Risco moral no mercado de saúde suplementar: efeito do copagamento na utilização dos serviços de saúde

Abstract

The goal of our study is to investigate the role of copayment as a regulatory mechanism in health services demand. Specifically, we want to understand the effect of copayment on the number and costs related to appointments, emergency appointments, and laboratory and imaging tests. Our dataset was obtained from a health insurance cooperative company (HIC). To evaluate the effects of copayment application in the health care utilization we apply a Propensity Score Matching (PSM) method, using the following estimators: One to one Matching (OM), Nearest Neighbor Matching (NNM), Radius Matching (RM) and Kernel Matching (KM). The results indicate the evidence of moral hazard effects in appointments and emergency appointments demand for those individuals with health insurance without copayment. Similar results are obtained when we consider the costs incurred by the HIC when providing these services. As for laboratory tests, there was no evidence on moral hazard effects. However, when we consider imaging tests, moral hazard effects were evidenced. HIC provision costs of laboratory and imaging tests showed a significant increase for those individuals with health care plan without copayment. Our results indicate that charging a copayment reduces demand and costs of those health care services considered in out study, highlighting the incentives due to the moral hazard existence in the health care insurance market.