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Adverse selection and risk selection in unregulated health insurance markets: Empirical evidence from South Africa's medical schemes.

机译：不受监管的健康保险市场的逆向选择和风险选择：来自南非医疗计划的经验证据。

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Health insurance arrangements developed in various social settings as a means of pooling health risks and health resources in order to protect members' income against unpredictable health costs but also in order to guarantee their access to health care. Problems of unregulated health insurance markets, like adverse selection and risk selection, are frequently discussed in academic and political circles in the context of either inefficiency or inequity. Though interest in regulation as a health sector reform instrument is growing, empirical studies of unregulated health insurance markets are still rare, particularly, in low and middle-income country settings. This thesis contributes to the body of research and literature that attempts to identify empirical evidence for adverse selection and risk selection. It aims to examine the following research question: Are unregulated health insurance markets characterised by adverse selection and/ or risk selection and do they thereby create inefficiency or inequity. The objective is to demonstrate empirically whether or not these markets experience selection processes. First, this thesis derives a group method for empirical investigations into adverse selection and risk selection from which testable hypotheses can be derived. Second, this method is applied to case study data from a middle-income country. Longitudinal panel data is analysed, describing South Africa's health insurance market of medical schemes in the context of its post-deregulation experience over the four-year period 1995-1998, after premia risk-rating was legalised. The interpretation of the empirical results leads to three main findings. First, intense competition in the contested health insurance market causes favourable risk selection of low risks into and out of medical scheme plans. Second, unfavourable selection by medical scheme plans in the form of dumping high risks can be concluded. Third, there is no evidence for adverse selection and the typical adverse selection cycle cannot be observed. Exploring the policy relevance of the results, it is concluded that the effects of less health insurance regulation, in the context of middle-income country health sector reforms, conflicts with the common health policy objective of equity. More competition and efficiency comes at the price of less equity in health care access for the poor and sick, confirming the known efficiency-equity trade-off.
机译：在各种社会环境中发展了健康保险安排，作为汇集健康风险和健康资源的一种手段，目的是保护会员的收入免受不可预测的医疗费用的影响，同时也为了保证其获得医疗保健的机会。学术界和政治界经常在效率低下或不公平的背景下讨论诸如逆向选择和风险选择之类的不受监管的健康保险市场问题。尽管人们对监管作为一种卫生部门改革工具的兴趣正在增长，但是对不受监管的医疗保险市场的实证研究仍然很少，尤其是在中低收入国家。本论文对试图确定逆向选择和风险选择经验证据的研究和文献做出了贡献。它旨在研究以下研究问题：具有逆向选择和/或风险选择特征的不受监管的健康保险市场是否会造成效率低下或不公平。目的是通过经验证明这些市场是否经历了选择过程。首先，本文提出了一种用于逆向选择和风险选择的实证研究的分组方法，可以从中得出可检验的假设。其次，该方法适用于来自中等收入国家的案例研究数据。分析了纵向面板数据，描述了南非的医疗计划健康保险市场，该背景是根据1995年至1998年四年期的皮下血流风险评估合法化后的南非脱胎后经验。对经验结果的解释导致三个主要发现。首先，在有争议的健康保险市场中激烈的竞争导致低风险进入和退出医疗计划的有利风险选择。其次，可以得出医疗计划计划以高风险抛弃形式的不利选择。第三，没有证据表明可以进行逆向选择，并且不能观察到典型的逆向选择周期。探索结果的政策相关性，得出的结论是，在中等收入国家卫生部门改革的背景下，较少的医疗保险法规的影响与公平的共同卫生政策目标相冲突。竞争和效率的提高是以穷人和病人获得医疗服务的公平性较低为代价的，这证实了已知的效率与公平之间的权衡。

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    Hansl Birgit;

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