Optimal health insurance: the case of observable, severe illness

J Health Econ. 2000 Sep;19(5):585-609. doi: 10.1016/s0167-6296(00)00061-8.

Abstract

We explore optimal cost-sharing provisions for insurance contracts when individuals have observable, severe diseases with a discrete number of medically appropriate treatment options. Variation in preferences for alternative treatments is unobserved by the insurer and non-contractible. Interest in such situations is increasingly common, exemplified by disease carve-out programs and shared decision-making (SDM) tools. We demonstrate that optimal insurance charges a copay to patients choosing the high-cost treatment and provides consumers of the low-cost treatment a cash payment. A simulation of the effect of such a policy, based on prostate cancer, indicates a substantial reduction in moral hazard.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost Sharing*
  • Decision Making
  • Deductibles and Coinsurance / economics
  • Disease Management*
  • Fees and Charges
  • Humans
  • Insurance, Health / economics*
  • Insurance, Health / standards
  • Male
  • Models, Econometric
  • Morals
  • Patient Satisfaction / economics*
  • Prostatic Neoplasms / economics
  • Prostatic Neoplasms / therapy