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首页> 外文期刊>Portuguese Economic Journal >The economics of crowd out under mixed public/private health insurance
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The economics of crowd out under mixed public/private health insurance

机译：混合公共/私人健康保险的挤出经济

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It is well known that public insurance sometimes crowds out private insurance. Yet, the economic theory of crowd out has remained unstudied. Here, I show that crowd out causes two countervailing effects: (a) the intensive margin effect-since high demanders are crowded out, the private market now has a larger proportion of low demanders on the intensive margin (The intensive margin are those who have already bought private insurance), and so will drop quality to lower the price to the low demanders' liking; and (b) the extensive margin effect-before the public insurance expansion, the private sector had lowered quality to make insurance more affordable at the extensive margin (The extensive margin is the next group of people who would buy private insurance if the price decreased), but now that public insurance crowds out the extensive margin, quality can then be raised back up to the high demanders' liking. If the extensive margin effect dominates, then a new phenomenon of push out occurs, in which crowd out causes the private sector to raise quality and to increase the number of uninsured low demanders not eligible for public insurance. If the intensive margin effect dominates, then crowd out will cause the private sector to lower quality, causing the phenomenon of crowd-in, in which the number of uninsured low demanders that take-up private insurance increases. These two countervailing effects have important implications for any government policy that desires to eradicate all uninsurance. First, if push out is dominant, then the private sector will respond to the public insurance by pushing out and leaving some people newly uninsured. If crowd-in is dominant, then all people can be insured and the government can do it at a lower-than-anticipated level of expansion due to the private sector crowding in.
机译：众所周知，公共保险有时会排挤私人保险。然而，挤出理论的经济学理论尚未得到研究。在此，我证明了挤出竞争会产生两个抵消作用：（a）集约化保证金效应-由于高需求者被挤出，私人市场现在在集约化保证金上有较低比例的低需求者（集约化保证金是那些已经购买了私人保险），因此质量下降会降低价格，从而满足低需求者的需求; （b）广泛的边际效应-在公共保险扩张之前，私营部门降低了质量，使保险能够以广泛的边际负担得起（广泛的边际是当价格下降时会购买私人保险的下一组人） ，但是现在公共保险排挤了广大的利润，因此可以将质量提高到高需求者的喜好。如果广泛的边际效应占主导地位，那么就会出现一种新的推出现象，这种现象会导致私有部门提高质量并增加不符合公共保险资格的低保低需求者的数量。如果密集的边际效应占主导，那么挤占将导致私营部门质量下降，从而引起挤入现象，在这种现象中，购买私人保险的未投保的低需求者数量增加。这两个抵消作用对希望消除所有非保险的任何政府政策都具有重要意义。首先，如果推销占主导地位，那么私营部门将通过推销并让一些新的人失去保险来对公共保险做出反应。如果拥挤占主导地位，那么由于私营部门的拥挤，所有人都可以得到保险，政府可以以低于预期的扩张水平来做到这一点。

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