RESUMO
For decades, the Chilean health system has included a requirement for dependent workers to spend a certain percentage of their wages on health insurance. Since 1981, workers have been able to choose between public insurance and several private insurance providers. The reforms introduced more choice, moving away from reliance on an exclusive public provider. By 1999, about half of the country's active dependent workers had opted out of the public and into the private insurance system. The development of the private insurance system has been accompanied by controversy, however, regarding possible inequities in the utilization of medical services, the degree of risk segmentation, inefficiencies in the system's operation, and other factors. This paper discusses the issues of risk segmentation and equity. It starts by reviewing the system's design on a theoretical level, then deriving hypothesis and finally providing empirical evidence regarding these hypothesis. Particular attention is given to the issues of how individuals choose between the public and private system (to determine the reasons behind risk segmentation) and the differences in utilization among the various income groups (to clarify the issue of possible inequities).
Assuntos
Comportamento do Consumidor/economia , Planos de Assistência de Saúde para Empregados/economia , Reforma dos Serviços de Saúde/economia , Seleção Tendenciosa de Seguro , Programas Nacionais de Saúde/economia , Análise Atuarial , Chile , Financiamento Pessoal/estatística & dados numéricos , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Fundos de Seguro/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Privatização/economia , Setor Público/economia , Medição de Risco , Justiça Social , Fatores SocioeconômicosRESUMO
We study the existence of self-selection and moral hazard in the Chilean health insurance industry. Dependent workers must purchase health insurance either from one public or several private insurance providers. For them, we analyze the relationship between health care services utilization and the choice of either private or public insurance. In the case of independent workers, where there is no mandate, we analyze the relationship between utilization and the decision to voluntarily purchase health insurance. The results show self-selection against insurance companies for independent workers, and against public insurance for dependent workers. Moral hazard is negligible in the case of hospitalization, but for medical visits, it is quantitatively important.