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Ex-post moral hazard in the health insurance market: empirical evidence from German data

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  • Stefanie Thönnes

    (University of Paderborn)

Abstract

In this paper, I analyze whether premium refunds can reduce ex-post moral hazard behavior in the health insurance market. I do so by estimating the effect of these refunds on different measures of medical demand. I use panel data from German sickness funds that cover the years 2006–2010 and I estimate effects for the year 2010. Applying regression adjusted matching, I find that choosing a tariff that contains a premium refund is associated with a significant reduction in the probability of visiting a general practitioner. Furthermore, the probability of visiting a doctor due to a trivial ailment such as a common cold is reduced. Effects are mainly driven by younger (and, therefore, healthier) individuals, and they are stronger for men than for women. Medical expenditures for doctor visits are also reduced. I conclude that there is evidence that premium refunds are associated with a reduction in ex-post moral hazard. Robustness checks support these findings. Yet, using observable characteristics for matching and regression, it is never possible to completely eliminate a potentially remaining selection bias and results may not be interpreted in a causal manner.

Suggested Citation

  • Stefanie Thönnes, 2019. "Ex-post moral hazard in the health insurance market: empirical evidence from German data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(9), pages 1317-1333, December.
    • Handle: RePEc:spr:eujhec:v:20:y:2019:i:9:d:10.1007_s10198-019-01091-w
    DOI: 10.1007/s10198-019-01091-w
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    1. Aviva Aron-Dine & Liran Einav & Amy Finkelstein & Mark Cullen, 2015. "Moral Hazard in Health Insurance: Do Dynamic Incentives Matter?," The Review of Economics and Statistics, MIT Press, vol. 97(4), pages 725-741, October.
    2. Michael Gerfin & Boris Kaiser & Christian Schmid, 2015. "Healthcare Demand in the Presence of Discrete Price Changes," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1164-1177, September.
    3. Lex Borghans & Bart H. H. Golsteyn & James J. Heckman & Huub Meijers, 2009. "Gender Differences in Risk Aversion and Ambiguity Aversion," Journal of the European Economic Association, MIT Press, vol. 7(2-3), pages 649-658, 04-05.
    4. Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2005. "Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 151-184, February.
    5. Liran Einav & Amy Finkelstein & Stephen P. Ryan & Paul Schrimpf & Mark R. Cullen, 2013. "Selection on Moral Hazard in Health Insurance," American Economic Review, American Economic Association, vol. 103(1), pages 178-219, February.
    6. 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.
    7. David M. Cutler & Amy Finkelstein & Kathleen McGarry, 2008. "Preference Heterogeneity and Insurance Markets: Explaining a Puzzle of Insurance," American Economic Review, American Economic Association, vol. 98(2), pages 157-162, May.
    8. Stefan Boes & Michael Gerfin, 2016. "Does Full Insurance Increase the Demand for Health Care?," Health Economics, John Wiley & Sons, Ltd., vol. 25(11), pages 1483-1496, November.
    9. Claudia Pütz & Christian Hagist, 2006. "Optional deductibles in social health insurance systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(4), pages 225-230, December.
    10. Emily Oster, 2019. "Unobservable Selection and Coefficient Stability: Theory and Evidence," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 187-204, April.
    11. Marco Caliendo & Sabine Kopeinig, 2008. "Some Practical Guidance For The Implementation Of Propensity Score Matching," Journal of Economic Surveys, Wiley Blackwell, vol. 22(1), pages 31-72, February.
    12. Amitabh Chandra & Jonathan Gruber & Robin McKnight, 2010. "Patient Cost-Sharing and Hospitalization Offsets in the Elderly," American Economic Review, American Economic Association, vol. 100(1), pages 193-213, March.
    13. Helmut Farbmacher & Joachim Winter, 2013. "Per‐Period Co‐Payments And The Demand For Health Care: Evidence From Survey And Claims Data," Health Economics, John Wiley & Sons, Ltd., vol. 22(9), pages 1111-1123, September.
    14. Guido W. Imbens, 2015. "Matching Methods in Practice: Three Examples," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 373-419.
    15. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    16. Hendrik Schmitz, 2012. "More health care utilization with more insurance coverage? Evidence from a latent class model with German data," Applied Economics, Taylor & Francis Journals, vol. 44(34), pages 4455-4468, December.
    17. Johannes S. Kunz & Rainer Winkelmann, 2017. "An Econometric Model of Healthcare Demand With Nonlinear Pricing," Health Economics, John Wiley & Sons, Ltd., vol. 26(6), pages 691-702, June.
    18. Helmut Farbmacher & Peter Ihle & Ingrid Schubert & Joachim Winter & Amelie Wuppermann, 2017. "Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1234-1248, October.
    19. Çağatay Koç, 2011. "Disease‐Specific Moral Hazard and Optimal Health Insurance Design for Physician Services," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 78(2), pages 413-446, June.
    20. Jan Marcus, 2014. "Does Job Loss Make You Smoke and Gain Weight?," Economica, London School of Economics and Political Science, vol. 81(324), pages 626-648, October.
    21. Hayen, Arthur P. & Klein, Tobias J. & Salm, Martin, 2021. "Does the framing of patient cost-sharing incentives matter? the effects of deductibles vs. no-claim refunds," Journal of Health Economics, Elsevier, vol. 80(C).
    22. Lex Borghans & Bart H.H. Golsteyn & James J. Heckman & Huub Meijers, 2009. "Gender Differences in Risk Aversion and Ambiguity," Working Papers 200903, Geary Institute, University College Dublin.
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