Ex Ante Moral Hazard Pada Sistem Jaminan Kesehatan Nasional (JKN) di Indonesia

AbstrakPenelitian ini memberikan kontribusi berupa studi empiris ex ante moral hazard pada Sistem Jaminan Kesehatan Nasional (JKN) di Indonesia. Kami menemukan bahwa kepemilikan Program JKN memiliki hubungan negatif dengan aktivitas fisik dan hubungan positif dengan pengeluran rokok individu. Selanjutnya dengan menghitung efek marginal kami mendapatkan bahwa Program JKN mengurangi probabilitas individu untuk melakukan aktivitas fisik sebesar 2.7% dan mengurangi intensitas melakukan aktivitas fisik. Program JKN juga ditemukan berhubungan positif pengeluaran rokok individu bagi perokok. Hasil analisis menyatakan bahwa ada indikasi terjadinya ex ante moral hazard pada Program JKN karena terdapat hubungan yang positif antara kepemilikan JKN dan probabilitas individu melakukan perilaku kesehatan berisiko seperti aktivitas fisik dan perilaku merokok.Abstract This paper contributes to the empirical evidence of ex ante moral hazard on the National Health Insurance System (NHIS) in Indonesia. We find that JKN participation has a negative relationship with physical activity and positive relationship with smoking spending. Furthermore, by calculating marginal effect we obtained that JKN participation reduce the probability of physical activity by 2.7% and also reduce the intensity of individual physical activity. For the smoker, JKN Participation is expected increase in their spending for smoking. The result indicates that there is an evidence of ex ante moral hazard since there is a positive relationship between JKN participation and risky health behaviors such as physical activity and smoking behavior.

Ex-ante moral hazard: empirical evidence for private health insurance in Brazil

This paper explores the existence of ex-ante moral hazard in private health insurance in Brazil. Before the advent of illness, insured individuals have no incentives to seek preventive care if it is not previously contractible. The data set comprises longitudinal administrative records of health care utilization from a Brazilian employer-sponsored health insurance plan. The empirical strategy is based on an exogenous and anticipated shock in health insurance coverage not associated with health conditions. The results show an increase of up to 17% on medical visits and 22% on diagnostic tests due to the loss of health insurance. Medical visits start to increase five months before the individual leaves the health insurance pool, reaching its peak at two months prior to exit. For diagnostic tests, the increase was observed only in the last two months before the loss of health insurance coverage.

How Individual Characters Affect the Ex ante Moral Hazard of Basic Medical Insurance: Evidence from China

How individual characters affect the ex ante moral hazard of basic medical insurance still remain academically debatable. This paper based on divergent individual characters of insurers to analyze the roles of basic health insurance on the ex ante moral hazard. It found health level, marital status, income level and age are the key individual factors affecting ex ante moral hazard of basic health insurance. But the roles of rural-urban difference and gender are not obvious. It gives supplementary explanations to the medical service expenditure, waste of medical resources and other issues, and also put forward the corresponding policy recommendations.

Contractual Efficiency of PPP Infrastructure Projects: An Incomplete Contract Model

This study analyses the contractual efficiency of public-private partnership (PPP) infrastructure projects, with a focus on two financial aspects: the nonrecourse principal and incompleteness of debt contracts. The nonrecourse principal releases the sponsoring companies from the debt contract when the special purpose vehicle (SPV) established by the sponsoring companies falls into default. Consequently, all obligations under the debt contract are limited to the liability of the SPV following its default. Because the debt contract is incomplete, a renegotiation of an additional loan between the bank and the SPV might occur to enable project continuation or liquidation, which in turn influences the SPV’s ex ante strategies (moral hazard). Considering these two financial features of PPP infrastructure projects, this study develops an incomplete contract model to investigate how the renegotiation triggers ex ante moral hazard and ex post inefficient liquidation. We derive equilibrium strategies under service fees endogenously determined via bidding and examine the effect of equilibrium strategies on contractual efficiency. Finally, we propose an optimal combination of a performance guarantee, the government’s termination right, and a service fee to improve the contractual efficiency of PPP infrastructure projects.