:10.3406/ecop.2000.5991
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    1. Rothschild, Michael & Stiglitz, Joseph E, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, MIT Press, vol. 90(4), pages 630-49, November.
    2. Riley, John G, 1979. "Informational Equilibrium," Econometrica, Econometric Society, vol. 47(2), pages 331-59, March.
    3. Herschel I. Grossman, 1979. "Adverse Selection, Dissembling, and Competitive Equilibrium," Bell Journal of Economics, The RAND Corporation, vol. 10(1), pages 336-343, Spring.
    4. Hellwig, Martin, 1987. "Some recent developments in the theory of competition in markets with adverse selection ," European Economic Review, Elsevier, vol. 31(1-2), pages 319-325.
    5. Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
    6. Pauly, Mark V., 1984. "Is cream-skimming a problem for the competitive medical market?," Journal of Health Economics, Elsevier, vol. 3(1), pages 87-95, April.
    7. Jack, W., 1998. "Managing Competition in the Health Insurance Market," Papers 336, Australian National University - Department of Economics.
    8. Marquis, M. Susan, 1992. "Adverse selection with a multiple choice among health insurance plans: A simulation analysis," Journal of Health Economics, Elsevier, vol. 11(2), pages 129-151, August.
    9. Akerlof, George A, 1970. "The Market for 'Lemons': Quality Uncertainty and the Market Mechanism," The Quarterly Journal of Economics, MIT Press, vol. 84(3), pages 488-500, August.
    10. Wolfe, John R. & Goddeeris, John H., 1991. "Adverse selection, moral hazard, and wealth effects in the medigap insurance market," Journal of Health Economics, Elsevier, vol. 10(4), pages 433-459.
    11. Pauly, Mark V, 1986. "Taxation, Health Insurance, and Market Failure in the Medical Economy," Journal of Economic Literature, American Economic Association, vol. 24(2), pages 629-75, June.
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