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The Nordic Model - Embracing globalization and sharing risks

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Adverse selection<br />

problems explain why,<br />

e.g., comprehensive<br />

health insurance cannot<br />

be provided by<br />

competitive markets<br />

Consumers can have<br />

difficulties in making<br />

informed decisions,<br />

<strong>and</strong> the information<br />

required can sometimes<br />

be acquired better<br />

by public agencies<br />

Asymmetric information causes contractual externalities, which<br />

competitive markets often have problems with. A case in point<br />

is the market for health insurance, which suffers from an adverse<br />

selection problem. Adverse selection occurs when people know<br />

their own health <strong>risks</strong> better than the insurance company <strong>and</strong><br />

purchase insurance based on their private information. Insurance<br />

companies would like to know the health <strong>risks</strong>, too, but they may<br />

have to infer the <strong>risks</strong> (imperfectly) from individual purchasing<br />

behavior. Those who want to buy comprehensive coverage are<br />

suspected to have relatively poor health, forcing the price for<br />

comprehensive insurance higher than it would be if insurance were<br />

m<strong>and</strong>atory. As the price of comprehensive coverage rises, even<br />

less healthy will drop out of the pool. <strong>The</strong> process may not end<br />

until everyone, except the very sick, have been discouraged to buy<br />

comprehensive insurance. In that case a competitive market will<br />

be unable to provide full insurance. 4 For this reason, m<strong>and</strong>atory<br />

health insurance is widely regarded as desirable. 5 Even the U.S.<br />

is on the verge of adopting general health insurance, though the<br />

public sector will play a lesser role in the U.S. system.<br />

Public oversight. Market efficiency rests on the assumption that<br />

consumers can make informed decisions. In some cases information<br />

can be more cheaply acquired by an agency than by each<br />

individual separately. <strong>The</strong> safety of products is a case in point.<br />

Firms may be able to certify their products using a private agency,<br />

but given the firms’ bias towards profit, people may not trust their<br />

choice of agency. <strong>The</strong> credibility of the government often beats the<br />

credibility of a private agency. <strong>The</strong> safety of medicines, toys <strong>and</strong><br />

vehicles are illustrative. When consumers can rely on minimum<br />

st<strong>and</strong>ards assured by government, their monitoring costs can be<br />

significantly reduced.<br />

More complex issues arise when services are provided to<br />

people incapable of making decisions. Nursery homes are a topical<br />

example. Family members <strong>and</strong> friends can act as trustees, but they<br />

are not always perfect substitutes for the real consumer: the person<br />

in need of the nursing home. Government provided or subsidized<br />

nursing homes are a possible solution.<br />

Poor quality. Nursing homes, health care <strong>and</strong> primary schools<br />

bring up another potential advantage of public service supply. Profit<br />

<strong>The</strong> proper scope of the public sector · 141

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