Seleção adversa e risco moral no sistema de saúde brasileiro.

Abstract

The aim of this dissertation is to investigate the existence of adverse selection and moral hazard in the Brazilian health system. Brazilian health system is characterized as a mixed system: the public sector guarantees a full and free access for all individuals, whereas the private insurance is allowed to dispose supplemental health coverage. Nowadays, 25% of the whole population has private insurance. The dataset used is the 1998 PNAD (Pesquisa Nacional por Amostra Domiciliar), a Brazilian household sample survey. In 1998 we had an additional survey about health. This analysis relies on a household heads sample, since they are responsible to the family decision to purchase supplemental plan. The work is separate in two studies. The first study analyze the adverse selection in the process of decision to purchase health insurance, in the second study, we measure the moral hazard in the utilization of healthcare. Two variables of healthcare have been selected: medical visits and the number of inpatient days. These variables represent different types of healthcare and processes of making decisions. In our model of adverse selection, the decision of purchase health insurance is a binary choice. The selection is measure for characteristics unobservables and observables. The empirical implementation is Full Information Maximum Likelihood (FIML). For measure moral hazard, we estimate the over utilization in the private sector using a counter-factual analysis, the model is a negative binomial. The main findings suggest adverse selection for characteristics observables and moral hazard for both types of healthcare: for the visits model, we found that each individual in the private sector uses 32% more services than if they only have access to public services. For inpatient days, we found that each individual in the private sector uses 56% more services than if they only have access to public services.