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"Zweifel, Peter"
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Can Multi-Peril Insurance Policies Mitigate Adverse Selection?
The objective of this paper is to pursue an intuitive idea: for a consumer who represents an “unfavorable” health risk but an “excellent risk” as a driver, a multi-peril policy could be associated with a reduced selection effort on the part of the insurer. If this intuition should be confirmed, it will serve to address the decade-long concern with risk selection both in the economic literature and on the part of policy makers. As an illustrative example, a two-peril model is developed in which consumers deploy effort in search of a policy offering them maximum coverage at the current market price while insurers deploy effort designed to stave off unfavorable risks. Two types of Nash equilibria are compared: one in which the insurer is confronted with high-risk and low-risk types, and another one where both types are a “better risk” with regard to a second peril. The difference in the insurer’s selection effort directed at high-risk and low-risk types is indeed shown to be lower in the latter case, resulting in a mitigation of adverse selection.
Journal Article
Buying efficiency: optimal hospital payment in the presence of double upcoding
BackgroundWith DRG payments, hospitals can game the system by ’upcoding’ true patient’s severity of illness. This paper takes into account that upcoding can be performed by the chief physician and hospital management, with the extent of the distortion depending on hospital’s internal decision-making process. The internal decision making can be of the principal-agent type with the management as the principal and the chief physician as the agent, but the chief physicians may be able to engage in negotiations with management resulting in a bargaining solution.ResultsIn case of the principal-agent mechanism, the distortion due to upcoding is shown to accumulate, whereas in the bargaining case it is avoided at the level of the chief physician.ConclusionIn the presence of upcoding it may be appropriate for the sponsor to design a payment system that fosters bargaining to avoid additional distortions even if this requires extra funding.
Journal Article
Preference measurement in health using experiments
This contribution has three objectives. First, it seeks to justify the use of the economic criterion, “Provision of health care in accordance with the preferences of current and potential patients” for guiding decisions concerning the adoption of costly innovation in health. Next, it proposes the measurement of these preferences in the guise of willingness to pay (WTP) values through Discrete Choice Experiments (DCEs). Third, it purports to examine two popular arguments against accepting lay persons´ preferences, viz. that they are unwilling or unable to express preferences with regard to health and health care, and that their preferences are unstable, depending on the current state of health. Both of these arguments are refuted by the findings of four DCEs designed to measure WTP for attributes of health insurance and of the treatment of diabetes, respectively [Zweifel in J Regul Econ 29(3): 319–332, 2006; MacNeil Vrooman and Zweifel in Eur J Health Econ 12(1): 87–95, 2011; Sennhauser and Zweifel in: Jakovlijevic M (ed.), Health Economics and Policy Challenges in Global Emerging Markets. NOVA Publishers, Hauppauge NY, 2016].
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Bridging the gap between risk and uncertainty in insurance
This contribution evokes Orio Giarini’s courage to think ‘outside the box’. It proposes a practical way to bridge the gap between risk (where probabilities of occurrence are fully known) and uncertainty (where these probabilities are unknown). However, in the context of insurance, neither extreme applies: the risk type of a newly enrolled customer is not fully known, loss distributions (especially their tails) are difficult to estimate with sufficient precision, the diversification properties of a block of policies acquired from another company can be assessed only to an approximation, and rates of return on investment depend on decisions of central banks that cannot be predicted too well. This contribution revolves around the launch of an innovative insurance product, where the company has a notion of whether a favourable market reception is more likely than an unfavourable one, of the chance of obtaining approval from the regulatory authority and the risk of a competitor launching a similar innovation. Linear partial information theory is proposed and applied as a particular practical way to systematically exploit the imprecise information that may exist for all of these aspects. The decision-making criterion is maxEmin, an intuitive modification of the maximin rule known from games against nature.
Journal Article
The ‘Red Herring’ Hypothesis: Some Theory and New Evidence
The ‘red herring’ hypothesis (RHH) claims that apart from income and medical technology, proximity to death rather than age constitutes the main determinant of healthcare expenditure (HCE). This paper seeks to underpin the RHH with some theory to derive new predictions also for a rationed setting, and to test them against published empirical evidence. One set comprising ten predictions uses women’s longer life expectancy as an indicator of the difference in time to death in their favor. Out of 28 testing opportunities drawn from the published evidence, in the case of no rationing seven out of eleven result in full and two in partial confirmation; in the case of rationing, twelve out of 17 result in full and one in partial confirmation. The other set, containing 35 testing opportunities, concerns the age profile of HCE. In the case of no rationing, seven out of twelve result in full and four in partial confirmation; in the case of rationing, eleven out of 23 in full and nine in partial confirmation. There are but ten contradictions in total. Overall, the new tests of the RHH can be said to receive a good deal of empirical support, both from countries and settings with and without rationing.
Journal Article
Two-sided intergenerational moral hazard, long-term care insurance, and nursing home use
Two-sided intergenerational moral hazard occurs (i) if the parent's decision to purchase long-term care (LTC) coverage undermines the child's incentive to exert effort because the insurance protects the bequest from the cost of nursing home care, and (ii) when the parent purchases less LTC coverage, relying on child's effort to keep him out of the nursing home. However, a \"net\" moral hazard effect obtains only if the two players' responses to exogenous shocks fail to neutralize each other, entailing a negative relationship between child's effort and parental LTC coverage. We focus on outcomes out of equilibrium, interpreting them as a break in the relationship resulting in no informal care provided and hence high probability nursing home admission. Changes in the parent's initial wealth, LTC subsidy received, and child's expected inheritance are shown to induce \"net\" moral hazard, in contradistinction to changes in child's opportunity cost and share in the bequest.
Journal Article
Expanding insurability through exploiting linear partial information
This contribution aims to expand insurability using partial linear information (LPI) on probabilities of the type,$ {r}_{1}\\ge {r}_{3} $(with$ {r}_{1}+{r}_{2}+{r}_{3}+\\dots {r}_{n} = {1} $ ). LPI theory permits to exploit such weak information for systematic decision-making provided the decision-maker is willing to apply the maxEmin criterion in a game against Nature. The maxEmin rule is a natural generalization of expected profit (probabilities are known) and the maximin rule (probabilities are unknown). LPI theory is used to find out whether a crypto assets portfolio offered to an insurance company is insurable. In an example, an unfavorable future development of losses causes maximum expected loss to exceed the present value of premiums, rendering the portfolio uninsurable according to maxEmin. However, this changes when LPI concerning this development is available, while the integration of uncertain returns from investing the extra premium fails to achieve insurability in this example. Evidently, LPI theory enables insurers to accept risks that otherwise are deemed uninsurable.
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Mental health: A Particular Challenge Confronting Policy Makers and Economists
The first objective of this paper is to expound the particular challenge posed by the occurrence of inconsistency in the expression of preferences by mental health patients to both economists and policy makers. Since this difficulty cannot be resolved, the second aim of the paper is to identify agents who may be counted upon to identify the true patient preferences. A decision rule is developed to help identify these agents who may be family members or judges in court, who have the ability and incentive to make these decisions. No single agent is found to dominate with respect to the five dimensions of preference distinguished, constituting a major challenge to policy makers.
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The Grossman model after 40 years
This editorial presents a critical review of the health model pioneered by Michael Grossman (MGM) in 1972 [8]. It argues that whereas the MGM has great charm for economists, it fails to achieve acceptance by interested laypersons and policy makers. The main reasons for this failure are: (1) the assumption of a long and fixed planning horizon, (2) a fixed ratio between individuals healthcare expenditure and the cost of their own health-enhancing efforts regardless of their state of health, and (3) their presumed ability to restore the state of health deemed optimal at a speed that does not depend on their state of health. An alternative formulation emphasizing the stochastic nature of health production is sketched that conceptually provides solutions to these three problems. In addition, it permits discarding a popular medical argument that seems to undermine the very basis of welfare analysis applied to health by claiming preferences to be unstable: \"As long as you are healthy, you don't give a damn, but as soon as you are sick, you are prepared to sacrifice everything to restore your health.\" The editorial concludes by outlining a research program that may help health economists break away from their MGM fixation.
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