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Separating Selection and Incentive Effects: an Econometric Study of Swiss Health Insurance Claims Data

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  • Pierre-Yves Geoffard

    (PJSE - Paris-Jourdan Sciences Economiques - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - ENPC - École des Ponts ParisTech - CNRS - Centre National de la Recherche Scientifique, Institut d'économie et de management de la santé (IEMS) - UNIL - Université de Lausanne = University of Lausanne, CEPR - Center for Economic Policy Research - CEPR)

  • Lucien Gardiol

    (Institut d'économie et de management de la santé (IEMS) - UNIL - Université de Lausanne = University of Lausanne)

  • Chantal Grandchamp

    (CEPR - Center for Economic Policy Research - CEPR)

Abstract

This paper presents an empirical analysis of the link between health insurance coverage and health care expenditures. We use claims data for over 60 000 adult individuals covered by a major Swiss Health Insurance Fund, followed for up to four years. In the Swiss health insurance system, each individual can choose between five plans, corresponding to different levels of annual deductible. The data show a strong positive correlation between coverage and expenditure. We provide a simple method to separate selection effects (due to individual choice of coverage) and incentive effects (" moral hazard "). The method only requires that there exists an observable variable: 1. correlated with the unobservable health status; 2. not affected by incentives. The analysis of mortality rates indicates important selection effects, which is confirmed by the data on inpatient care. However, the positive correlation between coverage and outpatient expenditure is not fully explained by selection effects, and moral hazard effects are of the same order of magnitude.
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Suggested Citation

  • Pierre-Yves Geoffard & Lucien Gardiol & Chantal Grandchamp, 2006. "Separating Selection and Incentive Effects: an Econometric Study of Swiss Health Insurance Claims Data," Post-Print halshs-00754832, HAL.
    • Handle: RePEc:hal:journl:halshs-00754832
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    Cited by:

    1. Trottmann, Maria & Zweifel, Peter & Beck, Konstantin, 2012. "Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?," Journal of Health Economics, Elsevier, vol. 31(1), pages 231-242.
    2. Chantal Grandchamp & Lucien Gardiol, 2011. "Does a mandatory telemedicine call prior to visiting a physician reduce costs or simply attract good risks?," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1257-1267, October.
    3. van Kleef, R.C. & Beck, K. & van de Ven, W.P.M.M. & van Vliet, R.C.J.A., 2008. "Risk equalization and voluntary deductibles: A complex interaction," Journal of Health Economics, Elsevier, vol. 27(2), pages 427-443, March.

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