Moral hazard is the additional health care that is consumed because of insurance. Conventional theory regards moral hazard as being welfare decreasing. An alternative theory suggests that a portion is welfare decreasing but another portion is welfare increasing. The welfare-increasing portion is the additional health care that an insured consumer would have purchased if, instead of paying for any care, the insurer had paid him a cashier's check in an amount equal to the portion of his or her health care expenditures covered by the insurer under the standard insurance policy. In theoretical terms, the welfare-increasing portion of moral hazard is the response to income transfers that are contained within the insurance price reduction. This study proposes to decompose moral hazard into a welfare-increasing portion and a portion that is welfare decreasing for the general population of Americans, for those Americans with 9 of the 15 priority health conditions separately, and for all 15 priority health conditions combined. Using the 1996-2008 Medical Expenditure Panel Survey, it will use a 7-step process to (1) estimate health care spending using an instrumental variables approach to correct for the endogeneity of private and public health insurance, taking into account the possible choice of public insurance, (2) for each uninsured, estimate the income elasticity of demand from the income coefficients in step 1, (3) for the privately insured, estimate the portion of total spending that would have been paid for by the insurer (excluding cost sharing), (4) for each uninsured, use the coefficients from step 3 to estimate the amount of spending paid for by the insurer if they had been insured, (5) for each uninsured, use the income coefficients from step 2 to estimate the change in uninsured health care spending if they were insured with a contingent claims insurance policy that paid off with the same spending as in step 4, (6) for each uninsured, use the coefficients from step 1 to estimate the moral hazard spending if they had been insured, and (7) for each uninsured, the change in health care spending had the individual been insured by a contingent claims contract from step 5 is multiplied by the estimated spending in the uninsured state to determine the efficient portion of the additional health care spending. This efficient spending with a contingent claims policy is then compared to estimated overall moral hazard spending from step 6 to determine the amount of inefficient moral hazard. An analogous procedure will be repeated for the insured and for the entire sample. This study represents the first to estimate the portion of moral hazard that is efficient. This information will be used to make inferences about the proportion of the total health care spending in the U.S. that represents efficient moral hazard, and also will be used to evaluate appropriateness of imposing cost sharing on insured persons with the various priority health conditions.

Public Health Relevance

Conventional economic theory suggests that being insured creates incentives for people to purchase additional healthcare that is not worth the costs. An alternative theory suggests that some healthcare is wasteful, but a large portion is worth the costs. This proposal seeks to identify the portion of the additional health care that is worth the costs for the entire population and for those who are ill with certain health conditions.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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HSR Health Care Research Training SS (HCRT)
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Hagan, Michael
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University of Minnesota Twin Cities
Public Health & Prev Medicine
Schools of Public Health
United States
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