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Assurance-maladie : comment adapter les taux de remboursement aux dépenses individuelles de santé?

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  • Lipszyc, Barbara

    (CREPP, Université de Liège)

  • Marchand, Maurice

    (IAG, Université Catholique de Louvain)

Abstract

We consider a health insurance model with heterogeneous agents who only differ in illness severity. The public insurer intends to maximize the expected utility of people insured taking into account the premium paid by them to balance the insurer's budget. Without any ex post moral hazard, the reimbursement rate would be set at 100%. But with moral hazard, the individual decision, as regards medical expenses, varies with this rate. After a short presentation of the single rate case, we consider a two-rate reimbursement structure, with a threshold defining the scope of each rate, the one applying below the threshold and the other taking effect above this cut-off point. We want to determine the relative value of these two rates, as well as the amount of the threshold. Then we characterize a non-linear reimbursement, which is closer to the first-best solution. Some numerical simulations illustrate the analytical developments. They show how the reimbursement structure affects the risk sharing between the healthy and the sick and the efficiency loss caused by moral hazard. Nous considérons un modèle d’assurance-maladie dans lequel les agents ne se différencient que par la gravité de la maladie qui les atteint. L’État cherche à maximiser l’espérance d’utilité des assurés et décide en conséquence de rembourser une fraction des dépenses de santé. En l’absence d’aléa moral ex post, suivant lequel la décision individuelle de dépenses de santé est affectée par leur taux de remboursement, celui-ci pourrait être de 100 %. Cependant, avec aléa moral, la gratuité des soins n’est plus de mise. Après une brève présentation du cas d’un taux de remboursement uniforme, nous envisageons d’abord une structure de remboursement à deux taux, le premier s’appliquant en dessous d’un certain seuil de dépenses et le second au-delà du seuil. Nous voulons connaître la valeur relative de ces deux taux de remboursement, ainsi que le montant du seuil. Ensuite nous montrons les caractéristiques d’un remboursement non linéaire, qui nous rapproche un peu plus de la solution de premier rang. Des exemples numériques illustrent les développements analytiques et montrent comment le partage des risques entre bien-portants et malades et la perte d’efficacité due à l’aléa moral varient selon le schéma de remboursement.

Suggested Citation

  • Lipszyc, Barbara & Marchand, Maurice, 1999. "Assurance-maladie : comment adapter les taux de remboursement aux dépenses individuelles de santé?," L'Actualité Economique, Société Canadienne de Science Economique, vol. 75(1), pages 447-473, mars-juin.
  • Handle: RePEc:ris:actuec:v:75:y:1999:i:1:p:447-473
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