健康保险中的分类风险：遗传、预防与保险的交互作用

中文摘要

本文考察遗传风险因素与行为风险因素之间的相互作用如何影响健康保险中风险分类的福利效应。我表明, 在保险定价中使用行为信息可实现帕累托福利改进。它直接减少道德风险, 并通过降低保费间接缓解逆向选择。在某些条件下, 行为分类与禁止遗传分类相结合甚至能够实现功利主义最优。然而, 禁止遗传分类也可能诱发低效率的预防行为, 因为保险人无法针对遗传倾向定制激励。因此, 受监管的私人市场能否实现功利主义最优, 取决于遗传因素如何影响预防的生产率。如果遗传因素与行为因素之间的相互作用导致预防激励错配, 那么纳入行为分类的社会保险能够解决剩余的市场低效并最大化功利主义福利。• 遗传与健康行为之间的相互作用对保险监管具有重要意义。• 基于行为信息的风险分类改善福利。• 禁止使用遗传信息可能诱发低效率的预防行为。• 一个关键标准是遗传倾向如何影响预防的生产率。• 本文同时考察受监管的私人市场与社会保险。

Abstract

This paper examines how interactions between genetic and behavioral risk factors influence the welfare effects of risk classification in health insurance. I show that using behavioral information in insurance pricing Pareto-improves welfare. It directly reduces moral hazard and indirectly mitigates adverse selection by lowering premiums. Under certain conditions, behavioral classification combined with a ban on genetic classification even implements the utilitarian optimum. A ban on genetic classification, however, may also induce inefficient prevention behaviors because insurers cannot tailor incentives to genetic dispositions. As a consequence, the ability of a regulated private market to achieve the utilitarian optimum hinges on how genetic factors influence the productivity of prevention. If interactions between genetic and behavioral factors lead to misaligned prevention incentives, social insurance that incorporates behavioral classification can resolve the remaining market inefficiencies and maximize utilitarian welfare. • Interactions between genetics and health behavior matter for insurance regulation. • Risk classification based on behavioral information improves welfare. • A ban on the use of genetic information may induce inefficient prevention behaviors. • A key criterion is how genetic dispositions affect the productivity of prevention. • The paper considers both a regulated private market and social insurance.