BELİRLİ ŞARTLARA BAĞLI TIBBİ BAKIM İLE SAĞLIK DURUM ARASINDAKİ AHLAKİ TEHLİKEDEKİ DEĞİŞİM

Öz

Bu makale ahlaki tehlikenin büyüklüğünün bireyin sağlık durumuna ve hekim muayenehane ziyareti ile ilişkili tıbbi durumun türüne göre değişip değişmediğini inceler. Genelleştirilmiş momentler yöntemi özel sağlık sigortasının içselliğini, hekim hizmetlerinin negatif olmadığını ve süreksiz olduğunu irdelemek için uygulanmıştır. Sonuçlar akut duruma bağlı hekim ziyaretleri için sağlıklı ve hasta gruplar arasında ahlaki tehlike etkilerinde kayda değer bir farkı desteklemiyorken ahlaki tehlike etkisinin kronik duruma bağlı hekim ziyaretlerinde sağlıklı olanlar için daha yüksek olduğunu gösterir. Bu sonuçlar hekim bakımının homojen bir mal olmadığını ve talepteki ahlaki tehlikenin nicel karakterizasyonunun muayahane ziyaretlerinin özel durumlara bağlı olmasına ve incelenmekte olan sağlık gurubuna bağlı olduğunu ortaya koymaktadır.  

Anahtar Kelimeler

• ahlaki tehlike. Sağlığa özel harcamanın payı,şarta bağlı muayahane ziyareti,sayma verisi,GMM tahmini

THE VARIATION IN MORAL HAZARD ACROSS CONDITIONSPECIFIC MEDICAL CARE AND HEALTH STATUS

Öz

This paper examines whether the magnitude of moral hazard varies by the health status of the individual and the type of medical condition associated with the physician office visit. Generalized method of moments is implemented to address the endogeneity of private health insurance, and the nonnegativity and the discreteness of physician services use. The results indicate that the moral hazard effect is higher for the healthy for chronic condition related physician visits, while they do not support an appreciable difference in moral hazard effects between the healthy and sickly groups for acute condition related physician visits. These results suggest that physician care is not a homogenous good and the quantitative characterization of moral hazard in its demand depends on the particular condition-specific component of the visit and the health group under consideration.  

Anahtar Kelimeler

• moral hazard,health-specific cost sharing,condition-specific physician visits,count data,GMM estimation

Kaynakça

1. Agency for Health Care Research and Quality (2002). Household Component, Office-Based Medical Provider Visits and Medical Conditions Files of Medical Expenditure Panel Survey (MEPS), Rockville, MD: Agency for Health Care Research and Quality.
2. Arrow, J. K. (1963). Uncertainty and the Welfare Economics of Medical Care. American Economic Review, 53, 941-973.
3. Bhattacharya, J., Goldman D. and Sood, N. (2003). The Link between Public and Private Insurance and HIV-related Mortality. Journal of Health Economics, 22, 1105-1122.
4. Bound, J., Jaeger, D. A. and Baker, R. M. (1995). Problems with Instrumental Variables Estimation when the Correlation between the Instruments and the Endogenous Explanatory Variable is Weak. Journal of the American Statistical Association, 90, 443-450.
5. Buckley, N. J., Denton, F. T., Robb, A. L. and Spencer, B. G. (2004). The Transition from Good to Poor Health: An Econometric Study of the Older Population. Journal of Health Economics, 23, 1013-1034.
6. Chandra, A., Gruber, J. and McKnight, R. (2010). Patient Cost-Sharing, Hospitalization Offsets, and the Design of Optimal Health Insurance for the Elderly. American Economic Review, 100, 193-213.
7. Chernew, M. E., Encinosa, W. E. and Hirth, R. A. (2000). Optimal Health Insurance: The Case of Observable Severe Illness. Journal of Health Economics, 19, 585-609.
8. Chernew, M. E., Rosen, A. and Fendrick, A. M. (2007). Value-Based Insurance Design. Health Affairs, 26, w195-w203.

9. Cutler, D. M. and Zeckhauser, R. J. (2000). The Anatomy of Health Insurance. in: J. A. Culyer and J. P. Newhouse, eds., Handbook of Health Economics, Elseiver, Amsterdam, Chapter 11.
10. Deb, P. and Trivedi, P. K. (2006). Specification and Simulated Likelihood Estimation of a Nonnormal Treatment-outcome Model with Selection: Application to Health Care Utilization. Econometrics Journal, 9, 307-331.
11. Deb, P., Munkin, M. K. and Trivedi, P. K. (2006). Private Insurance, Selection, and Health Care Use: A Bayesian Analysis of a Roy-Type Model. Journal of Business and Economic Statistics, 24, 403-415.
12. Feldman, R. and Dowd, B. (1991). A New Estimate of the Welfare Loss of Excess Health Insurance. American Economic Review, 297-301.
13. Feldstein, M. S. (1973). The Welfare Loss of Excess Health Insurance. Journal of Political Economy, 81, 251-280.
14. Fendrick, A. M. and Chernew, M. E. (2006). Value-Based Insurance Design: A “Clinically Sensitive” Approach to Preserve Quality of Care and Contain Costs. American Journal of Managed Care, 12, 18-20.
15. Finkelstein, A. (2007). The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare. Quarterly Journal of Economics, 122, 1-37.
16. Frank, R. G., Glazer, J. and McGuire, T. G. (2000). Measuring Adverse Selection in Managed Health Care. Journal of Health Economics, 19, 829-854.
17. Freeman, R. B. (1981). The Effect of Unionism on Fringe Benefits. Industrial and Labor Relations Review, 34, 489-509.
18. Goldman, D. and Philipson, T. (2007). Integrated Insurance Design in the Presence of Multiple Medical Technologies. American Economic Review, 97, 427-432.
19. Grabowski, D. C. and Gruber, J. (2007). Moral Hazard in Nursing Home Use. Journal of Health Economics, 26, 560-577.
20. Hahn, B. (1994). Health Care Utilization: The Effect of Extending Insurance to Adults on Medicaid or Uninsured. Medical Care, 32, 227-239.
21. Hamilton, B. H. (2000). Does Entrepreneurship Pay? An Empirical Analysis of the Returns to Self-Employment. Journal of Political Economy, 108, 604-631.
22. Holtz-Eakin, D., Penrod, J. R. and Rosen, H. S. (1996). Health Insurance and the Supply of Entrepreneurs. Journal of Public Economics, 62, 209-235.
23. Hwang, W., Heller, W., Ireys, H. and Anderson, G. (2001). Out-of-Pocket Medical Spending for Care of Chronic Conditions. Health Affairs, 20, 267-278.
24. Johnson, R. W. and Crystal, S. (2000). Uninsured Status and Out-of-Pocket Costs at Midlife. Health Services Research, 35, 911-932.
25. Jones, A. M., Koolman, X. and Van Doorslaer, E. (2004). The Impact of Supplementary Private Health Insurance on the Use of Specialists in European Countries. photocopy.
26. Lohr, K. N., Brook, R. H., Kamberg, C. J., Goldberg, G. A., Leibowitz, A., Keesey, J., Reboussin, D. and Newhouse, J. P. (1986). Use of Medical Care in the Rand Health Insurance Experiment: Diagnosis- and Service-Specific Analyses in a Randomized Controlled Trial. Medical Care, 24, S1-S87.
27. Manning, G. W., Newhouse, J. P., Duan, N., Keeler, E. B. and Leibowitz, A. (1987). Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment. American Economic Review, 77, 251-277.
28. Manning, G. W. and Marquis, M. S. (1996). Health Insurance: The Tradeoff between Risk Pooling and Moral Hazard. Journal of Health Economics, 15, 609-639.
29. Marquis, M. S. and Long, S. H. (1994). The Uninsured Access Gap: Narrowing the Estimates. Inquiry, 31, 405-414.
30. Meer, J., Miller, D. L. and Rosen, H. S. (2003). Exploring the Health-Wealth Nexus. Journal of Health Economics, 22, 713-730.
31. Meer, J. and Rosen, H. S. (2004). Insurance and the Utilization of Medical Services. Social Science and Medicine, 58, 1623-1632.
32. Mullahy, J. (1997). Instrumental Variable Estimation of Count Data Models: Applications to Models of Cigarette Smoking Behavior. Review of Economics and Statistics, 79, 586-593.
33. Nyman, J. A. (1999). The Economics of Moral Hazard Revisited. Journal of Health Economics, 18, 811-824.
34. Nyman, J. A. (2003). The Theory of Demand for Health Insurance. Stanford University Press, Stanford, California.
35. Olson, C. A. (2002). Do Workers Accept Lower Wages in Exchange for Health Benefits. Journal of Labor Economics, 20, S91-S114.
36. Pauly, M. V. (1968). The Economics of Moral Hazard: Comment. American Economic Review, 58, 531-536.
37. Pauly, M. V. (2005). Effects of Insurance Coverage on Use of Care and Health Outcomes for Nonpoor Young Women. American Economic Review, 95, 219-223.
38. Pauly, M. V. and Herring, B. (2007). The Demand for Health Insurance in the Group Setting: Can You Always Get What You Want? Journal of Risk and Insurance, 74, 115-140.
39. Pauly, M. V. and Blavin, F. E. (2008). Moral Hazard in Insurance, Value-Based Cost Sharing and the Benefits of Blissful Ignorance. Journal of Health Economics, 27, 1407-1411.
40. Perry, C. M. and Rosen, H. S. (2001). Insurance and the Utilization of Medical Services among the Self-Employed. NBER Working Paper 8490.
41. Phelps, C. E. (2003). Health Economics, Third Edition, Addison-Wesley.
42. Remler, D. K. and Greene, J. (2009). Cost-Sharing: A Blunt Instrument. Annual Review of Public Health,” 30, 293-311.
43. Spillman, B. C. (1992). The Impact of Being Uninsured on Utilization of Basic Health Care Services. Inquiry, 29, 457-466.
44. Stock, J. H., Wright, J. H. and Yogo, M. (2002). A Survey of Weak Instruments and Weak Identification in Generalized Method of Moments. Journal of Business and Economic Statistics, 20, 518-529.
45. Wedig, G. (1988). Health Status and the Demand for Health: Results on Price Elasticities. Journal of Health Economics, 7, 151-163.
46. Wooldridge, J. M. (2002). Econometric Analysis of Cross Section and Panel Data. The MIT Press, Cambridge, Massachusetts.
47. Vera-Hernandez, A. M. (1999). Duplicate Coverage and Demand for Health Care: The Case of Catalonia. Health Economics, 8, 579-598.
48. ZWEIFEL, P. and W. G. MANNING (2000). Moral Hazard and Consumer Incentives in Health Care. in: J. A. Culyer and J. P. Newhouse, eds., Handbook of Health Economics, Elseiver, Amsterdam, Chapter 8.