moral hazard

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.

Health insurance is one of the most important financial resources for covering the growing costs of health care. Asymmetric information in the insurance market means that the insurer has less information about the health status of the insured person than the insured person him/herself and this leads to waste of treatment resources due to moral hazards. The aim of this study was to determine the effect of moral hazards in the health insurance industry.
This study was a cross-sectional descriptive-analytic research. The study population was all households residing in Iran. For data collection, the questionnaire of urban and rural households Income and Expenditure Survey of Iran Statistics Center was used. For identification and estimation of utility function parameters , the generalized method of moments (GMM) and instrumental variables model were used. GAUSS and E-views software were used for data analysis.
According to the results, there were moral hazards in the basic health insurance organizations (medical service insurance organization and Social Security organization) and the complementary insurance. In addition, during these three years, individuals covered by the medical service insurance, with an average elasticity of -2.78, had the lowest moral hazards and those covered by the complementary insurance, with an average elasticity of -3.86, had the highest moral hazards.
Insurance policy makers should control consumer's moral hazards.

Moral hazard is one of the most important issues in health insurance system. It happens when the insurance’s coverage and its utilization increase. The aim of this study was to assess the moral hazard of dental services in armed force social security insurance before and after soldiery. This was a descriptive-analytical study. One hundred and fifty soldiers from garrisons of Tehran were invited to the study. Data were collected using checklists. The models were estimated using logistic regression. Sixty five (43%) soldiers out of 150 had not used dental services before conscription. They began to use the services after receiving a substantial dental services insurance coverage. The results of this study showed that moral hazard had strong positive relationships with education, income, and ease of getting off from garrisons. The moral hazard had a negative relationship with the insurance coverage before soldiery. More dental services coverage, more demand and utilization of the services. It also increased the costs and quality of the services.

Effect of the deductibles on moral hazard has been approved in commercial insurance. But in medical care organizations that strategies are based on non-profitability conditions and major part of costs are funded through governmental supports, this can be different. In this survey evaluated the effect of the deductibles on moral hazard among insured’s of a Healthcare Organization in Tehran. This cross - sectional study was performed among insured’s of military healthcare organization in Tehran. 554 households have been selected from household budgeting survey data from 2010 that filtered based on membership in the Healthcare Organization. For data analysis Eviews software and Minitab statistical software were used. Results showed that there is a negative relationship between moral hazard and deductibles (with significance level of 85%). Also observed that increasing in income and age lead to increasing in moral hazard (with significance level of 90& 95%) but analysis showed that there was no significant relationship between marital status and moral hazard. When insured’s participate in medical losses in case of involving deductibles, it prevents enhancing using of unnecessary medical services by them.

Moral hazard is referred to behavior change of service-provider (physician) and service-consumer (patient) as the result of insurance. It is a serious concern for health insurance and insurance policies market in the health system reforms. Moral hazard usually leads to such unpleasant consequences as welfare loss، increasing health expenditures، decrease of insurance coverage، unnecessary use of resources، decrease of risk pooling benefits، as well as decrease in allocation and technical efficiency. There fore، in this review article، we want to describe the appropriate policy interventions to prevent moral hazard of consumers and healthcare providers. This is a review article. The related articles were taken from sound sites and reliable published texts. The databases such as Medline،Web of Science، Science Direct، Google Scholar، and Springer were explored based on appropriate key words used in current methods for moral hazard control in supply side and demand side. Demand policies only affect service demand on the part of patient، and do not impede extra service delivering on the part of service provider. So، more effort is needed from supply policies to monitor the use of extra services. In terms of demand aspect، such methods such as franchise، co-payment، waiting list، and encouragement for non-utilization are being used، while in terms of supply aspct، strategies like financial incentive and payment methods (fee-for-service، global payment)، reform of source-providing system structures and behavior interventions (exclusive referring and gate-keeping، use of clinical-guidelines)، and prospective supervision on use rate are being basically employed. Different methods used to control moral hazards may prevent source waste، unnecessary services delivering، and misallocation of resources through preventing low-value consumptions. As a result، efficiency can be promoted and health expenditures can also be controlled.