Health care reform, adverse selection and health insurance choice

This paper builds and estimates a dynamic choice model to examine the impact on health insurance selection of Chile's GES health care reform. This program provides guarantees in coverage and benefits to several health conditions in the context of a market where public and private health insurers coexist. Structural differences in premiums, benefits and out-of-pocket medical costs across systems may have caused adverse selection problems. Restrictions on pre-existing conditions in the private system mean that insurance selection could be a dynamic process in which current choices can affect future health insurance selection. In fact, estimation results suggest there is willingness to pay to have access to private insurance to those affected by pre-existing conditions. The GES reform may have also altered health insurance choices, as it seems to have significantly reduced out-of-pocket medical costs to people affected by the covered illnesses. Simulations show an increase in participation in the public system of about 3.8 percentage points due to the reform, which is stronger for younger, healthier and more educated individuals. Therefore, the reform may have eased adverse selection problems in Chile's health care system by drawing low-risk individuals towards the public system. (C) 2019 Elsevier B.V. All rights reserved.