I study job lock and job push, the twin phenomena believed to be caused by employment-contingent health insurance (ECHI). Using variation in Medicaid eligibility among household members of male workers as a proxy for shifts in workers’ dependence on employment for health insurance, I estimate large job lock and job push effects. For married workers, Medicaid eligibility for one household member results in an increase in the likelihood of a voluntary job exit over a four-month period by approximately 34%. For job push, the transition rate into jobs with ECHI among all workers falls on average by 26%.
{"title":"Does Government Health Insurance Reduce Job Lock and Job Push?","authors":"Scott Barkowski","doi":"10.2139/ssrn.3112739","DOIUrl":"https://doi.org/10.2139/ssrn.3112739","url":null,"abstract":"I study job lock and job push, the twin phenomena believed to be caused by employment-contingent health insurance (ECHI). Using variation in Medicaid eligibility among household members of male workers as a proxy for shifts in workers’ dependence on employment for health insurance, I estimate large job lock and job push effects. For married workers, Medicaid eligibility for one household member results in an increase in the likelihood of a voluntary job exit over a four-month period by approximately 34%. For job push, the transition rate into jobs with ECHI among all workers falls on average by 26%.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125203782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christian Bünnings, H. Schmitz, H. Tauchmann, Nicolas R. Ziebarth
This paper empirically assesses the relative role of health plan prices, service quality and optional benefits in the decision to choose a health plan. We link representative German SOEP panel data from 2007 to 2010 to (i) health plan service quality indicators, (ii) measures of voluntary benefit provision on top of federally mandated benefits, and (iii) health plan prices for almost all German health plans. Mixed logit models incorporate a total of 1,700 health plan choices with more than 50 choice sets for each individual. The findings suggest that, compared to prices, health plan service quality and supplemental benefits play a minor role in making a health plan choice.
{"title":"How Health Plan Enrollees Value Prices Relative to Supplemental Benefits and Service Quality","authors":"Christian Bünnings, H. Schmitz, H. Tauchmann, Nicolas R. Ziebarth","doi":"10.2139/ssrn.2583805","DOIUrl":"https://doi.org/10.2139/ssrn.2583805","url":null,"abstract":"This paper empirically assesses the relative role of health plan prices, service quality and optional benefits in the decision to choose a health plan. We link representative German SOEP panel data from 2007 to 2010 to (i) health plan service quality indicators, (ii) measures of voluntary benefit provision on top of federally mandated benefits, and (iii) health plan prices for almost all German health plans. Mixed logit models incorporate a total of 1,700 health plan choices with more than 50 choice sets for each individual. The findings suggest that, compared to prices, health plan service quality and supplemental benefits play a minor role in making a health plan choice.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124120858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Young people with private health insurance sometimes transition to the public health insurance safety net after they get sick, but popular sources of cross-sectional data obscure how frequently these transitions occur. We use longitudinal data on almost all hospital visits in New York from 1995 to 2011. We show that young privately insured individuals with diagnoses that require more hospital visits in subsequent years are more likely to transition to public insurance. If we ignore the longitudinal transitions in our data, we obscure over 80% of the value of public health insurance to the young and privately insured.
{"title":"What Do Longitudinal Data on Millions of Hospital Visits Tell Us About the Value of Public Health Insurance as a Safety Net for the Young and Privately Insured?","authors":"Amanda E. Kowalski","doi":"10.2139/ssrn.2555730","DOIUrl":"https://doi.org/10.2139/ssrn.2555730","url":null,"abstract":"Young people with private health insurance sometimes transition to the public health insurance safety net after they get sick, but popular sources of cross-sectional data obscure how frequently these transitions occur. We use longitudinal data on almost all hospital visits in New York from 1995 to 2011. We show that young privately insured individuals with diagnoses that require more hospital visits in subsequent years are more likely to transition to public insurance. If we ignore the longitudinal transitions in our data, we obscure over 80% of the value of public health insurance to the young and privately insured.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123274484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Medicare Part D, low income individuals receive subsidies to enroll into insurance plans. This paper studies how premiums are distorted by the combined effects of this subsidy and the default assignment of low income enrollees into plans. Removing this distortion could reduce the cost of the program without worsening consumers' welfare. Using data from the the first five years of the program, an econometric model is used to estimate consumers demand for plans and to compute what premiums would be without the subsidy distortion. Preliminary estimates suggest that the reduction in premiums of affected plans would be substantial.
{"title":"Pricing and Incentives in Publicly Subsidized Health Care Markets: The Case of Medicare Part D","authors":"F. Decarolis","doi":"10.2139/ssrn.2101668","DOIUrl":"https://doi.org/10.2139/ssrn.2101668","url":null,"abstract":"In Medicare Part D, low income individuals receive subsidies to enroll into insurance plans. This paper studies how premiums are distorted by the combined effects of this subsidy and the default assignment of low income enrollees into plans. Removing this distortion could reduce the cost of the program without worsening consumers' welfare. Using data from the the first five years of the program, an econometric model is used to estimate consumers demand for plans and to compute what premiums would be without the subsidy distortion. Preliminary estimates suggest that the reduction in premiums of affected plans would be substantial.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130610181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This statistical note compares insurance coverage rates and poor health status rates for self-employed working-age individuals to non-self-employed working-age individuals. Results are presented for two different age categories holding marital status constant.
{"title":"Statistical Note # 2: An Analysis of Insurance Coverage and Health Status for Self-Employed Working-Age Individuals","authors":"David P. Bernstein","doi":"10.2139/ssrn.1563525","DOIUrl":"https://doi.org/10.2139/ssrn.1563525","url":null,"abstract":"This statistical note compares insurance coverage rates and poor health status rates for self-employed working-age individuals to non-self-employed working-age individuals. Results are presented for two different age categories holding marital status constant.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117280148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This note uses data from the Household Component of the Medical Expenditures Panel Survey (MEPS-HC) for 1999 and 2006 to examine trend growth in household out-of-pocket health expenditures. Tabulations are presented for three different categories of insurance coverage - households where the household head has full-year coverage, households where the household head has part-year coverage, and households where the household head has no coverage. Tabulations are presented for the general working-age U.S. civilian non-institutional population and for the sub-population of households with at least one member with an overnight hospital stay. The results reveal an increase in the number of households with large out-of-pocket expenses, which is especially pronounced for households with at least one member with an overnight hospital stay.
{"title":"Statistical Note #1 Changes in Out-of-Pocket Expenses by Insurance Category (1999 to 2006)","authors":"David P. Bernstein","doi":"10.2139/ssrn.1521729","DOIUrl":"https://doi.org/10.2139/ssrn.1521729","url":null,"abstract":"This note uses data from the Household Component of the Medical Expenditures Panel Survey (MEPS-HC) for 1999 and 2006 to examine trend growth in household out-of-pocket health expenditures. Tabulations are presented for three different categories of insurance coverage - households where the household head has full-year coverage, households where the household head has part-year coverage, and households where the household head has no coverage. Tabulations are presented for the general working-age U.S. civilian non-institutional population and for the sub-population of households with at least one member with an overnight hospital stay. The results reveal an increase in the number of households with large out-of-pocket expenses, which is especially pronounced for households with at least one member with an overnight hospital stay.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131444035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets that control adverse selection and assure adequate access and coverage. We model Part D enrollment and plan choice assuming a discrete dynamic decision process that maximizes life-cycle expected utility, and perform counterfactual policy simulations of the effect of market design on participation and plan viability. Our model correctly predicts high Part D enrollment rates among the currently healthy, but also strong adverse selection in choice of level of coverage. We analyze alternative designs that preserve plan variety.
{"title":"Regulation of Private Health Insurance Markets: Lessons from Enrollment, Plan Type Choice, and Adverse Selection in Medicare Part D","authors":"Florian Heiss, D. McFadden, J. Winter","doi":"10.3386/W15392","DOIUrl":"https://doi.org/10.3386/W15392","url":null,"abstract":"We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets that control adverse selection and assure adequate access and coverage. We model Part D enrollment and plan choice assuming a discrete dynamic decision process that maximizes life-cycle expected utility, and perform counterfactual policy simulations of the effect of market design on participation and plan viability. Our model correctly predicts high Part D enrollment rates among the currently healthy, but also strong adverse selection in choice of level of coverage. We analyze alternative designs that preserve plan variety.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128620253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Irish health care system is unusual in that there is no subsidy for access to GP services for the majority of the population. Further a high proportion of the population has subsidised and supplementary private medical insurance. Current financial incentives and flows of subsidisation between the public and private sectors produce some odd features. Careful analysis of these financing mechanisms shows extensive inequities, with those on low incomes, but above the tax threshold, being the worst off. Further, the inequities and inefficiencies have been perpetuated by a lack of transparency in the health financing system. The authors explore the case for change and the options for Social Health Insurance (SHI) design that would be most relevant for the Irish health care system. Four possible scenarios for SHI are set out to improve equity and efficiency. The models vary according to the improved access that they give their members in terms of Primary Health Care, private/semi-private hospital beds and access to consultants. At one extreme, the levelling up (Rolls Royce) option provides hospital care on a par with what is currently available through private insurance and free GP access. At the other, the 'Mini' option reduces the cost of access to GPs and lowers public sector hospital charges for the uncovered population. Drawing on data from public accounts and the private insurance industry, the authors review the resource implications of these scenarios, with and without efficiency gains. Costs range from 2.2 billion to 380 million (or from an additional 1.5% to 0.3% of GDP). The authors also analyse the potential financing mechanisms. The additional payments for the options would range from 6.0% of taxable income for the Rolls Royce option to only 2.5% for the priority PHC option and 1.1% for the Mini. With efficiency gains these rates would reduce so that the Mini option pays for itself. Finally the authors explore the issues of transition and implementation, noting the institutional, stakeholder and capacity bottlenecks which currently exist.
{"title":"Addressing Inequities in the Irish Health Care System Through Social Health Insurance","authors":"S. Thomas, C. Normand, Samantha Smith","doi":"10.2139/ssrn.993750","DOIUrl":"https://doi.org/10.2139/ssrn.993750","url":null,"abstract":"The Irish health care system is unusual in that there is no subsidy for access to GP services for the majority of the population. Further a high proportion of the population has subsidised and supplementary private medical insurance. Current financial incentives and flows of subsidisation between the public and private sectors produce some odd features. Careful analysis of these financing mechanisms shows extensive inequities, with those on low incomes, but above the tax threshold, being the worst off. Further, the inequities and inefficiencies have been perpetuated by a lack of transparency in the health financing system. The authors explore the case for change and the options for Social Health Insurance (SHI) design that would be most relevant for the Irish health care system. Four possible scenarios for SHI are set out to improve equity and efficiency. The models vary according to the improved access that they give their members in terms of Primary Health Care, private/semi-private hospital beds and access to consultants. At one extreme, the levelling up (Rolls Royce) option provides hospital care on a par with what is currently available through private insurance and free GP access. At the other, the 'Mini' option reduces the cost of access to GPs and lowers public sector hospital charges for the uncovered population. Drawing on data from public accounts and the private insurance industry, the authors review the resource implications of these scenarios, with and without efficiency gains. Costs range from 2.2 billion to 380 million (or from an additional 1.5% to 0.3% of GDP). The authors also analyse the potential financing mechanisms. The additional payments for the options would range from 6.0% of taxable income for the Rolls Royce option to only 2.5% for the priority PHC option and 1.1% for the Mini. With efficiency gains these rates would reduce so that the Mini option pays for itself. Finally the authors explore the issues of transition and implementation, noting the institutional, stakeholder and capacity bottlenecks which currently exist.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130006154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Using a multivariate framework, we analyze recent trends in employer provision of retiree health insurance (RHI), eligibility for new retirees, and retiree contribution requirements. We also explore whether local labor market characteristics such as the unemployment rate influence RHI provision. Finally, we examine whether the Medicare Modernization Act (MMA) was associated with diverging trends in RHI access for Medicare-eligible and early retirees. Data come for the Medical Expenditure Panel Survey—Insurance Component (MEPS-IC). We find that, while RHI provision to existing retirees remained stable, eligibility for new retirees declined, and contribution requirements increased between 2000 and 2004. The local labor market had no effect on RHI provision. While early retiree coverage was more common than coverage for Medicare-eligible retirees, we did not find a divergence subsequent to MMA. These results suggest growing financial instability for retirees, both because RHI contribution requirements increased, and because businesses dropped coverage for new retirees.
{"title":"Older Workers' Access to Employer-Sponsored Retiree Health Insurance, 2000-2004","authors":"C. Eibner, Alice M. Zawacki, Elaine M. Zimmerman","doi":"10.2139/ssrn.1015616","DOIUrl":"https://doi.org/10.2139/ssrn.1015616","url":null,"abstract":"Using a multivariate framework, we analyze recent trends in employer provision of retiree health insurance (RHI), eligibility for new retirees, and retiree contribution requirements. We also explore whether local labor market characteristics such as the unemployment rate influence RHI provision. Finally, we examine whether the Medicare Modernization Act (MMA) was associated with diverging trends in RHI access for Medicare-eligible and early retirees. Data come for the Medical Expenditure Panel Survey—Insurance Component (MEPS-IC). We find that, while RHI provision to existing retirees remained stable, eligibility for new retirees declined, and contribution requirements increased between 2000 and 2004. The local labor market had no effect on RHI provision. While early retiree coverage was more common than coverage for Medicare-eligible retirees, we did not find a divergence subsequent to MMA. These results suggest growing financial instability for retirees, both because RHI contribution requirements increased, and because businesses dropped coverage for new retirees.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115354680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Insurance-based schemes for the financing of health care systems in developing countries face the structural challenge of labor-market informality. Neither community financing schemes nor supply-side subsidies seem to guarantee access to health care by the most vulnerable groups. But the expansion of subsidized insurance also implies higher pressures on social expenditure. This article is a review of the literature on this topic. It explores international experiences of the above mentioned types, and analyzes their relevance for Colombia.(La financiacion de los sistemas de salud en los paises en desarrollo mediante esquemas de aseguramiento, presenta el desafio estructural de la informalidad de los mercados laborales. Ni el esquema de financiamiento comunitario ni el del subsidio a la oferta, parecen ofrecer una garantia de acceso a los grupos mas vulnerables. Pero la extension de esquemas de seguro subsidiado tambien implica mayores presiones sobre el gasto social. Este articulo es una revision de la literatura sobre el tema, en el cual se revisan experiencias internacionales de los tipos mencionados, y se analiza su relevancia para Colombia.)
发展中国家以保险为基础的卫生保健系统融资计划面临劳动力市场非正规性的结构性挑战。社区筹资计划和供应方补贴似乎都不能保证最弱势群体获得保健服务。但补贴保险的扩大也意味着社会支出的压力加大。本文对这一主题的文献进行了综述。它探讨了上述类型的国际经验，并分析了它们对哥伦比亚的相关性。(1)《农业系统的财务状况》、《农业系统的财务状况》、《农业系统的财务状况》、《农业系统的财务状况》、《农业系统的财务状况》、《农业系统的财务状况》、《农业系统的财务状况》、《农业系统的财务状况》。“金融服务共同体”是指“金融服务共同体”，即“金融服务共同体”，即“金融服务共同体”，即“金融服务共同体”。Pero la extension de esquemas de seguro subsidiado tambien implicores presiones sobergasto social。这些文章包括对有关国家的文献的修订，包括对有关国家的国际经验的修订，以及对哥伦比亚相关情况的分析。
{"title":"Insurance for Poor People: A Tool for Financial Protection (Aseguramiento Para La Población Pobre: Una Herramienta De Protección Financiera)","authors":"R. A. Castaño, A. Zambrano","doi":"10.2139/SSRN.1541945","DOIUrl":"https://doi.org/10.2139/SSRN.1541945","url":null,"abstract":"Insurance-based schemes for the financing of health care systems in developing countries face the structural challenge of labor-market informality. Neither community financing schemes nor supply-side subsidies seem to guarantee access to health care by the most vulnerable groups. But the expansion of subsidized insurance also implies higher pressures on social expenditure. This article is a review of the literature on this topic. It explores international experiences of the above mentioned types, and analyzes their relevance for Colombia.(La financiacion de los sistemas de salud en los paises en desarrollo mediante esquemas de aseguramiento, presenta el desafio estructural de la informalidad de los mercados laborales. Ni el esquema de financiamiento comunitario ni el del subsidio a la oferta, parecen ofrecer una garantia de acceso a los grupos mas vulnerables. Pero la extension de esquemas de seguro subsidiado tambien implica mayores presiones sobre el gasto social. Este articulo es una revision de la literatura sobre el tema, en el cual se revisan experiencias internacionales de los tipos mencionados, y se analiza su relevancia para Colombia.)","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129177883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：