Ex ante and Ex post Moral Hazard in Public HealthInsurance in Thailand
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Abstract
Despite the much-acclaimed success of the Universal Coverage program that ensures virtually everyone in Thailand of gaining access to health insurance, there has recently been a fervent public debate over the possibility that the program may reduce prevention efforts of risky behaviors (ex ante moral hazard) or increase unnecessary healthcare utilization of the beneficiary (ex post moral hazard). This paper is the first empirical study on this issue in Thailand. Individual-level data from the Supplement Household Socioeconomic Survey in 2007 were used to investigate the effect on healthcare utilization of three different public health insurance programs: Universal Coverage (UC), Civil Servant Medical Benefits (CSMB), and Social Security (SS).The contribution of this study is two-fold. From a theoretical perspective, it is a pioneering empirical study that simultaneously estimates the effect of health insurance on both ex ante and ex post moral hazard. From a policy perspective, it provides the first empirical evidence that sheds light on the nature of moral hazard in public health insurance in Thailand. In particular, the estimation results show that the UC program is the only public health insurance program that does not exhibit any type of moral hazard. The recent proposed copayment of beneficiaries under the UC program as a preventive measure of moral hazard is therefore unnecessary and likely comes at a cost of reducing access to health insurance of the poor.
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