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Showing 2 results for Moral Hazard

M Soofi, M Bazyar, A Rashidian,
Volume 11, Issue 3 (10-2012)
Abstract

Background: Insurance coverage has a tendency to alter the consumer and provider's behavior. Moral hazard is a serious problem in all risk pooling systems, such as insurance and taxes-based financial systems that cause negative consequences as increased costs in the health system. Therefore we decide, at this review article, to discuss about moral hazard, in different classifications and effects on the insurance marketing and health system.
Materials & Methods: This is a review article. Relevant materials selected from published articles, studies, and sites. The databases of Medline, Web of Science, Science Direct, Google Scholar, and Springer were explored to use the key words of moral hazard and health insurance.
Results: Insurance covered individuals, knowing that their health expenditures will be reimbursed by insurance in the time of illness, and their demand medical services are more than un insurance covered individuals. On the other hand the providers have financial incentive to provide unnecessary and excess medical services. Different types of moral hazard like as ex ante and ex post moral hazard hidden information and hidden action moral hazard provider and consumer moral hazard may arise due to insurance coverage. These lead to negative consequences such as consumption of unnecessary care services, alteration of consumption pattern for inefficient use of resources, welfare loss, and an increase in the health expenditures.
Conclusion: Studying and controlling the effects of moral hazards seems necessary to prevent unwelcome outcomes as well as misallocation of financial resources.


Ebrahim Jaafaripooyan, Batoul Ahmadi, Baheshte Ebrahimi,
Volume 20, Issue 3 (12-2021)
Abstract

 Background and Aim: Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.
Methods: Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.
Results: 5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.
Conclusion: The abuse in the health service provision is a high risk for  health care managers  in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

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