Distinguishing moral hazard from access for high-cost healthcare under insurance.
<h4>Context</h4>Health policy has long been preoccupied with the problem that health insurance stimulates spending ("moral hazard"). However, much health spending is costly healthcare that uninsured individuals could not otherwise access. Field studies comparing those with more...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0231768 |
| _version_ | 1818194245928878080 |
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| author | Christopher T Robertson Andy Yuan Wendan Zhang Keith Joiner |
| author_facet | Christopher T Robertson Andy Yuan Wendan Zhang Keith Joiner |
| author_sort | Christopher T Robertson |
| collection | DOAJ |
| description | <h4>Context</h4>Health policy has long been preoccupied with the problem that health insurance stimulates spending ("moral hazard"). However, much health spending is costly healthcare that uninsured individuals could not otherwise access. Field studies comparing those with more or less insurance cannot disaggregate moral hazard versus access. Moreover, studies of patients consuming routine low-dollar healthcare are not informative for the high-dollar healthcare that drives most of aggregate healthcare spending in the United States.<h4>Methods</h4>We test indemnities as an alternative theory-driven counterfactual. Such conditional cash transfers would maintain an opportunity cost for patients, unlike standard insurance, but also guarantee access to the care. Since indemnities do not exist in U.S. healthcare, we fielded two blinded vignette-based survey experiments with 3,000 respondents, randomized to eight clinical vignettes and three insurance types. Our replication uses a population that is weighted to national demographics on three dimensions.<h4>Findings</h4>Most or all of the spending due to insurance would occur even under an indemnity. The waste attributable to moral hazard is undetectable.<h4>Conclusions</h4>For high-cost care, policymakers should be more concerned about the foregone efficient spending for those lacking full insurance, rather than the wasteful spending that occurs with full insurance. |
| first_indexed | 2024-12-12T00:59:14Z |
| format | Article |
| id | doaj.art-d08b9e1e36ed4c63b054058d355d74f2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-12T00:59:14Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-d08b9e1e36ed4c63b054058d355d74f22022-12-22T00:43:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01154e023176810.1371/journal.pone.0231768Distinguishing moral hazard from access for high-cost healthcare under insurance.Christopher T RobertsonAndy YuanWendan ZhangKeith Joiner<h4>Context</h4>Health policy has long been preoccupied with the problem that health insurance stimulates spending ("moral hazard"). However, much health spending is costly healthcare that uninsured individuals could not otherwise access. Field studies comparing those with more or less insurance cannot disaggregate moral hazard versus access. Moreover, studies of patients consuming routine low-dollar healthcare are not informative for the high-dollar healthcare that drives most of aggregate healthcare spending in the United States.<h4>Methods</h4>We test indemnities as an alternative theory-driven counterfactual. Such conditional cash transfers would maintain an opportunity cost for patients, unlike standard insurance, but also guarantee access to the care. Since indemnities do not exist in U.S. healthcare, we fielded two blinded vignette-based survey experiments with 3,000 respondents, randomized to eight clinical vignettes and three insurance types. Our replication uses a population that is weighted to national demographics on three dimensions.<h4>Findings</h4>Most or all of the spending due to insurance would occur even under an indemnity. The waste attributable to moral hazard is undetectable.<h4>Conclusions</h4>For high-cost care, policymakers should be more concerned about the foregone efficient spending for those lacking full insurance, rather than the wasteful spending that occurs with full insurance.https://doi.org/10.1371/journal.pone.0231768 |
| spellingShingle | Christopher T Robertson Andy Yuan Wendan Zhang Keith Joiner Distinguishing moral hazard from access for high-cost healthcare under insurance. PLoS ONE |
| title | Distinguishing moral hazard from access for high-cost healthcare under insurance. |
| title_full | Distinguishing moral hazard from access for high-cost healthcare under insurance. |
| title_fullStr | Distinguishing moral hazard from access for high-cost healthcare under insurance. |
| title_full_unstemmed | Distinguishing moral hazard from access for high-cost healthcare under insurance. |
| title_short | Distinguishing moral hazard from access for high-cost healthcare under insurance. |
| title_sort | distinguishing moral hazard from access for high cost healthcare under insurance |
| url | https://doi.org/10.1371/journal.pone.0231768 |
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