Theory of health insurance

J Health Adm Educ. 1998 Winter;16(1):41-66.

Abstract

The conventional explanation for purchasing insurance is to transfer risk. Psychologists, however, have shown that this explanation does not match actual behavior. They find that people generally prefer the risk of no loss at all to the certainty of a smaller actuarially equivalent loss, a situation exactly opposite to the one represented by the purchase of insurance. Nevertheless, people do purchase insurance, so there must be an explanation other than risk transfer for purchasing it. Of the explanations so far advanced, however, none have yet developed a wide acceptance. Regardless of risk issues, people will be more likely to purchase insurance when the premium is low compared to the value of the coverage to the consumer. Moral hazard raises the premium, as does adverse selection. The presence of either makes the purchase of insurance less likely. With health insurance, the tax subsidy can reduce the effective premium to less than the actuarially fair cost of insurance. This would increase the likelihood that health insurance is purchased. Finally, because of the value we place on our health, we desire access to a full range of health care. Health insurance is often the only affordable way of gaining access to this care, given the high costs of many of these procedures.

MeSH terms

  • Actuarial Analysis
  • Attitude to Health
  • Choice Behavior
  • Consumer Behavior / economics*
  • Consumer Behavior / statistics & numerical data
  • Fees and Charges
  • Health Services Needs and Demand
  • Health Services Research
  • Humans
  • Insurance, Health / economics*
  • Models, Econometric*
  • Risk*
  • Tax Exemption
  • United States