Notes

1. One has only to look in a few newspapers across Canada for examples of the increasing pressure on the system: ``Doctors' Protest Crimps System: Nearly 7,000 Physicians Will Close Offices Today to Protest Funding.'' (The Vancouver Sun, March 8, 1998); ``Health Crisis Ignored by [Health] Authority, MD Says.'' (The Edmonton Journal, January 28, 1998); and ``Surgery Gets the Squeeze: Hospitals Clear Way for Emergency Cases.'' (The Montreal Gazette, February 16, 1998).
2. Maclean's/Medical Post/Angus Reid poll results reported in Maclean's (December 2, 1996).
3. Ekos Research Final Report to the National Forum on Health submitted on January 31, 1997, Exhibit 2.8.
4. In the insurance market, this is known as the law of large numbers. Roughly, the law of large number states that random movements of a large number of individual items tend to offset one another. It is based on the well-known statistical normal curve. See Lipsey and Steiner 1978: 21 for more details. As well, for more details on modeling the benefits of insurance see Evans 1984: 30-33.
5. Extensive health insurance can be blamed in part for the low degree of competition in the medical market-place as it tends to reduce or even eliminate (if coverage is extensive) individuals' and physicians' incentives to shop around for lower prices (Arrow 1963). As well, individuals have little incentive to demand the lowest paid qualified worker (Feldstein 1971a). It follows that in a health care system with widespread insurance coverage, it is more difficult to incorporate alternate health professionals, such as registered nurses, who in many instances can provide the same quality of service as physicians but at a lower cost.
6. The premium charged by the insurer likely will exceed the actuarial value because of administrative costs. As long as different policies are offered at premiums that are similarly unfair, however, Arrow's results still hold. For more details see Arrow 1963: 969-71.
7. By definition, with catastrophic insurance (or MRI) very few families should be deprived of medical care since there is an income-related limit on how much is paid out-of-pocket.
8. See Evans 1984: 60-64 for more details on the altruistic and paternalistic nature of this externality. Arrow 1963 notes that the individuals' preference for improving the health of others seems to be stronger than for improving other aspects of their welfare.
9. This would be true only if the government, and not the health care provider, received the user charge.
10. It has been argued that many theoretical analyses avoid distributional issues and assume a single-person economy. For example, Arrow (1963) made such an assumption when he demonstrated that deductibles and co-insurance can be welfare enhancing. Years later, Arrow relaxed this assumption and used a model with a very large population but assumed that each member of the population was identical in order to bypass distributional considerations. Evans (1993) notes that no one, with the exception of Arrow, has pointed out the limitations of such restrictive assumptions. Evans argues that models based on these restrictive assumptions do not and cannot help us analyze the welfare effects of cost sharing.
11. Supplier-induced demand will be discussed in more detail in a later section.
12. In economics this is generally referred to as ``asymmetric information.''
13. It is also important to note that if market failure occurs, even efficient government intervention will not necessarily improve overall welfare. This is known as the theory of second best: ``correcting an inefficiency in one part of an economy will not necessarily improve welfare, and could actually reduce it, if there remain uncorrected inefficiencies in other parts of the economy.'' See Kennedy 1995: 17-18 for more details.
14. There can be a clause that allows individuals to opt out and purchase a similar catastrophic policy in the private insurance market. However, because of risk-pooling and economies of scale, in theory it should be difficult for private insurance providers to match the premium offered by the government.
15. It is important to keep in mind that there is an opportunity cost associated with the employer's contribution. That is, the money put by an employer into an individual's MSA cannot be spent elsewhere--on wages or the latest computer equipment, for example.
16. For a more detailed analysis and evaluation of the introduction of Medisave, Medishield and Medifund accounts in the Singapore health care system, see Hsiao 1995, Massaro and Wong 1995, and Asher 1995.
17. Price elasticity measures the responsiveness of quantity to a change in price. In this particular case, it measures how individuals change the amount of medical care they use when the price of care changes.
18. It is important to note that most studies exploring these issues are conducted using data from the United States, and that the Canadian and American health care systems are quite different. The former is mainly publicly funded and is characterized by universal health care (every citizen is insured) and free access (no deductibles, co-insurance, or user charges for insured services). The latter is about evenly split between public and private funding, and uses different forms of cost sharing rather extensively. One would, therefore, expect a larger welfare loss from health insurance in Canada than in the United States.
19. MDE or maximum dollar expenditure is a term commonly used by The RAND Corporation. It is synonymous with upper limits on out-of-pocket expenditures.
20. The RAND Corporation, based in Santa Monica, California, is a nonprofit institution that tries to improve public policy through research and analysis. It attempts to achieve complete objectivity by avoiding partisanship and disregarding vested interests. For a more in-depth discussion of the design of the HIE experiment, see New-house 1993: ch. 2.
21. Due to the difficulty in translating the MDEs used in the HIE into current Canadian dollars, all figures are in late 1970s US$. The transformation introduces several technical problems as it is not clear what price level indices, which base year, and which exchange rates should be used to calculate these amounts into more appropriate figures. According to Manning and Marquis 1996, the $1,000 deductible of the 1970s is approximately $2,500 in 1995 US$.
22. Statistical significance means that conclusions can be drawn from the data. If a parameter estimate is not statistically significant, then there is too much variability in the variable, and nothing can really be said about the variable's effect. In this case, since the tests are significant, we can reject the hypothesis that there are no differences in the effect that the insurance plans have on people's use and spending on health care.
23. The RAND HIE estimates have the advantage of being based on experimental data, which are preferred because they originate from random controlled trials (RCTs). RCTs that examine health insurance have the advantage of controlling for adverse selection. In an RCT, individuals are randomly assigned to a health insurance plan; they do not choose a plan. Studies that rely on historical data connot control for adverse selection. Individuals who have similar sociodemographic characteristics may choose the same insurance plan. Thus, the responses to the variable examined (eg cost sharing) may not be due to the insurance plan but rather to common sociodemographic characteristics.
24. The HIE (Newhouse et al. 1993) elasticity estimates, based on the experimental data, range from -0.10 to -0.22 for all care and from -0.13 to -0.31 for out-patient care.
25. Feldstein and Gruber use data from the 1987 National Medical Expenditure Survey (NMES), which is collected by the Agency for Health Care Policy and Research. The sample used contains 6,000 insurance units and the data are weighted to correct for any changes in income and demographic mix between 1987 and 1995. Health care spending is defined as expenditures on physicians and hospitals.
26. The data used by Feldstein and Gruber tend to overestimate the ``original'' average level of spending by the lowest income group because the lowest income group represents the rather peculiar combination of being below the poverty line and being insured privately.
27. See Keeler et al. 1996. The absence of a control group does not allow researchers to isolate the precise effect of the variable studied and variables other than the introduction of MSAs may explain a change in health spending.
28. Note that these firms adopted MSAs despite unfavourable tax treatment. MSA benefits are taxed as income at the federal level while traditional employer-based health benefits are not.
29. The firms surveyed were the Golden Rule Insurance Company Plan in Indianapolis, IN; Valley Surgical Group in Phoenix, AZ; Morris County Hospital in Kansas; Dominion Resources in Richmond, VA; Progress Sharing Company in Saco, ME; Quaker Oats Company; and Windham Hospital in Willimantic, CT.
30. Those who are both poor and sick are the most disadvantaged segment of the population but it is important to note that the vast majority of the population is neither sick nor poor.
31. The ``poor'' are defined as families that spend 70 percent or more of their income on food, clothing and shelter. This was the standard definition used by the Economic Council of Canada. See Beck 1974 for details.
32. These results suggest that a 100 percent increase in surgeons--a doubling of the surgeon population--would only increase the total number of surgeries by 9 percent.
33. To justify this conclusion, Rice and Labelle cite Barer, Evans and Labelle 1985, 1988; Barer and Evans 1986; and several studies that have been reviewed in Gabel and Rice 1985 but are not cited in Feldman and Sloan 1988.
34. Results of a COMPAS poll conducted for Southam News between November 15 and 25, 1997. They were printed in The Vancouver Sun (December 17, 1997).
35. Results of a national poll conducted among 1,515 Canadians in September, 1997 by the Angus Reid Group and commissioned by the Consumer Policy Institute.
36. While the costs of such a computer system may be high, there will be cost savings in the form of increased efficiency and decreased fraud, as well as additional benefits in the form of more accurate and more accessible information.

References

Alderson, M.R. (1970). Social class and the health services. Medical Officer 124: 51-59.

American Academy of Actuaries [AAA] (1995). Medical Savings Accounts: Cost Implications and Design Issues (May). Washington, DC: American Academy of Actuaries.

American Medical Association (1994). Why the American Medical Association Supports Medical Savings Accounts, Analysis. American Medical Association.

Arrow, Kenneth J. (1963). Uncertainty and the welfare of medical care. American Economic Review 53: 941-73.

------ (1968). The economic of moral hazards: further comment. American Economic Review 58: 537-39.

------ (1976). Welfare analysis of changes in health coinsurance rates. In Rossett, R.N. (ed.), The Role of Health Insurance in the Health Services Sector (New York: National Bureau of Economic Research): 2-23.

Asher, Mukul G. (1995). Compulsory savings in Singapore: an alternative to the Welfare State. NCPA Policy Report No. 198.

Barchet, Stephen (1995). Medical Savings Accounts -A Building Block for Sound Health Care. Washington Medical Savings Account Project, Evergreen Freedom Foundation.

Barer, Morris, and Robert Evans (1986). Riding north on a south-bound horse? Expenditures, prices, utilization and incomes in the Canadian health care system. In R. Evans and G. Stoddart (ed.), Medicare at Maturity: Achievements, Lessons and Challenges (Calgary, AB: University of Calgary Press).

Barer, Morris, Robert Evans, and R. Labelle (1985). The Frozen North: Controlling Physician Costs through Controlling Fees: The Canadian Experience. Washington, DC: Office of Technology Assessment.

------ (1988). Direct Charges to Patient: Snare or Delusion? Toronto: Ontario Economic Council.

Barer, Morris, Robert Evans, and G. Stoddart (1979). Direct Charges to Patient: Snare or Delusion? Toronto, ON: Ontario Economic Council.

Barer, Morris, and G. Stoddart (1981). Analysis of demand and utilization through episodes of medical services. In J. van der Gaag and M. Perlman (eds.), Health, Economics and Health Economics. Amsterdam: North Holland.

Beck, R.G. (1974). The effects of co-payment on the poor. The Journal of Human Resources 9: 129-42.

Beck, R.G., and J.M. Horne (1980). Utilization of publicly insured health services in Saskatchewan, during and after copayment. Medical Care 18, 8 (August): 787-806.

Bérubé, G. (1997). Épargne-santé: Vaugeois remet ça! Le Devoir (September 13/14).

Bond, Michael (1996). Medical savings accounts free doctors and patients from managed care. Perspective on Current Issues (August 8). The Buckeye Institute.

Bond, Michael T, Brian P. Hershizer, and Mary W. Hrivnak (1996). Reducing Employee Health Expenses with Medical Savings Accounts. Compensation & Benefits Review September/October: 51-56.

Buchanan J.L., E.B. Keeler, J.E. Rolph, and M.R. Holmer (1991). Simulating health expenditures under alternative insurance plans. Management Science 37: 1067-90.

Bunce, Victoria C. (1996). Medical Savings Accounts: Questions and Answers. Position Paper, Council for Affordable Health Insurance.

Canada, Hall Commission (1964). Royal Commission on Health Services. Ottawa, ON: Queen's Printer.

Canada, Receiver General (1996). Public Accounts of Canada 1996: Volume I, Summary Report and Financial Statements. Ottawa, ON: Supply and Services Canada.

Chassin M.R., et al. (1987). Does inappropriate use explain geographic variations in the use of health care services. Journal of American Medical Association 258, 18 (November 13): 2533-37.

Crew, M. (1969). Coinsurance and the welfare economics of medical care. American Economic Review 89: 906-08.

Cromwell, J., and J.B. Mitchell (1986). Physician induced demand for surgery. Journal of Health Economics 18: 407-24.

Davies, K., and R. Louise (1972). The substitution of hospital outpatient care for inpatient care. The Review of Economics and Statistics 54, 2: 109-20.

Debrock, L., and R.J. Arnould (1992). Utilization control in HMOs. Quarterly Review of Economics and Finance 32.

Deeds, Catherine (1995). Medical savings accounts: good for health care reform, good for families. Insight. Family Research Council.

Diehr, P.K., et al. (1990). What is too much variation? The null hypothesis in small area analysis. Health Services Research 24: 741-71.

Duan, Naihua et al. (1982). A Comparison of Alternatives Models of the Demand for Medical Care. R-2754-HHS. Santa Monica, CA: RAND Corporation.

------ (1984). Choosing between the sample-selection model and the multi-part model. Journal of Business and Economic Statistics 2: 283-89.

Eichner, Matthew J., Mark B. McClellan, and David A. Wise (1996). Insurance or Self-Insurance? Variation, Persistence, and Individual. NBER Working Paper No. 5640.

Evans, Robert (1974). Supplier-induced demand. In M. Perl-man (ed.), The Economics of Health Care and Medical Care (London: MacMillan): 162-73.

------ (1982). A Retrospective on the New Perspective. Journal of Health Politics, Policy and Law 7 (Summer): 325-44.

------ (1984). Strained Mercy: The Economics of Canadian Health Care. Toronto: Butterworths.

------ (1987). Hang together or hang separately: the viability of a universal health care system in an aging society. Canadian Public Policy--Analyse de Politiques 13, 2:165-80.

------ (1993). User fees for health care: why a bad idea keeps coming back. HPRU 93:9D. Vancouver, BC: Health Policy Research Unit, Centre for Health Services and Policy Research, University of British Columbia.

Feldman, R., and F. Sloan (1988). Competition among physicians: Revisited. Journal of Health Politics, Policy and Law 13.

------ (1989). Reply from Feldman and Sloan. Journal of Health Politics, Policy and Law 14.

Feldstein, M. (1971a). A new approach to national health insurance. Public Interest 48: 93-105.

------ (1971b). Hospital cost inflation: a study of nonprofit price dynamics. American Economic Review 61, 5: 853-72.

------ (1973) The welfare loss of excess health insurance. Journal of Political Economy 81: 251-79.

Feldstein, M., and B. Friedman (1977). Tax subsidies, the rational demand for insurance and the health care crisis. Journal of Public Economics 7: 155-78.

Feldstein, M., and J. Gruber (1994). A Major Risk Approach to Health Insurance Reform. NBER Working Paper No. 4852.

Ferguson, B. (1994). Physician Supply Behaviour and Supplier-Induced Demand. Working Paper 84-08. Queen's University/University of Ottawa Economics Projects Study of Cost Effectiveness of the Canadian Health Care System. University of Ottawa.

Ferguson B., and A. Crawford (1989). Supplier-induced demand: a disequilibrium test. Applied Economics 21: 597-609.

Folland, S., and M. Stano (1989). Sources of small area variation in the use of medical care. Journal of Health Economics 8: 85-107.

Forster, D.P. (1976). Social class differences in sickness and general practitioner consultations. Health Trends: 8, 2: 29-32.

Fuchs, V.R. (1978). The supply of surgeons and the demand for operations. Journal of Human Resources. Supplement.

Fuchs, V.R., and M. Kramer (1972). Determinants of Expenditure for Physicians' Services in the United States, 1948-68. New York, NY: National Bureau of Economic Research.

Gabel, J.H., and T.H. Rice (1985). Reducing public expenditures for physicians' services: the price of paying less. Journal of Health Politics, Policy and Law 9: 595-609.

Health Canada, Policy and Consultation Branch (1996). National Health Expenditures in Canada 1975-1994, Summary Report. Ottawa, ON: Minister of Public Works and Government Services Canada.

------ (1997) National Health Expenditures in Canada 1975-1996, Fact Sheets. Ottawa, ON: Minister of Public Works and Government Services Canada.

Hemenway, D., et al. (1990). Physicians' response to price incentives to financial incentives. New England Journal of Medicine 322: 1059-63.

Hickson, G.B., W.A. Altemeier, and J.M. Perrin (1987). Physician reimbursement by salary or fee-for-service: effect on physician practice behaviour in a randomized prospective study. Pediatrics 80: 344-50.

Himmelstein, D.V., and S. Woolhandler (1991). The deteriorating administrative efficiency of the US health care system. New England Journal of Medicine 324, 18: 1253-58.

Horry, Isabella, and M. Walker (1994). Government Spending Facts Two. Vancouver, BC: The Fraser Institute.

Hsiao, William C. (1995). Medical savings accounts: lessons from Singapore. Health Affairs (Summer): 260-66.

Huang, L.F., and R.N. Rosett (1973). The effect of health insurance on the demand for medical care. Journal of Political Economy 81, part 1 (March/April).

Keeler, E.B., J.D. Malkin, D.P. Goldman, and J. Buchanan (1996). Can medical savings account for the nonelderly reduce health care costs? The Journal of the American Medical Association 275, 21: 1666-71.

Keeler, Emmett B., Joseph P. Newhouse, and C.E. Phelps (1977). Deductibles and the demand for medical care services: the theory of a consumer facing a variable price schedule under uncertainty. Econometrica 45, 3 (April): 641-55.

Keeler et al. (1988). The Demand for Episodes of Medical Treatment in the Health Insurance Experiment. R-3454-HHS. Santa Monica, CA: RAND Corporation.

Kennedy, Peter W. (1995). Cost-Benefit Analysis. Victoria, BC: Department of Economics, University of Victoria.

Kirkman-Liff, Bradford L. (1994). Health care reform in the Netherlands, Germany, and the United Kingdom. In A. Blomqvist and D. Brown (eds.), Limits to Care: Reforming Canada's Health System in an Age of Restraint (Toronto, ON: C.D. Howe Institute): 167-216.

Krasnik, A. et al. (1990). Changing remuneration systems: effects on activity in general practice. British Medical Journal 300:1698-701.

Le Grand, Julian (1978). The distribution of public expenditures: the case of health care. Economica 45: 125-42.

------ (1982). The Strategy of Equality, Redistribution and the Social Services. London: George Allen & Unwin.

------ (1991). The distribution of health care revisited: a commentary on Wagstaff, van Doorslaer and Paci, and O'Donnell and Propper. Editorial. Journal of Health Economics 10: 239-45.

Lipsey, Richard C., and Peter O. Steiner (1978). Economics. London: Harper & Row.

Lohr, K.N., et al. (1986). Termination of medical benefits: does it affect health? New England Journal of Medicine 311, 19: 1266-68.

Lurie, N., et al. (1984). Termination from Medi-Cal: does it affect health? New England Journal of Medicine 311, 6: 480-84.

------ (1986). Termination of Medi-Cal benefits: a follow-up study one year later. New England Journal of Medicine 31, 19: 1266-68.

Manning, W.G., et al. (1988). Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment. R-3476-HHS (February). Santa Monica, CA: RAND Corporation.

Manning, W.G., and Marquis, M.S. (1996). Health insurance: the tradeoff between risk pooling and moral hazard. Journal of Health Economics 15: 609-39.

Marquis, M.S., and Martin R. Holmer (1996). Alternative models of choice under uncertainty and demand for health insurance. Review of Economics and Statistics 78, 3 (August): 421-27.

Massaro, Thomas, and Yu-Ning Wong (1995). Positive experience with medical savings accounts in Singapore. Health Affairs (Summer): 267-72.

------ (1996). Medical Savings Accounts: The Singapore Experience. NCPA policy report no. 203.

Matthews, Merrill (1997). Medical savings accounts: new legislation is a step in the right direction. Available on audio cassette of speeches from Putting Patients First, a Fraser Institute Conference (November 3 and 4), Vancouver, BC.

McArthur, William, Cynthia Ramsay, and Michael Walker (1996). Healthy Incentives: Canadian Health Care Reform in an International Context. Vancouver: The Fraser Institute.

McKeown, Thomas (1979). The Role of Medicine: Dream, Mirage or Nemesis? Oxford: Basil Blackwell.

McPherson, K., et al. (1981). Regional variations in the use of common surgical procedures: within and between England and Wales, Canada and the United States. Social Science and Medicine 15a: 273-288.

Miller, Tom (1996). MSAs: Panacea or placebo? Update. Competitive Enterprise Institute.

Morreim, E. (1995). Lifestyles of the risky and infamous: from managed care to managed lives. Hastings Center Report 25, 6 (November/December): 5-12.

Musgrave, Gerald L. (1995). Health economics outlook: two theories of health economics. Business Economics (April): 7-13.

Newhouse, J.P. (1996). Policy watch medicare. Journal of Economic Perspectives 10, 3: 159-67.

------ (1995). Economists, policy entrepreneurs, and health care reform. Health Affairs (Spring): 182-98.

------ (1981). The erosion of the medical market place. In Richard Sheffler (ed.), Advances in Health Economics and Services Research, vol. 2 (JAI Press): 1-34.

Newhouse, J.P., and The Insurance Experiment Group (1993). Free for All? Lessons from the RAND Health Insurance Experiment. A RAND Study. Cambridge, MA: Harvard University Press.

O'Donnell, Owen, and Carol Propper (1991a). Equity and the distribution of UK National Health Service resources. Journal of Health Economics 10: 1-19.

------ (1991b) Reply: equity and the distribution of UK National Health Service resources. Journal of Health Economics 10: 247-49.

Ozanne, Larry (1996). How will medical savings accounts affect medical spending. Inquiry 33: 225-36.

Park, R.E., et al. (1986). Physician Ratings of Appropriate Indications for Six Medical and Surgical Procedures. R-3280-CWF/HF/PMT/RWJ Rand/UCLA Health Services Utilization Study. Santa Monica, CA: RAND Corporation.

Pauly, Mark V. (1968). The economics of moral hazards. American Economic Review 58: 231-37.

Pauly, Mark V., and John C. Goodman (1995). Tax credits for health insurance and medical savings accounts. Health Affairs 14, 2 (Spring): 126-39.

Phelps, C.E. (1992). Health Economics. New York, NY: Harper Collins.

Phelps, C.E., and Newhouse, J.P. (1974). Coinsurance, the price of time, and the demand for medical services. Review of Economics and Statistics 56, 3: 334-42.

Rice, T. (1984). Physician-induced demand for medical care: new evidence from the Medicare Program. Advances in Health Economics and Health Services Research 5: 129-60.

Rice, T., and R. Labelle (1989). Do physicians induce demand for medical services? Journal of Health Politics, Policy and Law 14.

Richardson, J.R.J. (1981). The inducement hypothesis: that doctors create the demand for their own services. In J. van der Gaag and M. Perlman (eds.), Health, Economics and Health Economics. Amsterdam: North Holland.

Rochaix, L. (1993). Financial incentives for physicians: the Québec experience. Health Economics 2: 163-76.

Roemer et al. (1975). Copayments for ambulatory care: penny-wise and pound-foolish. Medical Care 13: 457-66.

Roos, Leslie, and B. Sharp (1989). Innovation, centralization and growth: coronary artery graft bypass surgery in Manitoba. Medical Care 27, 5: 441-52.

Rossister, L.F., and G.R. Wilensky (1981). The magnitude and determinants of physician initiated visits in the United States. In J. van der Gaag and M. Perlman (eds.), Health, Economics and Health Economics. Amsterdam: North Holland.

Rossister, L.F., and G.R. Wilensky (1983). The relative importance of physician initiated visits in the United States. Milbank Memorial Quarterly/Health Society 61: 252-77.

Rutten, F., E. van Doorslaer, and A. Wagstaff (eds.) (1993). Equity in the Finance and Delivery of Health Care: An International Perspective. Oxford: Oxford University Press.

Sine, JJ. (1994). Demand for Episodes of Care in the China Health Insurance Experiment. RGSD-110. RAND Graduate School.

Soderstrom, Lee (1995). Notes on Canada-US health cost comparisons. McGill University.

Stano, M. (1987). A further analysis of the physician inducement controversy. Journal of Health Economics 6: 197-211.

The Economist (1997). A survey of the world economy: the future of the state (September 20).

Tussing, A.D. (1983). Physician induced demand for medical care: Irish general practitioners. Economic and Social Review 14: 225-47.

Tussing, A.D., and M.J. Wojtowycz (1986). Physician induced demand by Irish GPs. Social Science and Medicine 23: 851-60.

Vayda, E. (1973). A comparison of surgical rates in England and Wales. New England Journal of Medicine 289: 1224-29.

Wennberg, J.E., B.A. Barnes, and M. Zubkoff (1982). Professional uncertainty and the problem of supplier induced demand in the demand for medical care. Milbank Memorial Quarterly/Health and Society 61: 252-77.

Winkens, R.A.G., et al. (1992). Effect of feedback on test ordering behaviour of general practitioners. British Medical Journal 25: 1093-96.

Winslow et al. (1988). The appropriateness of performing coronary artery bypass surgery. Journal of American Medical Association 260, 18: 505-09.

Zeckhauser, Richard (1970). Medical insurance: a case study of the tradeoff between risk spreading and appropriate incentives. Journal of Economic Theory 2, 1: 10-26.

info@fraserinstitute.ca You can contact us at the above email address for any comments or information requests. Please report any dead links or technical problems.

If you know someone who would be interested in this web page, please enter their email address below, and we will forward this URL to them: Email Address:

Last Modified: Wednesday, October 20, 1999.