Opting Out of Public Insurance: Is It Socially Acceptable?

Carine Franc and Laurence Abadie
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Carine Franc: CREGAS, INSERM U537–80 rue du Général Leclerc, 94275 LE KREMLIN BICETRE Cedex, France, e-mail: franc@kb.inserm.fr
Laurence Abadie: MODEME—IAE, University of Lyon 3-6, Cours Albert Thomas, 69008 Lyon, France, e-mail: abadie@univ-lyon3.fr

The Geneva Risk and Insurance Review, 2004, vol. 29, issue 2, 115-136

Abstract: The privatization of social services is being increasingly discussed. The market of social services is often characterized by market failures, like informational asymmetries, externalities, distributional problems, which all justify public intervention. But the quality of services provided by public authorities or by private insurers in the context of health insurance is different and could be observable. The public reimbursement of health care is often conditional on rules, like the choice of the physician or the hospital, that induce a disutility of using social insurance instead of private insurance. An alternative solution to a complete privatization is to allow some individuals to opt out. We can imagine that the government allows and even in some cases favors part of the population leaving the public health insurance system. We analyze the situations where the opting out is welfare improving. We then study the optimal policy depending on the characteristics of the economy considering a Rawlsian criterion. The Geneva Papers on Risk and Insurance Theory (2004) 29, 115–136. doi:10.1023/B:GEPA.0000046565.39206.7c

Date: 2004
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