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Ordeals, inequalities, moral hazard and non-monetary incentives in health care

Published online by Cambridge University Press:  28 May 2020

Daniel M. Hausman*
Affiliation:
Department of Philosophy, University of Wisconsin–Madison, 600 N. Park Street, Madison, WI53706, USA

Abstract

This essay begins by summarizing the reasons why unregulated health-care markets are inefficient. The inefficiencies stem from the asymmetries of information among providers, patients and payers, which give rise to moral hazard and adverse selection. Attempts to ameliorate these inefficiencies by means of risk-adjusted insurance and monetary incentives such as co-pays and deductibles lessen the inefficiencies at the cost of increasing inequalities. Another possibility is to rely on non-monetary incentives, including ordeals. While not a magic bullet, these are feasible methods for addressing the inadequacies of market provision of health care, such as moral hazard.

Type
Symposium Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Arrow, K. 1963. Uncertainty and the welfare economics of medical care. American Economic Review 53, 941973.Google Scholar
Brock, D. 2003. Ethical issues in the use of cost-effectiveness analysis for the prioritization of health care resources. In Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis, ed. Tan-Torres Edeger, T., Baltussen, R., Adam, T., Hutubessy, R., Acharya, A., Evans, D.B. and Murray, C.J.L., 289311. Geneva: World Health Organization.Google Scholar
Daniels, N. 1994. Four unsolved rationing problems. Hastings Center Report 24, 2729.10.2307/3562841CrossRefGoogle ScholarPubMed
Eyal, N., Romain, P. and Robertson, C. 2018. Can rationing through inconvenience be ethical? Hastings Center Report 48, 1022.CrossRefGoogle ScholarPubMed
Finkelstein, A., Arrow, K.J., Gruber, J., Newhouse, J.P. and Stiglitz, J.E. 2015. Moral Hazard in Health Insurance. New York, NY: Columbia University Press.Google Scholar
Johnson, R. 2017. Where the senate health care bill fails. New York Times, 26 June. <https://www.nytimes.com/2017/06/26/opinion/senate-health-care-bill.html>..>Google Scholar
Kamm, F. 2002. Health and equity. In Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications, ed. Murray, C.J.L., Salomon, J.A., Mathers, C.D., Lopez, A.D. and World Health Organization, 685706. Geneva: World Health Organization.Google Scholar
Lomasky, L. 1981. Medical progress and national health care. Philosophy & Public Affairs 10, 6588.Google ScholarPubMed
Menzel, P. 2012. Justice and fairness: a critical element in U.S. health system reform. Journal of Law, Medicine, and Ethics 40, 582597.10.1111/j.1748-720X.2012.00691.xCrossRefGoogle ScholarPubMed
Nichols, A. and Zeckhauser, R. 1982. Targeting transfers through restrictions on recipients. American Economic Review Papers and Proceedings 72, 372377.Google Scholar
Prainsack, B. and Buyx, A. 2011. Solidarity: Reflections on an Emerging Concept in Bioethics. Swindon: Nuffield Foundation.Google Scholar
Titmuss, R. 1971. The Gift Relationship: From Human Blood to Social Policy. New York, NY: Random House.Google Scholar
Walzer, M. 1983. Spheres of Justice: A Defense of Pluralism and Equality. New York, NY: Basic Books.Google Scholar