Abstract
Economic theory must be tested by reality to prove that the goal is achievable and reproducible. However, health care economics do not always theorize based on modern-day medical practice, which results in detachment of some economic recommendations from real-life medicine. The theory of “moral hazard” assumes that patients will utilize more medical services if they transfer the risk of cost to insurances. In this article, we will revisit the understanding of appropriate avoidance of medical services and incorporate no-show rate, avoidance of care, and nonadherence into the concept of health services utilization. The primary goal of this interdisciplinary commentary is to bridge economic theory with clinical practice. It is written from the perspective of a clinical practitioner, who applies realities of everyday medicine to economic reasoning. The author hopes that this abstract will extend the field of vision of health care economics.
Highlights
The concept of “moral hazard” could be used as a justification against welfare or presented as a prediction for rising expenditures with universal coverage
Rational economic behavior and has nothing to do with morality; individuals would use more medical services if the cost is distributed among a large group [1]
“Moral hazard”: appropriate avoidance of care and effect on health The classic RAND Study in the 1980s was designed to answer the question: does cost-sharing lead to less service utilization? The study compared five groups with various cost-sharing plans, from no cost-sharing, to 25%, 50%, and 95% sharing, and the fifth group was provided with a health managed organization plan that had no costsharing but had regulated allowances [4]
Summary
The concept of “moral hazard” could be used as a justification against welfare or presented as a prediction for rising expenditures with universal coverage. The principle is translated into people utilizing more healthcare services if insurance companies take on the burden of the expense, especially by providing full coverage. People would buy insurance not to avoid losses, but to gain wealth and the access to medical care [2,3].
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