医疗保险HealthInsurance(卫生经济学).ppt

医疗保险 Health Insurance n医疗保险 Health Insurance n提供一种分散由疾病引起的财务风险的方式 Provide a way to diversify financial risks associated with illness n医疗保险的需求理论 The theory of demand for health insurance n个人希望最大化其效用 An individual wishes to maximize his or her utility n如果事件确定，每个人最大化其确定的效用 if there are certain events, individual maximizes his or her certainty utility n如果事件不确定，每个人最大化其期望效用 if there are uncertain events, individual maximizes his or her expected utility 医疗保险 Health Insurance n期望效用 Expected utility n生病的概率生病时的财富所带来的效用健康的概率健 康时的财富所带来的效用 =probability of illness utility of wealth with illness + probability of healthy utility of wealth with healthy n例子，假设 Example, assume n约翰有$20,000 的年收入，年内没有储蓄和贷款 John has $20,000 annual income, no saving and borrowing n健康的概率95% ，医疗支出为0，财富为$20,000 With 95% probability, he will be healthy. When he is healthy, his health care expenditure is 0 and his wealth is $20,000 n生病的概率5% ，医疗支出$10,000 ，财富$10,000 with 5% probability, he will be sick. When he is sick, his health care expenditure is $10,000 and his wealth is reduced to $10,000. 医疗保险 Health Insurance n两种可选的行动方案 Two alternative courses of action n他可以购买保险，承担一个数目不大的保险费 He can purchase insurance and incur a small loss in the form of the insurance premium n他也可以自我保险 He can self-insure n生病概率小，但是一旦生病损失很大 small possibility of a large loss if the illness occurs n不生病的概率大，也没有医疗支出 large possibility that the medical loss will not occur n问题：哪种选择可以使他的效用最大化？ Question: which choice provides him with a higher level of utility 医疗保险 Health Insurance n如果约翰购买医疗保险 If John would buy health insurance n保险费预期医疗保健支出 insurance premium= expected health care expenditure n=95% 0 + 5%10,000 n=500 n他的财富 20,000-500=19500 His wealth =20,000-500=19500 n他的确定效用 His certainty utility= n如果约翰不愿购买医保 If John wouldnt buy health insurance n他的财富将是$20,000 或者$10,000 his wealth could be $20,000 or $10,000 n他的预期效用 his expected utility= 医疗保险 Health Insurance n约翰的偏好财富的效用 Johns preference-utility of wealth n 财富 效用 边际效用 n 10,000 100 n 12,000 130 n 14,000 155 n 16,000 168 n 18,000 176 n 19,500 178 n 20,000 180 医疗保险 Health Insurance n约翰的财富的效用 Johns utility of wealth n如果他购买保险，其确定效用 if he would buy insurance, his certainty utility= nU(财富=19500)=178 n如果他不愿购买保险，其期望效用 if he wouldnt buy insurance,his expected utility= n5% U(w=10,000) + 95% U(w=20,000) n=5% 100 + 95% 180 = 176 n约翰的确定效用大于期望效用 Johns certainty utility is greater than the expected utility n如果购买保险，情况将得到改善 He will be better off if he buys insurance n不确定性导致效用损失 uncertainty leads to a loss of utility 医疗保险 Health Insurance n效用函数对购买保险行为的影响 The role of utility function in the purchase of insurance n线性效用函数，边际效用不变 Utility is linear function of wealth and marginal utility is constant n 财富 效用 边际效用 n 10,000 100 n 12,000 120 n 14,000 140 n 16,000 160 n 18,000 180 n 19,500 195 n 20,000 200 医疗保险 Health Insurance n效用函数 Utility function nU = a Y, Y=财富 nU=0.01Y n利用约翰的例子 use Johns example n他的确定效用= n他的期望效用= n确定效用期望效用 His certainty utility = his expected utility n他是风险中性的 he is risk neutral 医疗保险 Health Insurance W1W2W3 W U U1 U2 U3 W W1W2W3 MU 医疗保险 Health Insurance n效用函数对购买保险行为的影响 The role of utility function in the purchase of insurance n效用函数是财富的增函数，边际效用递增 Utility is increasing function of wealth and marginal utility is increasing n 财富 效用 边际效用 n 10,000 100 n 12,000 130 n 14,000 165 n 16,000 205 n 18,000 250 n 19,500 280 n 20,000 300 医疗保险 Health Insurance n效用函数 Utility function nU = a Yb, Y=财富, b 1 nU=0.01Yb n利用约翰的例子 use Johns example n他的确定效用= n他的期望效用= n确定效用期望效用 His certainty utilityhis expected utility n他将购买保险 he will buy insurance n他是风险规避者 he is risk averse 医疗保险 Health Insurance B A 140 200 20000 10000 19500 W U W MU 199 D 197 C 医疗保险 Health Insurance n纯保险金 Pure premium n预期医疗支出 expected health expenditure n额外费用 Loading cost n执行保险政策时所发生的管理费用和其他 相关费用administrative and other costs associated with underwriting an insurance policy n最高保险费 Maximum premium n当期望效用不大于确定效用时，人们愿意 支付的保险费的最大金额 the maximum amount the person would be willing to pay as long as his expected utility is not greater than his certainty utility 保险怎样影响医疗保健的需求 How Insurance Affects a Demand Curve for Health Care m 15 30 15 0 510 pm 具有50%共付 率保险的需求 没有保险 时的需求 道德风险 Moral Hazard n道德风险 Moral hazard problem n如果有保险，个人倾向于减少对健康的关注individuals would take care of themselves less if they had insurance n由于保险降低了医疗服务的价格，和自己支付所有费用相比， 人们将消费更多的医疗保健 since insurance lowers the price of medical care to individuals, they will consume more health care than if they had to pay the entire price themselves. n道德风险问题 The moral hazard problem n取决于需求的价格弹性 depend on the price elasticity of demand n价格弹性越大，道德风险问题越严重 The more elastic demand, the more the moral hazard problem n价格弹性越小，道德风险问题越轻 the more inelastic demand, the less the moral hazard problem 道德风险 Moral Hazard Demand 0Q1 Pm P1 QQ2 BC Demand 0Q1 Pm P1 Q B 道德风险 Moral Hazard n保险责任范围政策 Insurance coverage policy n对越缺乏弹性的服务，保险责任范围越大 more complete coverage for more inelastic services n对弹性越大的服务，保险责任范围越小 less coverage for more elastic services n利用需求的价格弹性制定保险责任范围政策 是限制道德风险的一种方法 use the price elasticity of demand to set up insurance coverage policy is a way to limit moral hazard problem 道德风险 Moral Hazard n共付保险和起付线 Coinsurance and deductible n限制道德风险的另一种方法 another ways to limit moral hazard problem n降低福利损失 reduce welfare loss n管理保健 HMOs n限制道德风险的一种方法 a way to limit moral hazard problem n医生具有限制患者的医疗保险消费的激励 physicians have incentive to reduce consumers consumption on health care 道德风险 Moral Hazard M P0 P0 0 M0 M1 Pm 100%共付 率的需求 n共付保险产生的福利影响 50%共付率的 需求 B A C 道德风险 Moral Hazard n起付线（扣除保险） deductible n要求被保人在就医时先支付一笔固定的费用，保 险公司支付其余的费用。 n扣除保险有几种方式： n应用于每一医疗服务单位，如阑尾切除术。 n累积性的，如，被保人一年内门诊服务支付费用累积达 到100圆，保险公司就承担100元以外的就诊费用。 道德风险 Moral Hazard Demand 0 M1 M3 Pm P1 MM2 BCD F n起付线产生的福利影响 管理保健 HMOs n管理保健 HMOs n医疗保险的一种组织形式，保险者和医疗服务提供者的功能结合 在一起 a form of health care organization in w