預防性醫療是否可納入健康保險承保範圍？-道德風險模型應用

Could Preventive Care be Included in Health Insurance Coverage?–An Application of Moral Hazard Model

張雅涵(Ya-Han Chang)

指導教授 ： 孫鈺峯

嶺東科技大學/財經學院/財務金融研究所/碩士(2014年)

https://doi.org/10.6823/LTU.2014.00045

摘要

本研究探討預防性醫療納入承保範圍時，存在道德風險的情況下是否會降低保險成本。本研究仿照洪乙禎 (2007) 建立一個兩期保險模型，並假設第一期的預防性醫療有可能降低第二期疾病發生的機率和發病的損失幅度，我們發現第二期的保險成本會降低，是因為預防性醫療會降低發病的損失幅度，而第一期的成本會增加，原因是預防性醫療是消費者的選擇行為，而不是一個隨機事件，消費者可能因為預防性醫療的使用變便宜了而增加使用量。但預防性醫療可降低發病的機率和降低生病發生損失的幅度效果勝於道德風險發生時的損失，所以將預防性醫療納入保險的承保範圍可以改善健康保險市場效率。

關鍵字

道德風險 ； 資訊不對稱 ； 自負額 ； 預防性醫療

並列摘要

This paper explores the possibility of reducing health insurance costs under moral hazard when preventive treatment covered by insurance. We construct a two-period model of insurance based Hong (2007) and we assume that treatment in the first period may affect the probability and severity of being sick in the second period. Insurance coverage and treatment care level in the first period will be affected by their influence on second-period outcomes. We found that the cost of health insurance in the second period is reduced because preventive care to reduce the probability and the severity of illness. In the first period, the cost of health insurance is increased because preventive care can lead to moral hazard, since such preventive care is considered the consumer’s choice, not a random event. If preventive treatment covered by insurance generating function that reduced the probability and the severity of illness is greater than the loss of moral hazard effect, the insurance may improve the efficiency when preventive treatment covered by insurance.

並列關鍵字

moral hazard ； asymmetric information ； deductibles ； preventive care

參考文獻

王寸久(2010)，「醫療保險市場－道德風險下管理型醫療費用控制之研究」，亞

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經濟論文，35(2)，211–254。

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