Nonparametric Bounds on the Effect of Deductibles in Health Care Insurance on Doctor Visits - Swiss Evidence

We evaluate the effect of the size of deductibles in the basic health insurance in Switzerland on the probability of a doctor visit. We employ nonparametric bounding techniques to minimise statistical assumptions. In order to tighten the bounds we consider two further assumptions: mean independence of an instrument and monotone treatment response. Under these two assumption we are able to bound the causal effect of high deductibles compared to low deductibles below zero. We conclude that the difference in health care utilisation is partly due to a reduction of moral hazard effects.

[1]  P. Chiappori,et al.  Moral Hazard and the Demand for Physician Services: First Lessons from a French Natural Experiment , 1998 .

[2]  D. Rubin,et al.  Constructing a Control Group Using Multivariate Matched Sampling Methods That Incorporate the Propensity Score , 1985 .

[3]  J. Heckman,et al.  Instrumental Variables, Selection Models, and Tight Bounds on the Average Treatment Effect , 2000 .

[4]  Libertad González.  Nonparametric Bounds on the Returns to Language Skills , 2004, SSRN Electronic Journal.

[5]  M. Schellhorn.  The effect of variable health insurance deductibles on the demand for physician visits. , 2001, Health economics.

[6]  E. Vytlacil,et al.  Threshold Crossing Models and Bounds on Treatment Effects: A Nonparametric Analysis , 2005 .

[7]  P. Geoffard,et al.  Separating Selection and Incentive Effects: an Econometric Study of Swiss Health Insurance Claims Data , 2003 .

[8]  A. Chevalier,et al.  Monotonicity and the Roy Model , 2002 .

[9]  Edward Vytlacil,et al.  Treatment Effect Bounds : An Application to Swan-Ganz Catheterization ∗ , 2011 .

[10]  Alberto Abadie.  Semiparametric instrumental variable estimation of treatment response models , 2003 .

[11]  Donna K. Ginther,et al.  Alternative Estimates of the Effect of Schooling on Earnings , 2000, Review of Economics and Statistics.

[12]  C. Manski.  Monotone Treatment Response , 2009, Identification for Prediction and Decision.

[13]  E. Keeler,et al.  Health insurance and the demand for medical care: evidence from a randomized experiment. , 1987, The American economic review.

[14]  C. Manski,et al.  Monotone Instrumental Variables with an Application to the Returns to Schooling , 1998 .

[15]  R. Winkelmann.  Health Care Reform and the Number of Doctor Visits - an Econometric Analysis , 2001, SSRN Electronic Journal.

[16]  Wählbare Selbstbehalte in der Krankenversicherung der Schweiz: Nachfragesteuerung oder Selektion? , 2004 .

[17]  G. Imbens,et al.  Large Sample Properties of Matching Estimators for Average Treatment Effects , 2004 .

[18]  W. Manning,et al.  Moral Hazard and Consumer Incentives in Health Care , 2000 .

[19]  Martin Schellhorn,et al.  The Evolution of Income-Related Inequalities in Health Care Utilization in Switzerland Over Time , 2004, SSRN Electronic Journal.

[20]  D. Rubin,et al.  The central role of the propensity score in observational studies for causal effects , 1983 .

[21]  Charles F. Manski,et al.  The Selection Problem , 1990 .

[22]  C. Manski.  Nonparametric Bounds on Treatment Effects , 1989 .

[23]  John V. Pepper,et al.  The Intergenerational Transmission of Welfare Receipt: A Nonparametric Bounds Analysis , 2000, Review of Economics and Statistics.