Browsing by Autor "David Bardey"

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A welfare analysis of genetic testing in health insurance markets with adverse selection and prevention
(Wiley, 2025) David Bardey; Philippe De Donder
Abstract Personalized medicine remains in its early stages, with expensive genetic tests offering limited actionable insights for prevention. As a result, few individuals undergo testing, and health insurance contracts pool all agents regardless of genetic background. However, as tests become cheaper and more informative, more people may choose to get tested, influencing both insurance pricing and contract types. We examine how the proportion of individuals taking genetic tests and the informativeness of these tests affect whether equilibrium contracts remain pooling or become separating. We find that increasing test uptake can reduce welfare, particularly when it leads to a shift from pooling to separating contracts. Similarly, lower prevention effort costs, reflecting more informative tests, can harm welfare if they induce separation. These findings suggest that policies promoting genetic testing or reducing prevention costs may not always be beneficial, especially when the market equilibrium remains in a pooling state.
¿Cómo afectan los esquemas de pago el acceso y el gasto en salud?: evidencia del sistema de salud colombiano
(2023) Camilo Arias; David Bardey; Mariángela Chávez; Jaime Cardona; Laura Martínez‐Rodríguez; J. L. Ortiz
Uno de los mayores retos que enfrentan los sistemas de salud en el mundo es el de proveer servicios y tecnologías en salud de manera sostenible y eficiente. En este estudio se presenta evidencia de los efectos de cambiar el esquema de remuneración a las aseguradoras, al pasar de un esquema retrospectivo a uno prospectivo. A partir del análisis de un experimento natural, presentado en Colombia, y generado por el cambio en la forma de remuneración de servicios y tecnologías de salud financiados a través de la Unidad de Pago por Capitación (UPC), utilizamos los registros de la totalidad de medicamentos que se comercializaron en el país, entre el año 2011 y el 2018, para implementar múltiples especificaciones de modelos de diferencias en diferencias, con tratamiento escalonado, para estimar efectos sobre la media y sobre la distribución de precios, cantidades y gasto de los medicamentos. Encontramos evidencia relacionada con que la inclusión de medicamentos, en el esquema de remuneración prospectivo (UPC), desde el retrospectivo (recobros), generó reducciones en los precios de los medicamentos y aumentos en las cantidades comercializadas. Los efectos en el gasto son positivos para los percentiles inferiores a la mediana y negativos en los percentiles superiores a la mediana, con significancia económica, pero no estadística. Se encuentra evidencia relacionada con que la inclusión de medicamentos en la UPC tiene efectos sobre sus sustitutos terapéuticos, ocasionando aumentos en sus precios y cantidades.
Informality and Optimal Public Policy
(2019) David Bardey; Daniel Mejía
This article tackles the feature of optimal public policy such as the level of enforcement and the supply of public goods in an economy characterized by a huge informal sector. We consider informality as the group of productive activities which, before hand, do not comply (totally or partially) with government regulations. The Government intervenes as a Stackelberg leader and has to decide how to allocate public expenditures, collected through the tax system, between the provision of a public good, which can only be used for formal activties, and enforcement eort, aimed at detecting informal rms that evade taxes. Taking the public policy as given, a representative family, owner of a representative rm, decides how to split a x amount of labour supply between formal and informal activities. Our results show that the greater are the distortions in the process of tax collection, the larger is the size of the informal sector. Finally we derive the properties of the optimal public policy. In particular, we show that the shadow cost of public fund represent the rationale of enforcement spending. We also point out that the size of the tax distortion (e.g. the shadow cost of public funds) is inversely related to total income, the tax rate and the provision of the public good.
Integración vertical en el sector colombiano de la salud
(2016) David Bardey; Giancarlo Buitrago
This paper provides a literature review dealing with vertical integration in healthcare systems with a special emphasis in the Colombian health care sector. We start by introducing some general concerns about vertical integration by presenting some of its traditional advantages and disadvantages. Next, we focus on the consequences of vertical integration in the healthcare sector, taking advantage of the US experience. Then, we describe the Colombian healthcare system and some changes of the vertical integration regulation. Finally, the authors provide some public policy recommendations regarding this regulation. In particular, we recommend to switch from a regulatory approach to a supervision model.
Médecine personnalisée, tests génétiques et assurance santé : une tension exacerbée entre antisélection et discrimination des risques
(Association d'économie financière, 2017) David Bardey; Philippe De Donder
Nous vivons actuellement l’avènement de la médecine personnalisée, souvent définie comme l’utilisation des caractéristiques génétiques individuelles à des fins de diagnostic, de prévention et de traitements médicaux. Ces avancées médicales et technologiques rendent urgente une réflexion sur les conséquences de cette nouvelle forme d’information sur le marché de l’assurance santé. Une décision fondamentale consiste à déterminer si l’information issue des tests génétiques doit ou non être révélée aux assureurs privés. Cet article présente d’abord les conséquences économiques qui découlent de la réponse donnée à cette question : discrimination des risques quand les assureurs ont accès à l’information génétique de leurs clients, et antisélection quand ils ne l’ont pas. Nous passons ensuite en revue les quatre formes de régulation de l’information génétique observées de par le monde, avant de présenter les principaux résultats d’une étude à la fois théorique et expérimentale que nous avons menée récemment, et qui a pour but de comparer deux régulations existantes. Nous concluons avec quelques pistes de recherche sur notre agenda. Classification JEL : C91, D82, G22, I18.
Physicians’ incentives to adopt personalised medicine: Experimental evidence
(Elsevier BV, 2021) David Bardey; Samuel Kembou Nzalé; Bruno Ventelou