Policyholder Homogeneity and Equity in the Regulation of Compulsory Health Insurance in Developing Countries

Abstract

This article analyses the agency relationship between the State (the social insurer) and the insured in the context of a public health insurance system designed to optimise social expenditure on reimbursement while making the insured more responsible. This public health insurance system had the following characteristics: growth of the co-payment as a function of the cost of care and the smoothed income of policyholders; growth of the deductible as a function of the smoothed income of policyholders; independence of the co-payment and deductible from income categories; exclusion of low-income policyholders from access to certain types of care. We have developed a moral hazard model with policyholder homogeneity, which has enabled us to identify the components of their optimal financial participation. The properties of these financial participation components highlight the characteristics of the public health insurance system, including the potential to exclude low-income policyholders from access to certain types of care. The assumption that agents are homogeneous has been identified as the source of this potential for exclusion.