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Asymmetric Information With Multiple Risks: The Case of the Chilean Private Health Insurance Market

Author

Listed:
  • Dolores de la Mata
  • Matilde P. Machado
  • Pau Olivella
  • Nieves Valdés

Abstract

We extend the Rothshild and Stiglitz (1976) model to two sources of risk –inpatient and outpatient risk– to better proxy real‐world health insurance markets. We uncover an interesting theoretical possibility: Take individuals A and B, who are low risks in, say, the inpatient dimension but A is riskier in the outpatient dimension. Then, A may enjoy less coverage than B in the inpatient dimension (coverage reversal). This phenomenon indicates that when testing for adverse selection in a given dimension, one has to treat individuals who differ in the other dimension separately. With this insight in mind, we adapt the Chiappori and Salanié (2000) positive correlation test to this multi‐dimensionality and use it to test for adverse selection using individual‐level claims data for the privately insured in Chile. This empirical analysis indicates that overlooking the aforementioned need of separating samples can potentially lead to biased conclusions.

Suggested Citation

  • Dolores de la Mata & Matilde P. Machado & Pau Olivella & Nieves Valdés, 2026. "Asymmetric Information With Multiple Risks: The Case of the Chilean Private Health Insurance Market," Health Economics, John Wiley & Sons, Ltd., vol. 35(5), pages 712-729, May.
    • Handle: RePEc:wly:hlthec:v:35:y:2026:i:5:p:712-729
    DOI: 10.1002/hec.70075
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    1. de Meza, David & Webb, David C., 2017. "False diagnoses: pitfalls of testing for asymmetric information in insurance markets," LSE Research Online Documents on Economics 65744, London School of Economics and Political Science, LSE Library.
    2. Chiappori, Pierre-Andre & Durand, Franck & Geoffard, Pierre-Yves, 1998. "Moral hazard and the demand for physician services: First lessons from a French natural experiment," European Economic Review, Elsevier, vol. 42(3-5), pages 499-511, May.
    3. Keith J. Crocker & Arthur Snow, 2011. "Multidimensional Screening in Insurance Markets with Adverse Selection," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 78(2), pages 287-307, June.
    4. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    5. Philippe Donder & Jean Hindriks, 2009. "Adverse selection, moral hazard and propitious selection," Journal of Risk and Uncertainty, Springer, vol. 38(1), pages 73-86, February.
    6. Liran Einav & Amy Finkelstein & Mark R. Cullen, 2010. "Estimating Welfare in Insurance Markets Using Variation in Prices," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(3), pages 877-921.
    7. Geoffard, Pierre-Yves & Gardiol, Lucien & Grandchamp, Chantal, 2005. "Separating Selection and Incentive Effects in Health Insurance," CEPR Discussion Papers 5380, Centre for Economic Policy Research.
    8. David Meza & David C. Webb, 2017. "False Diagnoses: Pitfalls of Testing For Asymmetric Information In Insurance Markets," Economic Journal, Royal Economic Society, vol. 127(606), pages 2358-2377, November.
    9. Thomas G. McGuire & Jacob Glazer, 2000. "Optimal Risk Adjustment in Markets with Adverse Selection: An Application to Managed Care," American Economic Review, American Economic Association, vol. 90(4), pages 1055-1071, September.
    10. David de Meza & David C. Webb, 2017. "False Diagnoses: Pitfalls of Testing for Asymmetric Information In Insurance Markets," Economic Journal, Royal Economic Society, vol. 127(606), pages 2358-2377.
    11. Amy Finkelstein & James Poterba, 2014. "Testing for Asymmetric Information Using “Unused Observables” in Insurance Markets: Evidence from the U.K. Annuity Market," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 81(4), pages 709-734, December.
    12. Daniel McFadden & Carlos Noton & Pau Olivella, 2015. "Minimum coverage regulation in insurance markets," SERIEs: Journal of the Spanish Economic Association, Springer;Spanish Economic Association, vol. 6(3), pages 247-278, August.
    13. 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 2242-2258, December.
    14. Sebastian Panthöfer, 2016. "Risk Selection under Public Health Insurance with Opt‐Out," Health Economics, John Wiley & Sons, Ltd., vol. 25(9), pages 1163-1181, September.
    15. Liran Einav & Amy Finkelstein, 2011. "Selection in Insurance Markets: Theory and Empirics in Pictures," Journal of Economic Perspectives, American Economic Association, vol. 25(1), pages 115-138, Winter.
    16. 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.
    17. Pierre-Andre Chiappori & Bernard Salanie, 2000. "Testing for Asymmetric Information in Insurance Markets," Journal of Political Economy, University of Chicago Press, vol. 108(1), pages 56-78, February.
    18. Olivella, Pau & Vera-Hernandez, Marcos, 2007. "Competition among differentiated health plans under adverse selection," Journal of Health Economics, Elsevier, vol. 26(2), pages 233-250, March.
    19. Claude Fluet & François Pannequin, 1997. "Complete Versus Incomplete Insurance Contracts under Adverse Selection with Multiple Risks," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 22(2), pages 81-101, December.
    20. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    21. Hanming Fang & Michael P. Keane & Dan Silverman, 2008. "Sources of Advantageous Selection: Evidence from the Medigap Insurance Market," Journal of Political Economy, University of Chicago Press, vol. 116(2), pages 303-350, April.
    22. David Hemenway, 1990. "Propitious Selection," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 105(4), pages 1063-1069.
    23. McGuire, Thomas G. & Newhouse, Joseph P. & Normand, Sharon-Lise & Shi, Julie & Zuvekas, Samuel, 2014. "Assessing incentives for service-level selection in private health insurance exchanges," Journal of Health Economics, Elsevier, vol. 35(C), pages 47-63.
    24. Maarten C. W. Janssen & Vladimir A. Karamychev, 2008. "On Bundling in Insurance Markets," Vienna Economics Papers 0809, University of Vienna, Department of Economics.
    25. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 90(4), pages 629-649.
    26. Duarte, Fabian, 2012. "Price elasticity of expenditure across health care services," Journal of Health Economics, Elsevier, vol. 31(6), pages 824-841.
    27. Alma Cohen & Peter Siegelman, 2010. "Testing for Adverse Selection in Insurance Markets," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 77(1), pages 39-84, March.
    28. Jack, William, 2006. "Optimal risk adjustment with adverse selection and spatial competition," Journal of Health Economics, Elsevier, vol. 25(5), pages 908-926, September.
    29. 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.
    30. Michael Anderson & Carlos Dobkin & Tal Gross, 2012. "The Effect of Health Insurance Coverage on the Use of Medical Services," American Economic Journal: Economic Policy, American Economic Association, vol. 4(1), pages 1-27, February.
    31. Wilson, Charles, 1977. "A model of insurance markets with incomplete information," Journal of Economic Theory, Elsevier, vol. 16(2), pages 167-207, December.
    32. Ellis, Randall P. & McGuire, Thomas G., 2007. "Predictability and predictiveness in health care spending," Journal of Health Economics, Elsevier, vol. 26(1), pages 25-48, January.
    33. Bolhaar, Jonneke & Lindeboom, Maarten & van der Klaauw, Bas, 2012. "A dynamic analysis of the demand for health insurance and health care," European Economic Review, Elsevier, vol. 56(4), pages 669-690.
    34. Keane, Michael & Stavrunova, Olena, 2016. "Adverse selection, moral hazard and the demand for Medigap insurance," Journal of Econometrics, Elsevier, vol. 190(1), pages 62-78.
    35. Hanming Fang & Zenan Wu, 2018. "Multidimensional private information, market structure, and insurance markets," RAND Journal of Economics, RAND Corporation, vol. 49(3), pages 751-787, September.
    36. de Meza, David & Webb, David C, 2001. "Advantageous Selection in Insurance Markets," RAND Journal of Economics, The RAND Corporation, vol. 32(2), pages 249-262, Summer.
    37. Pau Olivella & Marcos Vera‐Hernández, 2013. "Testing for Asymmetric Information in Private Health Insurance-super-," Economic Journal, Royal Economic Society, vol. 123(567), pages 96-130, March.
    38. Bardey, David & Buitrago, Giancarlo, 2017. "Supplemental health insurance in the Colombian managed care system: Adverse or advantageous selection?," Journal of Health Economics, Elsevier, vol. 56(C), pages 317-329.
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    More about this item

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • L13 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Oligopoly and Other Imperfect Markets
    • D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design

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