مخاطرات اخلاقی

Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.

Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.

5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.

The abuse in the health service provision is a high risk for  health care managers  in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

The purpose of this study was to investigate the existence of two phenomena of adverse selection and moral hazards in the Iranian supplementary health insurance market.

First, a demand model for the use of complementary health care services was defined under the least assumptions about how the insurance companies repay the policy, the distribution of the hidden health status of hospital clients and also the type of their supplementary insurance despite the two phenomena of unfavorable choise and moral hazards. The main model was estimated from GMM method and the existence of these two phenomena was tested using non-parametric statistical methods. The data used in this study were collected through a questionnaire and randomly from clients of 11 hospitals in the two groups of supplementary and uninsured treatment in Tehran.

The results showed that risk aversion for the consumption of health services is more than the consumption of composite goods and this amount is more for the insured than the uninsured, which indicates the low health status of the insured compared to other people. The Kolmogorov-Smirnov test also confirmed the different health distributions of the two groups. In addition, according to the results, there are small moral hazards in the insurance market. Moral hazards are lower for people with higher incomes, and the more insurance is demanded from people with higher incomes, the lower the moral hazards will be, and the lower the health of a person, the greater the moral hazards.

The results confirm the existence of adverse selection and moral hazards in complementary health insurance in Iran.

Health is recognized as one of the prerequisites for social welfare systems. Insurance coverage changes the behavior of the consumer (patient) and the provider (doctor) of the medical services, which is considered a moral hazard. This study was conducted with the aim of addressing the concept of moral hazard and its types and consequences in health insurance marketing.

This is a review article that its related articles have been selected from published literature in national and international databases. The database of English texts includes Pubmed, Science direct, Scopus and the Google Scholar search engine and Persian texts including Magiran, Sid, Irandoc, Iranmedex and Medlib. Articles were searched between the years of 2009 and 2018. Finally, among the articles founded, 52 related articles were selected, which studied moral hazard in health insurance system.

Moral hazards are caused by the change in service providers and consumer behavior as a result of being insured due to the presence of a third-party payer. The third-party is another agent or company, such as insurance, which covers the cost of patients and therefore the consumer and service provider are not motivated to reduce received services. In moral hazard, people with higher insurance coverage, make less efforts to prevent (ex-ante moral hazard), and with the onset of illness, they use more and better health care services (Ex-post moral hazard). The moral hazard of the consumer is the most significant form of moral hazard.

Moral hazards have negative consequences, such as reducing the welfare and increasing costs in the health system. It is essential to investigate and recognize the effects of moral hazard and its control in order to prevent undesirable outcomes and misallocation of resources. To control consumer moral hazard, one can use franchise, especially for highly elastic services.

Unethical behavior in the health sector entitledas widespread moral hazardandhave high share in the health system’s growing costs in the world. Presentstudy aimed to analyze the moral hazards of distribution medicines in pharmacies and the financial burden on insurance organizations.

Present cross sectionalstudywith reviewing the prescriptions provided to the two maingovernmental and private pharmaciesand usingindividual's disease information, moral hazards categorized in three separate branches. First category was the irrational prescribing the medication, second, the rate of drugs that are exposed to expire period and third category was tear off a leaf from the insurance booklets and writing some formal medications. Then with analyze the data, assessing the financial burden of moral hazards on medical insurance organizationswasconducted.

Irrational prescriptions had the mostprevalencebetween the observed moral hazardsandwere more frequented in public pharmacy. Irrational prescriptions cost was significantly higher in general physicians prescriptions than specialists. Also cost of moral hazards in public pharmacy was significantly higher than private one. The additional financial burden on insurance organizations was estimated 120 million Rialsin a month. Ethical Considerations: Gathered data was usedwith considering confidentiality and informed consent was taken from participants.

Financial burden assessment of moral hazards addition to confirming the importance of ethics in health systems and among health service providers in medicine section, represent the probability of control a large part of the health care system costs by promoting ethics.