Search

We analyze the existence and persistence of moral hazard over time to test the assumption of pent-up demand. We consider the effects of supplemental health insurance provided by a private insurer when added to compulsory public insurance that is already supplemented by private insurance. Using original panel data from a French mutuelle, we study the influence of insurance on all of the dimensions of healthcare expenditures: (1) the probability of using health care, (2) the number of uses conditional on use, and (3) the per unit cost of care. To conduct this study, we control, to the extent possible, for endogeneity because of adverse selection using the characteristics of our panel data. Our study allows us to confirm a positive and significant effect of the extra complementary health insurance on healthcare consumption, primarily in terms of the probability of using care. More interestingly, our results show that these effects are principally transitory mainly for the probability of using dental care and optical care and depend on income. Finally, we show that individuals did not postpone health care before enrollment. Copyright © 2015 John Wiley & Sons, Ltd.

En santé, un individu averse au risque choisit de s’assurer afin de réduire le risque financier associé à la maladie. L’hypothèsenaïve conduit à supposer que l’introduction d’une assurance santé réduit le Reste à charge (RAC), c’est-à-dire la dépense de santé qu’il supporte in fine après les remboursements des organismes d’assurance maladie. Toutefois, sous l’hypothèse de sensibilité au prix de la demande de soins, la souscription d’un contrat d’assurance santé induit une modification du comportement de consommation de soins, qu’il s’agisse d’aléa moral ou d’accès aux soins. Le lien entre assurance et RAC n’est donc pas si clair. À partir d’un panel de données individuelles d’assurés auxquels une sur-complémentaire d’assurance a été offerte (SHI), nous testons l’hypothèse selon laquelle l’assurance permet de réduire le RAC lié aux dépenses de santé (1) et nous étudions ensuite dans quelle mesure l’évolution des RAC est susceptible de caractériser une amélioration de l’accès aux soins (2). Les résultats montrent que SHI ne réduit pas le RAC et même l’augmente pour ceux qui ont choisi de souscrire tardivement. Cette hausse du RAC observée est principalement expliquée par une hausse du recours et non par une hausse de la dépense supportée en cas de recours. Nous observons que SHI a permis une solvabilisation et une diversification de la demande de services de soins. In health context, a risk-averse individual chooses to buy an insurance contract in order to reduce the financial risk associated with the disease. The naïve assumption would lead to suppose that the insurance reduces the residual co-payment of health expenses. However, under the price sensibility of health care demand assumption, the subscription to a health insurance contract leads to a change in health care consumptions, whether moral hazard and or access to care. Thus, the link between insurance and individual co-payment is not clear. From a panel of individual insured data for which an supplemental health insurance was offered (SHI), we test the hypothesis (1) that insurance reduces the financial risk to health spending and then we study how the evolution of co-payment is likely to characterize the access to care (2). The results show that SHI does not reduce the co-payment and even increases it for those who have chosen to subscribe later. This increase is mainly explained by an increase in use and not to an increase in the expenditure per use. We show that SHI has resulted in a solvency and in a diversification of health care services demand.

L'Enquete decennale sante (EDS) est realisee par l'INSEE depuis 1960. Elle vise a evaluer l'etat de sante de la population et a mesurer la consommation de soins et de prevention. Elle met en relation les consommations avec l'etat de sante declare et les caracteristiques sociodemographiques des individus. Lors de l'enquete 2002-2003, un examen de sante a ete propose aux personnes enquetees de 18 ans et plus et residant dans l'une des cinq extensions regionales : le Nord, la Picardie, l'Ile-de-France, la Champagne-Ardenne et la region PACA. Les examens ont ete realises par les Centres d'examens de sante (CES) de l'Assurance maladie. L'etude presentee ici confronte les donnees d'etat de sante declarees dans l'enquete aux donnees recueillies lors de l'examen de sante. Elle est issue d'une collaboration entre le CETAF (Centre technique d'appui et de formation des Centres d'examens de sante) et l'IRDES.

In France, about 90 per cent of the population is covered by private health insurance that supplements public health insurance. More than half of policyholders obtain their coverage through their employer. Considering the financial benefits associated with group contracts compared to individual contracts, we assume that switching behaviours vary among different beneficiaries during the transition to retirement. The gap in premiums at retirement between group and individual contracts gives the opportunity to study the marginal price effect on switching behaviours. In this study, we consider the nature of the contract prior to retirement (compulsory or voluntary membership group contract and individual contract) as an indirect measure of the price effect. We show the significance of this price effect as policyholders formerly enrolled in group contracts switch much more frequently than those formerly covered by an individual contract. We also discuss other determinants of the decision to switch private supplementary health insurance. The Geneva Papers (2008) 33, 610–626. doi:10.1057/gpp.2008.31

On January 1st 2008, a 0.5€ deductible levied on every prescription drug package purchased was introduced in France. This study aims at shedding light on the effect of this policy on prescription drug purchasing behavior among the targeted individuals. Declared behavior from a cross-sectional study based on participants in the French Health, Health Care and Insurance Survey of 2008. The determinants of having changed one’s prescription drugs consumption following the introduction of deductibles were explored based on the socio-behavioral model of Andersen and an economic model of drug demand. The empirical analysis used a logistic regression. All other factors being equal, individuals’ probability of having modified their drug consumption behaviour following the introduction of deductibles decreases with income level and health status (self-assessed health and suffering from a chronic disease). Deductibles on prescription drugs represent a significant financial burden for low-income individuals and those in poor health, with the potential effect of limiting their access to drugs.

Adverse selection, which is well described in the theoretical literature on insurance, remains relatively difficult to study empirically. The traditional approach, which focuses on the binary decision of “covered” or “not”, potentially misses the main effects because heterogeneity may be very high among the insured. In the French context, which is characterized by universal but incomplete public health insurance (PHI), we study the determinants of the decision to subscribe to supplemental health insurance (SHI) in addition to complementary health insurance (CHI). This work permits to analyze health insurance demand at the margin. Using a panelized dataset, we study the effects of both individual state of health, which is measured by age and previous individual health spending, and timing on the decision to subscribe. One striking result is the changing role of health risk over time, illustrating that adverse selection occurs immediately after the introduction of SHI. After the initial period, the effects of health risks (such as doctors’ previous health expenditures) diminish over time and financial risks (such as dental and optical expenses and income) remain significant. These results may highlight the inconsistent effects of health risks on the demand for insurance and the challenges of studying adverse selection.

In France, private health insurance, that supplements public health insurance, is essential for access to health care. About 90% of the population is covered by a private contract and around half of them obtain their coverage through their employer. Considering the financial benefits associated with group contracts compared to individual contracts, we assume that the switching behaviors vary among different beneficiaries during the transition to retirement. Indeed, despite a 1989 law, the gap in premiums increases at retirement between group and individual contracts affords the opportunity to study the marginal price effect on switching behaviors. In this study, we consider the nature of the contract prior to retirement (compulsory or voluntary membership group contract and individual contract) as an indirect measure of the price effect. We focus on its role and check for a large number of individual characteristics that may influence the new retirees' health insurance demand.

This paper develops an innovative method of constructing a concrete measure of health by taking into account individual health information. Using individual survey data from the 2002 IRDES Health and Health Insurance Survey, we propose a measurement of health based on the number of diseases and their respective severity level. The construction relies on a latent variable regression model explaining self-assessed health and controlling various social and health individual characteristics. We compare this construction to other methods proposed in literature for the measurement of health. Moreover, we show how the health index allows to compare distributions of health among di®erent populations and to evaluate inequalities in health in France by using stochastic dominance at first-order.

The French government introduced a ‘free complementary health insurance plan’ in 2000, which covers most of the out-of-pocket payments faced by the poorest 10% of French residents. This plan was designed to help the non-elderly poor to access health care. To assess the impact of the introduction of the plan on its beneficiaries, we use a longitudinal data set to compare, for the same individual, the evolution of his/her expenditures before-and-after enrolment in the plan. This before-and-after analysis allows us to remove most of the spuriousness due to individual heterogeneity. We also use information on past coverage in a difference-in-difference analysis to evaluate the impact of specific benefits associated with the plan. We attempt at controlling for changes other than enrolment through a difference-in-difference analysis within the eligible (rather than enrolled) population. Our main result is the plan's lack of an overall effect on utilization. This result is likely attributable to the fact that those who were enrolled automatically in the free plan (the majority of enrollees), already benefited from a relatively generous plan. The significant effect among those who enrolled voluntarily in the free plan was likely driven by those with no previous complementary coverage. Copyright © 2007 John Wiley & Sons, Ltd.

The French government introduced a "free supplementary health insurance plan" in 2000, which covers most of the out-of-pocket payments faced by the poorest 10% of French residents. This plan was designed to help the non-elderly poor to access health care. To assess the impact of the introduction of the plan on its beneficiaries, we use a longitudinal dataset to compare, for the same individual, the evolution of his/her expenditures before and after enrolment in the plan. This longitudinal analysis allows us to remove most of the spuriousness due to individual heterogeneity, and we also use information on past coverage to evaluate the impact of specific benefits associated with the plan. As a result, we can properly assess the impact of the plan on those who enrolled in it. However, we cannot assess the impact of the plan on all of those who were eligible to enrol. Our main result is the plan’s lack of an overall effect on utilization. This result is likely attributable to the fact that those who were enrolled automatically in the free plan (the majority of enrollees), already benefited from a relatively generous plan. The significant effect among those who enrolled voluntarily in the free plan was likely driven by those with no previous supplemental coverage.

In France, public health insurance is universal but incomplete, with private payments accounting for roughly 25% of all spending. As a result, most people have supplemental private health insurance. We investigate the effects of such insurance on the utilization of physician services using data from the 1998 Enquete sur la sante et la protection sociale, a nationally representative survey of the non-institutionalized French population. Our results indicate that insurance has a strong and significant effect on the utilization of physician services. Individuals with supplemental coverage have substantially more physician visits than those without. While French patients have greater freedom than patients in other countries to choose to see a specialist rather than a general practitioner, we find no evidence that supplemental insurance affects this decision.