This article analyses the agency relationship between the State (the social insurer) and the insured in the context of a public health insurance system designed to optimise social expenditure on reimbursement while making the insured more responsible. This public health insurance system had the following characteristics: growth of the co-payment as a function of the cost of care and the smoothed income of policyholders; growth of the deductible as a function of the smoothed income of policyholders; independence of the co-payment and deductible from income categories; exclusion of low-income policyholders from access to certain types of care. We have developed a moral hazard model with policyholder homogeneity, which has enabled us to identify the components of their optimal financial participation. The properties of these financial participation components highlight the characteristics of the public health insurance system, including the potential to exclude low-income policyholders from access to certain types of care. The assumption that agents are homogeneous has been identified as the source of this potential for exclusion.
References
[1]
Rothschild, M. and Stiglitz, J. (1976) Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information. TheQuarterlyJournalofEconomics, 90, 629-649. https://doi.org/10.2307/1885326
[2]
Stiglitz, J.E. (1977) Monopoly, Non-Linear Pricing and Imperfect Information: The Insurance Market. TheReviewofEconomicStudies, 44, 407-430. https://doi.org/10.2307/2296899
[3]
Laffont, J. (1987) Le risque moral dans la relation de mandat. Revueéconomique, 38, 5-23. https://doi.org/10.2307/3501509
[4]
Newhouse, J., et al. (1993) Free for all? Lesson from the Health Insurance Experiment. Harvard University Press.
[5]
Caussat, L. and Glaude, M. (1993) Dépenses médicales et couverture sociale. Economieetstatistique, 265, 31-43. https://doi.org/10.3406/estat.1993.5755
[6]
Genier, P. (1998) Assurance et recours aux soins. Une analyse microéconométrique à partir de l’enquête Santé 1991-1992 de l’Insee. Revueéconomique, 49, 809-819. https://doi.org/10.2307/3502811
[7]
Henriet, D. and Rochet, J. (1998) Les justifications de l’intervention publique dans les systèmes de santé. Économiepublique/Publiceconomics, 02|1998/2. https://doi.org/10.4000/economiepublique.1862
[8]
de Lagasnerie, G. (2009) Justice sociale et efficacité: Pour une nouvelle régulation de la demande de soins. Regardscroiséssurl’économie, 5, 112-119. https://doi.org/10.3917/rce.005.0112
[9]
Geoffard, P. and de Lagasnerie, G. (2012) Réformer le système de remboursement pour les soins de ville, une analyse par microsimulation. Economie et statistique, 455, 89-113. https://doi.org/10.3406/estat.2012.10019
[10]
Caussat, L., Le Minez, S. and Raynaud, D. (2005) L’assurance-maladie contribue-t-elle à redistribuer les revenus? Dossiers Solidarité et santé, 1, 7-41.
[11]
Raynaud, D. (2005) Les déterminants individuels des dépenses de santé: L’influence de la catégorie sociale et de l’assurance maladie complémentaire. DREES, Études et résultats.
[12]
Ross, S. (1973) The Economic Theory of Agency: The Principal’s Problem. American Economic Review, 63, 134-139.
[13]
Holmstrom, B. (1979) Moral Hazard and Observability. TheBellJournalofEconomics, 10, 74-91. https://doi.org/10.2307/3003320
[14]
Shavell, S. (1979) Risk Sharing and Incentives in the Principal and Agent Relationship. TheBellJournalofEconomics, 10, 55-73. https://doi.org/10.2307/3003319
[15]
Mirrlees, J. (1979) The Implications of Moral Hazard for Optimal Insurance, Seminar Given at the Conference in Honor of Karl Borch. Mimeo.
[16]
Aron-Dine, A., Einav, L., Finkelstein, A. and Cullen, M. (2015) Moral Hazard in Health Insurance: Do Dynamic Incentives Matter? ReviewofEconomicsandStatistics, 97, 725-741. https://doi.org/10.1162/rest_a_00518
