Demand Side Economics of Health Care Provision Under a Single Payer System: The Case of Croatia.

摘要

This dissertation consists of three chapters, connected via same data, examining asymmetric information problems in different cohorts.;In the first chapter, we use a structural approach to separately estimate moral hazard and adverse selection effects in health care utilization using hospital invoices data. Our model explicitly accounts for the heterogeneity in the opportunity cost of time for hospital visits which raises the total cost of hospital visits and dampens the moral hazard effect. A measure of moral hazard is derived as the difference between the observed and the counterfactual health care consumption. In the population of patients with non life-threatening diagnoses, our results indicate statistically significant and economically meaningful moral hazard. We also test for the presence of adverse selection by investigating whether patients with different health status sort themselves into different health insurance plans. Adverse selection is confirmed in the data because patients with estimated worse health tend to buy the insurance coverage and patients with estimated better health choose not to buy the insurance coverage.;The second chapter uses truncated count model and simulated maximum likelihood estimation technique to estimate gender differences in moral hazard in health care insurance. We use the dataset which consists of invoices for all outpatient services from a regional hospital in Croatia. Our theoretical model predicts that higher risk aversion is associated with smaller moral hazard effect. Given empirical evidence which seem to be supportive of the fact that women are more risk-averse then men, we hypothesize that moral hazard effect due to health insurance should be lower in women than in men. However our empirical results show that gender differences in moral hazard due to health insurance are statistically insignificant.;The third chapter uses fuzzy regression discontinuity design to estimate the moral hazard effect in health care consumption in the population of young adults. We use invoices data for outpatient hospital services from a regional hospital in Croatia. The estimation is complicated by the fact that the data set consists only of users of medical services. To address this issue we use a modified version of instrumental variables approach and found an 89% reduction in the number of hospital visits for individuals who lost insurance coverage when crossing the 18th birthday threshold.