Moral hazard and its implications on health insurance sector – overview of impact of COVID-19 pandemic


Kenneth J. Arrow's disruptive work, Medical Uncertainty and Welfare Economics, published in 1963, was one of the first studies investigating the effects of moral hazard on the healthcare sector. Since then, countless works exploring that subject have been published. The history of research on moral hazard in medical insurance shows that this concept is defined differently in other areas of the economy than healthcare.

The proposed work is an attempt to understand and conceptualise the moral hazard in health insurance. As uncommon circumstances marked 2020, we now consider health insurance through the impact of the SARS-CoV-2 pandemic. This work discusses the results of an investigation of the impact of moral hazard and its implications on the health insurance sector during COVID-19.

The author designed and conducted a study that presented several metrics involving the distribution of medical expenditures, the effect of price on medical care consumption, PLS (profit and loss sharing) concept and their mediating and moderating effect on moral hazard in the insurance sector.


  • Arrow, K. J. (1963). Uncertainty and the Welfare Economics of Medical Care. The American Economic Review, 53(5), 941–973.

  • Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.

  • Bedyńska, S., & Książek, M. (2012). Statystyczny drogowskaz: Praktyczny przewodnik wykorzystania modeli regresji oraz równań strukturalnych. 3 3. Wydawnictwo Akademickie Sedno : [Wydawnictwo Academica.

  • Bolhaar, J., Lindeboom, M., & van der Klaauw, B. (2012). A dynamic analysis of the demand for health insurance and health care. European Economic Review, 56(4), 669–690.

  • Boudreaux, M. H., Golberstein, E., & McAlpine, D. D. (2016). The long-term impacts of Medicaid exposure in early childhood: Evidence from the program’s origin. Journal of Health Economics, 45, 161–175.

  • Departament Studiów Makroekonomicznych i Finansów. (2021). Wyniki finansowe zakładów ubezpieczeń w 2020 roku. Główny Urząd Statystyczny.

  • Deutsche Bank (DB). 2020. European insurers: Solvency matters—April 2020, Research Report, April 2020.

  • Einav, L., & Finkelstein, A. (2018). Moral Hazard in Health Insurance: What We Know and How We Know It. Journal of the European Economic Association, 16(4), 957–982.

  • Finkelstein, A. (2007). The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare. The Quarterly Journal of Economics, 122(1), 1–37.

  • Folland, S., Goodman, A. C., Stano, M., Suchecka, J., Korona, M., Siciarek, M., & Wolters Kluwer Polska. (2011). Ekonomia zdrowia i opieki zdrowotnej. Wolters Kluwer Polska.

  • Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (Second edition). Guilford Press.

  • Hurley, J. (2000). An overview of the normative economics of the health sector (Vol. 1, pp. 55–118). Elsevier.

  • Komisja Nadzoru Finansowego. Raport o stanie sektora ubezpieczeń po I półroczu 2020.

  • Kowalski, A. (2016). Censored Quantile Instrumental Variable Estimates of the Price Elasticity of Expenditure on Medical Care. Journal of Business & Economic Statistics, 34(1), 107–117.

  • Laskowska, I. (2015). Private health insurance and the problem of moral hazard. Problemy Zarzadzania, 13(53), 58–68.

  • Manning, W. G., & Marquis, M. S. (1989). Health insurance: The trade-off between risk pooling and moral hazard. Rand Corp.

  • Morris, S., Devlin, N., Parkin, D., Nojszewska, E., Próchniak, M., Ciżkowicz, P., & Wolters Kluwer Polska. (2011). Ekonomia w ochronie zdrowia. Wolters Kluwer Polska.

  • Nyman, J. A. (2004). Is ‘Moral Hazard’ Inefficient? The Policy Implications Of A New Theory. Health Affairs, 23(5), 194–199.

  • Pauly, M. V. (1968). On the Theory of Optimum Externality: Comment. The American Economic Review, 58(3), 528–529. JSTOR.

  • Pauly, M. V. (2007). The Truth About Moral Hazard and Adverse Selection. SSRN Electronic Journal.

  • Suchecka, J., & Szmigiel, T. (2003). Hazard moralny w ubezpieczeniach zdrowotnych. Inwestycje Finansowe i Ubezpieczenia - Tendencje Światowe a Polski Rynek, 991, 597–604.

  • Swiss Re. 2020. National catastrophes and man-made disasters in 2017: A year of record breaking losses, Sigma 1/2018.

  • Union Bank of Switzerland (UBS). 2020. European insurance: Solvency II monthly monitor—stand and deliver, Global Research Report, 1 April 2020.

  • van Dijk, C. E., van den Berg, B., Verheij, R. A., Spreeuwenberg, P., Groenewegen, P. P., & de Bakker, D. H. (2013). Moral hazard and supplier-induced demand: empirical evidence in general practice. Health Economics, 22(3), 340–352.

  • Willis Towers Watson (WTW). 2020. Scenario Analysis of the Covid-19 pandemic: Analysis of key classes in the US and UK P&C Insurance Industries, 1 May 2020.

  • Zweifel, P., & Manning, W. (2000). Moral hazard and consumer incentives in health care. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of Health Economics (Vol. 1, pp. 409–459). Elsevier.

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