Do online applications for free assistive technology devices by individuals with disabilities introduce moral hazard? Evidence from Shanghai, China

• Published in: The International journal of health planning and management 2020-07, Vol.35 (4), p.897-909
• Main Authors: Huang, Xiaojing, Sun, Mei, Song, Yu, Li, Chengyue, Jin, Rong, Sun, Heqi, Wang, Weili, Zhang, Qi, Lu, Jun
• Format: Article
• Language: English
• Subjects: Adaptive technology; Adult; Aged; Aged, 80 and over; Applicants; Application; assistive technology devices; China; Community centers; Consumer Behavior; Databases, Factual; Disabilities; disability policy; Disabled Persons; Electronic devices; Expenditures; Female; Handicapped assistance devices; Humans; Internet; Logistic Models; Male; Middle Aged; Moral hazard; Morality; Morals; People with disabilities; Per capita; Prices; Self-Help Devices - economics; Sociodemographics; Young Adult
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.2972

Summary Objectives To examine whether moral hazard may exist under unsupervised home‐based online applications, leading to more assistive technology devices (ATDs) and larger per capita expenditures on ATDs than under supervised community center–based online applications. Methods Using the data from the Assistive Devices Resource Centre in Shanghai, descriptive statistics were estimated for the sociodemographics of applicants. Multiple linear regression and logistic regression were used to test the effect of the introduction of home‐based online applications. Results In 2015‐2016, there were marked increases of 22.3% in the total number of ATDs and 27.2% in the total expenditure on ATDs compared with 2013‐2014. The per capita number and expenditure also demonstrated an increasing trend. More devices were applied for in 2015‐2016 than in 2013‐2014, yielding a higher expenditure per capita (P < .001). Interestingly, with an invisible price, more devices were applied for at home than in community centers (P < .001), but the expenditure per capita was smaller (P < .001). Conclusions The introduction of online applications increased the number of ATDs per capita. The home‐based applications induced the purchase of more ATDs but not higher expenditures on ATDs. Individuals with disabilities tend to request the maximum number of ATDs allowed by the application rules, which is an indicator of moral hazard. The prices of ATDs were not visible for individuals with disabilities, which may cause individuals to order costlier ATDs when applying at home. Stricter review may be needed to reign in the potential moral hazard among online applicants with disabilities.