Reclassification Risk Management in the Health Insurance Market of Iran

Document Type : Original Article

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

Introduction: Reclassification risk in the health insurance market happens when premium
prices are determined based on the health level. It is necessary for insurance applicants to
manage this risk due to uncertainty about the individual’s health status in later periods.
Guaranteed renewable insurance fully covers this risk because the health level is not taken
into account in calculating the premiums. This study is an attempt to calculate the welfare
benefits resulting from the coverage of this risk by providing guaranteed renewable insurance
in this market.
Methods: The economic welfare model in the form of computable general equilibrium has
been used to measure welfare. The model is calibrated by the data of social accounting matrix
and national health accounts in 2011. Social accounting matrix is extracted based on the latest
input-output table for the economy of Iran presented in this yea
Results: The results show that, in general, the more guaranteed renewable insurance expands
in the health insurance market, the greater the welfare effects will be; therefore, the elimination
of basic insurance from this market and provision of the same insurance for all people in the
form of guaranteed renewable insurance (complete elimination of reclassification risk) can
increase economic welfare up to 6%.
Conclusion: Reclassification risk management by providing guaranteed renewable insurance
in the health insurance market of Iran, due to increasing the welfare of the insured, will lead
to the provision of a unit insurance plan and equal access to health services for all.

Keywords


1. Rees R, Wambach A. The Microeconomics of Insurance. Foundations and Trends® in Microeconomics. 2008;4(1–2):1-163. doi: 10.1561/0700000023.
2. Fleitas S, Gowrisankaran G, Sasso AL. Reclassification Risk in the Small Group Health Insurance Market. New York: National Bureau of Economic Research; 2020. doi: 10.3386/w24663.
3. Pashchenko S, Porapakkarm P. Welfare costs of reclassification risk in the health insurance market. Journal of Macroeconomics. 2015;45:21- 44. doi: 10.1016/j.jmacro.2015.04.003.
4. Cuadrado C, Crispi F, Libuy M, Marchildon G, Cid C. National Health Insurance: A conceptual framework from conflicting typologies. Health Policy. 2019;123(7):621-9. doi: 10.1016/j. healthpol.2019.05.013.
5. Cochrane JH. Time-consistent health insurance. Journal of Political Economy. 1995;103(3):445-73. doi: 10.1086/261991.
6. Hendel I, Lizzeri A. The role of commitment in dynamic contracts: Evidence from life insurance. The Quarterly Journal of Economics. 2003;118(1):299-328. doi: 10.3386/w7470.
7. Finkelstein A, McGarry K, Sufi A. Dynamic Inefficiencies in Insurance Markets: Evidence from Long-Term Care Insurance. Am Econ Rev. 2005;95(2):224-28. doi: 10.1257/000282805774669808.
8. Pauly MV, Kunreuther H, Hirth R. Guaranteed renewability in insurance. Insurance: Mathematics and Economics. 1995;17(1):64-5. doi: 10.1016/0167-6687(95)91057-S.
9. Pauly M., Nickel A., Kunreuther H. Guaranteed renewability with group insurance. Insurance: Mathematics and Economics. 1998;23(3):305. doi: 10.1016/S0167-6687(98)90047-6
10. Feldman R, Schultz J. Consumer demand for guaranteed renewability in health insurance. Journal of Consumer Policy. 2004;27(1):75-97. doi: 10.1023/b:copo.0000014050.29925.ba.
11. Herring B, Pauly MV. Incentive-compatible guaranteed renewable health insurance premiums. J Health Econ. 2006;25(3):395-417. doi: 10.1016/j.jhealeco.2005.09.008.
12. Abdus S. A Game‐Theoretical Interpretation of Guaranteed Renewability in Health Insurance. Risk Management and Insurance Review. 2010;13(2):195-206. doi: 10.1111/j.1540- 6296.2010.01182.x.
13. Pauly MV, Menzel K, Kunreuther H, Hirth RA. Guaranteed renewability uniquely prevents adverse selection in individual health insurance. Journal of Risk and Uncertainty. 2011;43(2):127- 39. doi: 10.1007/s11166-011-9124-2.
14. Handel B, Hendel I, Whinston MD. Equilibria in health exchanges: Adverse selection
 ersus reclassification risk. Econometrica. 2015;83(4):1261-313. doi: 10.3982/ECTA12480.
15. Handel BR, Hendel I, Whinston MD. The welfare effects of long-term health insurance contracts. New York: National Bureau of Economic Research, 2017. doi: 10.3386/w23624.
16. Hendel I, editor Dynamic selection and reclassification risk: Theory and empirics. Advances in Economics and Econometrics: Volume 1: Eleventh World Congress; 2017: Cambridge University Press. doi: 10.1017/9781108227162.003.
17. Ghaemi F, Assari Arani A, Sadeghi H, Agheli L. Economic Welfare Effect of Providing Guaranteed Renewable Insurance in the Health Insurance Market of Iran. Iranian Economic Review. 2020.
18. Hofmann A, Eugster P. Guaranteed Renewability in Health Insurance: Taking into Account Changes in Risk Status and the Cost of Dying. Journal of Insurance Regulation. 2020;39(6).
19. Hoy M, Mirza A, Sadanand A. Guaranteed renewable life insurance under demand uncertainty. Journal of Risk and Insurance. 2017. doi: 10.1111/jori.12320.
20. Hobbins AP, Barry L, Kelleher D, Shah K, Devlin N, Ramos Goni JM, et al. Do people with private health insurance attach a higher value to health than those without insurance? Results from an EQ-5D-5 L valuation study in Ireland. Health Policy. 2020;124(6):639-46. doi: 10.1016/j. healthpol.2020.03.005.
21. Nyman JA. The theory of demand for health insurance. California: Stanford University Press; 2003.
22. Hosoe N, Gasawa K, Hashimoto H. Textbook of computable general equilibrium modeling: programming and simulations. New York: Springer; 2010. doi: 10.1057/9780230281653.
23. Statistical Center of Iran. Input output table. 2011.
24. Central Insurance of Iran. Insurance industry statistical yearbook. 2011.
25. Statistical Center of Iran. National health account. 2011.
26. Iranian National Tax Administration. Tax capacities of Iran’s economy. 2016.
27. Statistical Center of Iran. Household income and expenditure survey. 2011.
28. Go DS, Lofgren H, Ramos FM, Robinson S. Estimating parameters and structural change in CGE models using a Bayesian cross-entropy estimation approach. Washington: The World Bank; 2015. doi: 10.1596/1813-9450-7174.
29. Bajzik J, Havranek T, Irsova Z, Schwarz J. The Elasticity of Substitution between Domestic and Foreign Goods: A Quantitative Survey. 2019.
30. Greenaway D, Milner C. Trade and industrial policy in developing countries: A manual of policy analysis. Michigan: University of Michigan Press; 1993. doi: 10.3998/mpub.14118.
31. United Nations. International standard industrial classification of all economic activities. 2008. doi: 10.1787/3089c273-en.