医疗保险会引发事前道德风险吗?理论分析与经验证据

医疗保险在增加医疗服务可及性的同时,也可能导致被保险人降低其在出险前防范疾病风险的投入,从而导致经济学理论中的"事前道德风险"(ex-ante moral hazard)。本文利用2000—2009中国健康与营养调查(CHNS)数据,采用基准模型、工具变量模型和一阶差分模型,首次全面考察了新型农村合作医疗中的事前道德风险问题。结果表明,在控制参保行为的内生性后,新农合的参与显著改变了个体的生活方式,提高了其吸烟、饮酒、久坐、摄入高热量食物等不健康行为的倾向,并引致体重超重概率的增加。在此基础上,我们对新农合及配套制度的改革提供了政策建议。

A Theoretical and Empirical Investigation on the Ex-ante Moral Hazard Induced by the New Rural Cooperative Medical Scheme

Health insurance can improve the accessibility of medical care, but it can also lead to ex-ante moral hazard by reducing the self protection investment of the insured. Based on the 2000-2009 China Health and Nutrition Survey (CHNS) data, we use the baseline regressions, instrumental variables (IV) and first difference (FD) estimations to test the ex-ante moral hazard effect of the New Rural Cooperative Medical Scheme (NRCMS) in China. After controlling the endogeneity of insurance participation, we find that NRCMS participation tends to decrease the health risk prevention among the enrollees by increasing their tendency of smoking, drinking, being sedentary, consuming high calorie food as well as being overweight. Policy proposals on reforming the NRCMS program are given based on the above findings.