Basic versus supplementary health insurance: Moral hazard and adverse selection

Boone, Jan

doi:10.1016/j.jpubeco.2015.05.009

Cited by 15 publications

(8 citation statements)

References 26 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A notable concern when estimating the effects of insurance on health outcomes is the potential presence of adverse selection and moral hazard. 16 In adverse selection health risky individuals would self-select into insurance, while moral hazard implies abuse of the medical scheme through over utilisation. 17 A classical method to evade the influence of these behaviours is randomly allocating the insurance amongst the subjects, which is not possible for secondary data based studies.…”

Section: Introductionmentioning

confidence: 99%

<p>The Effects of Health Insurance on Health-Seeking Behaviour: Evidence from the Kingdom of Saudi Arabia</p>

Al-Hanawi

Mwale

Kamninga³

2020

RMHP

View full text Add to dashboard Cite

Background: Saudi Arabia's healthcare sector is growing at a hasty stride; nevertheless, the quality of healthcare consumption remains challenged by the growing caseload in free public health facilities. Insurance could ease this pressure by moving some healthcare demand to private facilities conditional on its ability to enact health-seeking behaviour. These potential effects remain under-investigated. Therefore, the aim of this study was to investigate whether health insurance nudges health-seeking behaviour using data from Saudi Arabia. Materials and Methods: The study used nationally representative secondary data, obtained from the Family Health Survey, conducted in 2018, in Saudi Arabia. Health-seeking behaviour was measured by individual attendance of medical check-up. To account for endogeneity due to non-random selection of individuals into insurance, the analysis employed the inverse propensity weighting and the instrumental variables methods. Results: The results revealed that health insurance leads to increased chances of going for medical check-up. The effects are higher amongst non-Saudi nationals relative to citizens. Furthermore, people who purchase personal health insurance schemes are more likely to go for checks-ups, followed by individuals provided by the private sector and government sector. Finally, the study found that insurance positively nudges hypertension, diabetes, and cholesterol specific medical check-ups. Conclusion:The findings indicated the need for health policy to increase access to health insurance in Saudi Arabia. A notable policy response is the introduction of national health insurance coverage, which has already proven in other countries as an effective measure to attain universal access to improved health. Nevertheless, results from this study highlighted variations in demand for health seeking based on type of insurance with highest returns in personal insurance. Policy should leverage on this behaviour response by introducing insurance packages that share premiums with citizens to incentivise utilisation. The results can also be used to design policy responses to demand for insurance, in the entire Arabian Gulf region, since these countries have similar health financing mechanism with Saudi Arabia.

show abstract

Section: Introductionmentioning

confidence: 99%

<p>The Effects of Health Insurance on Health-Seeking Behaviour: Evidence from the Kingdom of Saudi Arabia</p>

Al-Hanawi

Mwale

Kamninga³

2020

RMHP

View full text Add to dashboard Cite

show abstract

“…It is needed for most households to get covered with that and in this regard, governmental organization should support households. Most of the studies confirmed the protective effect of supplementary insurance (27)(28)(29).…”

Section: Discussionmentioning

confidence: 69%

The Households Health Spending and Impoverishment: A Study After Iran's Health Transformation Plan

et al. 2018

View full text Add to dashboard Cite

Background: Iran's Health Transformation Plan (HTP) was implemented to decrease households' out of pocket and protect them from facing catastrophic health expenditure and impoverishment from 2014. It is needed to assess the effect of HTP; therefore, the study aimed to examine the households' impoverishment due to health expenditure after HTP. Methods: A household survey was carried out in 2017 in Sistan and Baluchestan province in southeast Iran. About 2400 households were selected as the study sample using a multi-stage sampling technique. The household section of the World Health Survey questionnaire was used to collect data. Independent variables contained households' characteristics, household income, chronic illness status, the use of health services, and health spending. The dependent variable was whether the household was faced with health spending impoverishment. Mixed effects logistic regression was used to assess the effect of the independent variables on the impoverishment using SPSS software 21. Results: About 7.5% of the households had no basic insurance and 757 (31.6) heads' of the households were unemployment. The results showed that about 5.4% of the households impoverished due to health expenditure. The households in the furthest region were forced with impoverishment more than other regions (23.0%). Living in a rural area, unemployment, economic status, and inpatients and outpatient costs were the main determinates on impoverishment (P < 0.05). In addition, having supplementary insurance was a protective factor in facing impoverishment (P = 0.05). Conclusions:In general, despite the implementation of HTP, healthcare expenditures leading to impoverishment of high percent of the households and Iranian development goals have not been fulfilled in this region. Economic poverty of the people may also be an important factor in this regard. It is recommended that outpatient services are covered by health insurances.

show abstract

“…However, the finding is in contrast with another study which reported that health insurance has an effect on increased utilization of healthcare services, particularly in situations where an insured individual is still able to access quality care in the absence of insurance [ 33 ]. However, a notable concern with analysis of the influence of health insurance on care-seeking behaviour is the potential presence of a moral hazard that had been previously reported [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of sub-national social health insurance scheme on enrollees’ health seeking behaviour in Anambra state, Nigeria: a pre and post study

Onyemaechi

Ezenwaka

2022

BMC Public Health

View full text Add to dashboard Cite

Background Appropriate health-seeking behaviour (HSB) is crucial for improving health outcomes and achieving universal health coverage (UHC). Accessing healthcare through the state social health insurance scheme (SSHIS) could lead to improved HSB. The study explores the influence of access to healthcare through health insurance on the HSB of the enrollees of the SSHIS in southeast, Nigeria. Methods A descriptive cross-sectional study undertaken in twelve health facilities in Anambra state using quantitative and qualitative research methods. Data were collected through a facility-based survey (n = 447) and sex-disaggregated focus group discussions (n = 12) of health insurance enrollees. Univariate and bivariate analyses were performed for quantitative data, while qualitative data were analyzed using a manual content approach. Result The findings revealed a positive change in enrollee’s HSB post-health insurance enrollment. Majority (83%) of the respondents reported that they immediately take action when ill post-health insurance enrollment as against 34% (pre-health insurance) resulting in a 49% increase, with a statistically significant difference (p < 0.02). There was a statistically significant association between positive HSB and marital status (p < 0.04); educational level (p < 0.00); occupation (p < 0.03) and ownership of health facility (p < 0.00). There was an increase in the percentage of enrollees who use the hospital as their first choice of provider during an illness episode post-health insurance enrollment. This increased from 37.4% to 90.2% (post-health insurance enrollment), representing a 52.8% increase, which is statistically significant (p < 0.03), in seeking care in hospitals. Similarly, the percentage (46%) of enrollees using patent medicine vendors (PMVs) as their first choice of provider when ill prior to enrollment in health insurance decreased to 8.1% post-health insurance enrollment, representing a 38% decline with a statistically significant (p < 0.00) drop in PMV patronage. Reasons for positive HSB include low cost of services and availability of quality care such as quality drugs, presence of doctors, and other skilled health workers by the health insurance facilities. Conclusion Health insurance has been established as an effective strategy for improving appropriate HSB. Hence, increasing coverage of health insurance among the uninsured is crucial in improving access to quality and affordable health care towards achieving UHC, particularly in developing countries.

show abstract

Basic versus supplementary health insurance: Moral hazard and adverse selection

Cited by 15 publications

References 26 publications

<p>The Effects of Health Insurance on Health-Seeking Behaviour: Evidence from the Kingdom of Saudi Arabia</p>

<p>The Effects of Health Insurance on Health-Seeking Behaviour: Evidence from the Kingdom of Saudi Arabia</p>

The Households Health Spending and Impoverishment: A Study After Iran's Health Transformation Plan

Influence of sub-national social health insurance scheme on enrollees’ health seeking behaviour in Anambra state, Nigeria: a pre and post study

Contact Info

Product

Resources

About