Classification risk in health insurance: The interaction of genetics, prevention, and insurance
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风险分类的福利效应。我证明，在保险定价中使用行为信息能够实现帕累托福利改进：它既直接减少道德风险，又通过降低保费间接缓解逆向选择。在特定条件下，将行为分类与禁止遗传分类相结合甚至可以实现功利主义最优。然而，禁止遗传分类也可能诱发低效率的预防行为，因为保险公司无法根据遗传倾向制定有针对性的激励措施。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位，那么纳入行为分类的社会保险便可消除剩余的市场低效率，并使功利主义福利最大化。
• 遗传因素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能够改善福利。
• 禁止使用遗传信息可能诱发低效率的预防行为。
• 一个关键判据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两种情形。
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.