Economic Welfare Effect of Providing Guaranteed Renewable Insurance in the Health Insurance Market of Iran

Authors

1 Department of Health Economics, Faculty of Management and Economics, Tarbiat Modares University, Tehran, Iran

2 Department of Economic Development and Planning, Faculty of Management and Economics, Tarbiat Modares University, Tehran, Iran

3 Department of Agricultural Economics, Economic Research Institute, Tarbiat Modares University, Tehran, Iran

Abstract

Reclassification risk is a downside for the insurance applicants in the face of a sharp increase in premiums due to the deterioration of individual health conditions. Guaranteed renewable (GR) health insurance directly protects the applicants against the mentioned risk. The reason for this support is the existence of a prepayment in the first insurance premium. Instead, the premiums in the next years are independent of the applicant’s future health. The current study aimed at evaluating the effect of providing this new insurance policy in the health insurance market of Iran on economic welfare of health insurance applicants. This evaluation was conducted in the form of two hypotheses, including "provision of GR insurance along with other insurance" and “the replacement of all insurance with GR insurance”. The economic welfare at micro-level is measured by changes in household consumption. In an econometric model, the policy effect was evaluated through propensity score matching. In general, the provision of GR insurance in the health insurance market of Iran increased the welfare of insurance applicants. However, the welfare benefits are greater in the second hypothesis. If the integration plan for insurance funds be implemented, GR insurance can be a good alternative to all insurance funds due to the elimination of reclassification risk and the increase of the welfare of health insurance applicants.

Keywords


Abdus, S. (2010). A Game Theoretical Interpretation of Guaranteed Renewability in Health Insurance. Risk Management and Insurance Review, 13(2), 195-206.
Caliendo, M., & Kopeinig, S. (2008). Some Practical Guidance for the Implementation of Propensity Score Matching. Journal of Economic Surveys, 22(1), 31-72.
Cochrane, J. (1995). Time-Consistent Health Insurance. Journal of Political Economy, 103(3), 445–473.
Feldman, R., & Schultz, J. (2004). Consumer Demand for Guaranteed Renewability in Health Insurance. Journal of Consumer Policy, 27(1), 75-97.
Finkelstein, A., Garry, K. M., & Sufi, A. (2005). Dynamic Inefficiencies in Insurance Markets: Evidence from Long-term Care Insurance. American Economic Review, 95(2), 224–228.
Fleitas, S., Gowrisankaran, G., & Sasso, A. L. (2019). Reclassification Risk in the Small Group Health Insurance Market. New York: National Bureau of Economic Research.
Haddad, G. K. (2015). Econometrics of Micro-Data and Policy Evaluation. Tehran: Ney (in Persian).
Handel, B. R., Hendel, I., & Whinston, M. D. (2017). The Welfare Effects of Long-term Health Insurance Contracts. New York: National Bureau of Economic Research.
---------- (2015). Equilibria in Health Exchanges: Adverse Selection versus Reclassification Risk. Econometrica, 83(4), 1261-1313.
Hendel, I. (2017). Dynamic Selection and Reclassification Risk: Theory and Empirics. Cambridge: Cambridge University Press.
Hendel, I., & Lizzeri, A. (2003). The Role of Commitment in Dynamic Contracts: Evidence from Life Insurance. The Quarterly Journal of Economics, 118(1), 299–327.
Herring, B., & Pauly, M. V. (2006). Incentive-Compatible Guaranteed Renewable Health Insurance Premiums. Journal of Health Economics, 25(3), 395-417.
Hosoe, N., Gasawa, K., & Hashimoto, H. (2010). Textbook of Computable General Equilibrium Modeling: Programming and Simulations. New York: Springer.
Iran Health Insurance Organization. (2019). Iranian insurance coverage. Retrieved from https://ihio.gov.ir/
Iranian Ministry of Health and Medical Education. (2014). Collection Guidelines for Health System Reform Plan. Retrieved from http://treatment.sbmu.ac.ir/uploads/HSE_Chapter_930207_1400.pdf
Iranian Social Security Organization. (2014). The Social Security Laws and Regulations. Retrieved from http://www.tamin.ir/file/file/115398
Islamic Consultative Assembly of Iran. (1994). General Health Insurance Law. Retrieved from http://rc.majlis.ir/fa/law/show/92470
Kermani, M. S., & Ghaderi, H. (2004). Demand for Medical Care in Urban Areas of Iran: An Empirical Investigation. Iranian Economic Review, 9(11), 123-140.
Khandker, S., Koolwal, G., & Samad, H. (2009). Handbook on Impact Evaluation: Quantitative Methods and Practices. Washington: The World Bank.
Letafat, M., Beyranvand, T., Aryankhesal, A., Behzadifar, M., & Behzadifar, M. (2018). Universal Health Coverage in Iran. Iranian Journal of Public Health, 47(7), 1061-1062.
Maher, A., Bahadori, M., & Ravangard, R. (2017). The Integration of Health Insurance Funds as a Reform Approach in Iran. Shiraz E-Medical Journal, 18(2), 22-24.
Pashchenko, S., & Porapakkarm, P. (2015). Welfare Costs of Reclassification Risk in the Health Insurance Market. Journal of Macroeconomics, 45, 21-44.
Pauly, M. V., Menzel, K., Kunreuther, H., & Hirth, R. A. (2011). Guaranteed Renewability Uniquely Prevents Adverse Selection in Individual Health Insurance. Journal of Risk and Uncertainty, 43(2), 127-139.
Pauly, M., Kunreuther, H., & Hirth, R. (1995). Guaranteed Renewability in Insurance. Insurance: Mathematics and Economics, 17(1), 64-65.
Pauly, M., Nickel, A., & Kunreuther, H. (1998). Guaranteed Renewability with Group Insurance. Insurance: Mathematics and Economics, 23(3), 305-306.
Pindyck, R., & Rubinfeld, D. (2015). Microeconomics (8nd). New Jersey: Pearson Education Limited.
Plan and Budget Organization of Iran. (2017). The Sixth Five-year Development Plan. Retrieved from https://www.mporg.ir/FileSystem/View/File.aspx?FileId=f4afa150-ee8b-4237-b169-f16f8b2c532b
---------- (2010). The Fifth Five-year Development Plan. Retrieved from http://rc.majlis.ir/fa/law/show/790196
Ranabhat, C. L., Atkinson, J., Park, M. B., Kim, C. B., & Jakovljevic, M. (2018). The Influence of Universal Health Coverage on Life Expectancy at Birth and Healthy Life Expectancy: A Multi-Country Cross-Sectional Study. Frontiers in Pharmacology, Retrieved from https://www.frontiersin.org/articles/10.3389/fphar.2018.00960/full
Rees, R., & Wambach, A. (2008). The Microeconomics of Insurance. Boston: Foundations and Trends.
Sepehrdoust, H. (2009). Health Care Analysis and Regional Disparities in Different Provinces of Iran. Iranian Economic Review, 14(24), 113-134.
Sirag, A., Nor, N. M., Abdullah, R., & Mustapha, N. (2017). Health Financing: Does Governance Quality Matter? Iranian Economic Review, 21(3), 693-723.
Statistical Center of Iran. (2013-2016). Household Income and Expenditure Survey. Retrieved from https://www.amar.org.ir
Stuart, E. A., Huskamp, H. A., Duckworth, K., Simmons, J., Song, Z., Chernew, M. E., & Barry, C. L. (2014). Using Propensity Scores in Difference-in-Differences Models to Estimate the Effects of a Policy Change. Health Services and Outcomes Research Methodology, 14(4), 166-182.
United Nations. (2019). Sustainable Development Goals. Retrieved from https://www.un.org/sustainabledevelopment/sustainable-development-goals/
Varian, H. R. (1992). Microeconomic Analysis (3nd). New York: W. W. Norton & Company.
World Health Organization. (2019a). Primary Health Care towards Universal Health Coverage. Retrieved from https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_12-en.pdf
---------- (2019b). Universal Health Coverage. Retrieved from https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
Yavari, K., & Mehrnoosh, M. (2006). Determinants of Life Expectancy: A Cross-Country Analysis. Iranian Economic Review, 11(15), 131-142.