Disentangling Moral Hazard and Adverse Selection in Private Health Insurance

J Econom. 2021 May;222(1):141-160. doi: 10.1016/j.jeconom.2020.07.030. Epub 2020 Aug 7.


Moral hazard and adverse selection create inefficiencies in private health insurance markets and understanding the relative importance of each factor is critical for addressing these inefficiencies. We use claims data from a large firm which changed health insurance plan options to isolate moral hazard from plan selection, estimating a discrete choice model to predict household plan preferences and attrition. Variation in plan preferences identifies the differential causal impact of each health insurance plan on the entire distribution of medical expenditures. Our estimates imply that 53% of the additional medical spending observed in the most generous plan in our data relative to the least generous is due to adverse selection. We find that quantifying adverse selection by using prior medical expenditures overstates the true magnitude of selection due to mean reversion. We also statistically reject that individual health care consumption responds solely to the end-of-the-year marginal price.

Keywords: Adverse Selection; Attrition Bias; C21; C23; Health Insurance; I11; I13; Moral Hazard; Nonadditive Selection Model; Price Elasticity; Quantile Treatment Effects.