期刊
JOURNAL OF HEALTH ECONOMICS
卷 49, 期 -, 页码 153-168出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jhealeco.2016.06.012
关键词
Health insurance; Public option; Adverse selection; Individual mandate; German insurance
Conventional wisdom suggests that if private health insurance plans compete alongside a public option, they may endanger the latter's financial stability by cream-skimming good risks. This paper argues that two factors may contribute to the extent of cream-skimming: (i) degree of horizontal differentiation between public and private options when preferences are heterogeneous; (H) whether contract design encourages choice of private insurance before information about risk is revealed. I explore the role of these factors empirically within the unique institutional setting of the German health insurance system. Using a fuzzy regression discontinuity design to disentangle adverse selection and moral hazard, I find no compelling support for extensive cream-skimming of public option by private insurers despite their ability to fully underwrite risk. A model of demand for private insurance supports the idea that heterogeneity in non pecuniary preferences and long-term structure of private insurance contracts may be muting cream skimming in this setting. (C) 2016 Elsevier B.V. All rights reserved.
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