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"Behavioral Hazard in Health Insurance" [pdf], [online appendix] (with K. Baicker and S. Mullainathan),
Quarterly Journal of Economics, accepted
BEHAVIORAL HAZARD IN HEALTH INSURANCE
Katherine Baicker
Harvard University
Sendhil Mullainathan
Harvard University
Joshua Schwartzstein
Dartmouth College
June 11, 2015
Abstract
A fundamental implication of standard moral hazard models is overuse of low-value medical
care because copays are lower than costs. In these models, the demand curve alone can be used
to make welfare statements, a fact relied on by much empirical work. There is ample evidence,
though, that people misuse care for a different reason: mistakes, or “behavioral hazard.” Much
high-value care is underused even when patient costs are low, and some useless care is bought
even when patients face the full cost. In the presence of behavioral hazard, welfare calculations
using only the demand curve can be off by orders of magnitude or even be the wrong sign. We
derive optimal copay formulas that incorporate both moral and behavioral hazard, providing
a theoretical foundation for value-based insurance design and a way to interpret behavioral
“nudges.” Once behavioral hazard is taken into account, health insurance can do more than
just provide financial protection — it can also improve health care efficiency. JEL Codes:
D03, I12, I13, I30, I38