Adverse Selection in Low-Income Health Insurance Markets: Evidence from an RCT in Pakistan
American Economic Journal: Applied Economics · 2023 · Torben Fischer、Markus Frölich、Andreas Landmann
中文摘要
我们就首次获得保险保障的低收入群体在住院保险中的逆向选择提供了稳健证据。巴基斯坦的一项大规模随机对照试验使我们能够将逆向选择与道德风险区分开来，估计需求曲线不同位置上的选择如何变化，并检验限制逆向选择的简单措施。结果显示，个人保单中存在大量逆向选择，由此造成福利损失，并带来市场崩溃的风险。将保单在家庭或更高层级进行捆绑，几乎可以消除逆向选择，从而减轻其福利后果，并促进保险供给的可持续性。（JEL D82, G22, I13, I18, O15, O16）
Abstract
We present robust evidence on adverse selection in hospitalization insurance for low-income individuals that received first-time access to insurance. A large randomized control trial from Pakistan allows us to separate adverse selection from moral hazard, estimate how selection changes at different points of the demand curve, and test simple measures to limit adverse selection. The results reveal substantial selection in individual policies, leading to welfare losses and the threat of a market breakdown. Bundling insurance policies at the household level or higher almost eliminates adverse selection, thus mitigating its welfare consequences and facilitating sustainable insurance supply. (JEL D82, G22, I13, I18, O15, O16)