A espiral de antisseleção no mercado brasileiro de planos de saúde individuais
DOI:
https://doi.org/10.1590/http://dx.doi.org/10.1590/0101-41615036amjPalavras-chave:
Seleção adversa, Antisseleção, Planos de saúde individuais, Seguro saúdeResumo
A antisseleção de tipos de risco em seguros saúde pode ser um fenômeno perverso e comprometedor do equilíbrio das carteiras. A escalada desse efeito está associada às medidas de garantia de renovação da apólice e estabelecimento de subsídio cruzado entre diferentes tipos. O objetivo é avaliar efeitos da introdução de planos populares no mercado brasileiro de planos de saúde individuais. Os resultados não sugeriram a presença de subsídios intergeracionais. Mas, se forem introduzidos produtos competitivos em preços relativos, o movimento anti-seletivo de segurados é tal que compromete a sustentabilidade financeira das operadoras, evidenciando movimento de espiral com deterioração das carteiras.
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Referências
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Cutler, David, and Richard J. Zeckhauser. 1997. “Adverse Selection in Health Insurance.” Cambridge, MA. https://doi.org/10.3386/w6107.
Frech, H. E., and Michael P. Smith. 2015. “Anatomy of a Slow-Motion Health Insurance Death Spiral.” North American Actuarial Journal 19 (1): 60–72. https://doi.org/10.1080/10920277.2014.982871.
Grossman, Herschel I. 1979. “Adverse Selection, Dissembling, and Competitive Equilibrium.” The Bell Journal of Economics 10 (1): 336. https://doi.org/10.2307/3003335.
Klugman, Stuart A, Harry H Panjer, and Gordon E Willmot. 2012. Loss Models: From Data to Decisions. Edited by Wiley Series in Probability and Statistics. Wiley. 4th ed. New York.
Leida, Hans; Bluhm, William. 2015. Individual Health Insurance. Winsted: ACTEX.
Maia, Ana Carolina; Monica V. Andrade; Flavia L. C. Feres. 2012. “Estudo Longitudinal Do Efeito Da Idade e Tempo Até a Morte Em Gastos Com Saúde.” Rede de Economia Aplicada Working Paper 037. http://reap.org.br/wp-content/uploads/2012/05/037-Estudo-Longitudinal-dos-Efeitos-do-Gasto.pdf.
Neudeck, Werner, and Konrad Podczeck. 1996. “Adverse Selection and Regulation in Health Insurance Markets.” Journal of Health Economics 15 (4): 387–408. https://doi.org/10.1016/S0167-6296(96)00488-2.
Paolucci, Francesco, Andre Den Exter, and Wynand Van De Ven. 2006. “Solidarity in Competitive Health Insurance Markets: Analysing the Relevant EC Legal Framework.” Health Economics, Policy and Law 1 (02): 107. https://doi.org/10.1017/S1744133105000137.
Patient Protection and Affordable Care Act, 42 U.S.C. § 18001. 2010.
Rothschild, Michael, and Joseph Stiglitz. 1976. “Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information.” The Quarterly Journal of Economics 90 (4): 629. https://doi.org/10.2307/1885326.
Rousseeuw, Peter J. 1987. “Silhouettes: A Graphical Aid to the Interpretation and Validation of Cluster Analysis.” Journal of Computational and Applied Mathematics 20 (November): 53–65. https://doi.org/10.1016/0377-0427(87)90125-7.
Ven, W P van de, R. C. van Vliet, F. T. Schut, and E. M. van Barneveld. 2000. “Access to Coverage for High-Risks in a Competitive Individual Health Insurance Market: Via Premium Rate Restrictions or Risk-Adjusted Premium Subsidies?” Journal of Health Economics 19 (3): 311–39. http://www.ncbi.nlm.nih.gov/pubmed/10977194.
van de Ven, Wynand P. M. M., and René C. J. A. van Vliet. 1995. “Consumer Information Surplus and Adverse Selection in Competitive Health Insurance Markets: An Empirical Study.” Journal of Health Economics 14 (2): 149–69. https://doi.org/10.1016/0167-6296(94)00043-4.
Ward, Joe H. 1963. “Hierarchical Grouping to Optimize an Objective Function.” Journal of the American Statistical Association 58 (301): 236–44. https://doi.org/10.1080/01621459.1963.10500845.
Wei, Andrew. 2010. “Modeling Anti-Selective Lapse and Optimal Pricing in Individual and Small Group Health Insurance.” Society of Actuaries’ Publications February: 1–43.
Wilson, Charles. 1977. “A Model of Insurance Markets with Incomplete Information.” Journal of Economic Theory 16 (2): 167–207. https://doi.org/10.1016/0022-0531(77)90004-7.
Anderson, G. F., B. K. Frogner, R. A. Johns, and U. E. Reinhardt. 2006. “Health Care Spending And Use Of Information Technology In OECD Countries.” Health Affairs 25 (3): 819–31. https://doi.org/10.1377/hlthaff.25.3.819.
Belli, Paolo. 2001. How Adverse Selection Affects the Health Insurance Market. Policy Research Working Papers. The World Bank. https://doi.org/10.1596/1813-9450-2574.
Bluhm, William. 1983. Cumulative Anti-Selection Theory. Society of Actuaries 50th Anniversary Monograph.
Bowers, Newton L., Hans U. Gerber, James C. Hickman, Donald A. Jones, and Cecil J. Nesbitt. 1997. Actuarial Mathematics. Edited by David Anderson. 2nd ed. United States of America: The Society of Actuaries.
BRASIL. 2017. Ministério Da Saúde. Agência Nacional de Saúde Suplementar. Caderno de Informação Da Saúde Suplementar: Beneficiários, Operadoras e Planos.
Chernew, Michael E., and Joseph P. Newhouse. 2011. “Health Care Spending Growth.” In Handbook of Health Economics, 1–43. https://doi.org/10.1016/B978-0-444-53592-4.00001-3.
Cutler, David; Zeckhauser, Richard; Altman, Daniel. 1998. “Adverse Selection and Adverse Retention.” American Economic Review 88: 122–26.
Cutler, David M., and Richard J. Zeckhauser. 2000. “Chapter 11 The Anatomy of Health Insurance.” In , 563–643. https://doi.org/10.1016/S1574-0064(00)80170-5.
Cutler, David, and Richard J. Zeckhauser. 1997. “Adverse Selection in Health Insurance.” Cambridge, MA. https://doi.org/10.3386/w6107.
Frech, H. E., and Michael P. Smith. 2015. “Anatomy of a Slow-Motion Health Insurance Death Spiral.” North American Actuarial Journal 19 (1): 60–72. https://doi.org/10.1080/10920277.2014.982871.
Grossman, Herschel I. 1979. “Adverse Selection, Dissembling, and Competitive Equilibrium.” The Bell Journal of Economics 10 (1): 336. https://doi.org/10.2307/3003335.
Klugman, Stuart A, Harry H Panjer, and Gordon E Willmot. 2012. Loss Models: From Data to Decisions. Edited by Wiley Series in Probability and Statistics. Wiley. 4th ed. New York.
Leida, Hans; Bluhm, William. 2015. Individual Health Insurance. Winsted: ACTEX.
Maia, Ana Carolina; Monica V. Andrade; Flavia L. C. Feres. 2012. “Estudo Longitudinal Do Efeito Da Idade e Tempo Até a Morte Em Gastos Com Saúde.” Rede de Economia Aplicada Working Paper 037. http://reap.org.br/wp-content/uploads/2012/05/037-Estudo-Longitudinal-dos-Efeitos-do-Gasto.pdf.
Neudeck, Werner, and Konrad Podczeck. 1996. “Adverse Selection and Regulation in Health Insurance Markets.” Journal of Health Economics 15 (4): 387–408. https://doi.org/10.1016/S0167-6296(96)00488-2.
Paolucci, Francesco, Andre Den Exter, and Wynand Van De Ven. 2006. “Solidarity in Competitive Health Insurance Markets: Analysing the Relevant EC Legal Framework.” Health Economics, Policy and Law 1 (02): 107. https://doi.org/10.1017/S1744133105000137.
Patient Protection and Affordable Care Act, 42 U.S.C. § 18001. 2010.
Rothschild, Michael, and Joseph Stiglitz. 1976. “Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information.” The Quarterly Journal of Economics 90 (4): 629. https://doi.org/10.2307/1885326.
Rousseeuw, Peter J. 1987. “Silhouettes: A Graphical Aid to the Interpretation and Validation of Cluster Analysis.” Journal of Computational and Applied Mathematics 20 (November): 53–65. https://doi.org/10.1016/0377-0427(87)90125-7.
Ven, W P van de, R. C. van Vliet, F. T. Schut, and E. M. van Barneveld. 2000. “Access to Coverage for High-Risks in a Competitive Individual Health Insurance Market: Via Premium Rate Restrictions or Risk-Adjusted Premium Subsidies?” Journal of Health Economics 19 (3): 311–39. http://www.ncbi.nlm.nih.gov/pubmed/10977194.
van de Ven, Wynand P. M. M., and René C. J. A. van Vliet. 1995. “Consumer Information Surplus and Adverse Selection in Competitive Health Insurance Markets: An Empirical Study.” Journal of Health Economics 14 (2): 149–69. https://doi.org/10.1016/0167-6296(94)00043-4.
Ward, Joe H. 1963. “Hierarchical Grouping to Optimize an Objective Function.” Journal of the American Statistical Association 58 (301): 236–44. https://doi.org/10.1080/01621459.1963.10500845.
Wei, Andrew. 2010. “Modeling Anti-Selective Lapse and Optimal Pricing in Individual and Small Group Health Insurance.” Society of Actuaries’ Publications February: 1–43.
Wilson, Charles. 1977. “A Model of Insurance Markets with Incomplete Information.” Journal of Economic Theory 16 (2): 167–207. https://doi.org/10.1016/0022-0531(77)90004-7.
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17-11-2020
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Copyright (c) 2020 Ana Carolina Maia, João Vinícius França Carvalho
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O detentor dos direitos autorais da revista é o Departamento de Economia da Faculdade de Economia, Administração, Contabilidade e Atuária da Universidade de São Paulo.
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Maia, A. C. ., & Carvalho, J. V. F. . (2020). A espiral de antisseleção no mercado brasileiro de planos de saúde individuais. Estudos Econômicos (São Paulo), 50(3), 535-568. https://doi.org/10.1590/http://dx.doi.org/10.1590/0101-41615036amj
