During the last two decades, the treatment of infertility has improved dramatically. These treatments, however, are expensive and rarely covered by insurance, leading many states to adopt regulations mandating that health insurers cover them. In this paper, we explore the effects of benefit mandates on the utilization and outcomes of infertility treatments. We find that use of infertility treatments is significantly greater in states adopting comprehensive versions of these mandates. While greater utilization had little impact on the number of deliveries, mandated coverage was associated with a relatively large increase in the probability of a multiple birth. For relatively low fertility patients who responded to the expanded insurance coverage, treatment was often unsuccessful and did not result in a live birth. For relatively high fertility patients, in contrast, treatment often led to a multiple, rather than a singleton, birth. We also find evidence that the beneficial effects on the intensive treatment margin that have been proposed in other studies are relatively small. We conclude that, while benefit mandates potentially solve a problem of adverse selection in this market, these benefits must be weighed against the costs of the significant moral hazard in utilization they induce.
{"title":"Mandated Health Insurance Benefits and the Utilization and Outcomes of Infertility Treatments","authors":"M. Bundorf, M. Henne, L. Baker","doi":"10.3386/W12820","DOIUrl":"https://doi.org/10.3386/W12820","url":null,"abstract":"During the last two decades, the treatment of infertility has improved dramatically. These treatments, however, are expensive and rarely covered by insurance, leading many states to adopt regulations mandating that health insurers cover them. In this paper, we explore the effects of benefit mandates on the utilization and outcomes of infertility treatments. We find that use of infertility treatments is significantly greater in states adopting comprehensive versions of these mandates. While greater utilization had little impact on the number of deliveries, mandated coverage was associated with a relatively large increase in the probability of a multiple birth. For relatively low fertility patients who responded to the expanded insurance coverage, treatment was often unsuccessful and did not result in a live birth. For relatively high fertility patients, in contrast, treatment often led to a multiple, rather than a singleton, birth. We also find evidence that the beneficial effects on the intensive treatment margin that have been proposed in other studies are relatively small. We conclude that, while benefit mandates potentially solve a problem of adverse selection in this market, these benefits must be weighed against the costs of the significant moral hazard in utilization they induce.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133516700","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}
Pub Date : 2003-11-01DOI: 10.1111/j.1468-2354.2008.00487.x
D. Blau, Donna B. Gilleskie
Using data from the Health and Retirement Survey, we estimate preference and expectations parameters of a structural model of the employment and medical care decisions of older men in order to evaluate the role of health insurance. The budget constraint incorporates detailed cost-sharing characteristics of private health insurance and Medicare as well as rules and requirements associated with Social Security and private pensions. Simulations imply that changes in health insurance, including access and restrictions to retiree health insurance and Medicare, have a modest impact on employment behavior among older males, with the greatest effect on men in bad health.
{"title":"The Role of Retiree Health Insurance in the Employment Behavior of Older Men","authors":"D. Blau, Donna B. Gilleskie","doi":"10.1111/j.1468-2354.2008.00487.x","DOIUrl":"https://doi.org/10.1111/j.1468-2354.2008.00487.x","url":null,"abstract":"Using data from the Health and Retirement Survey, we estimate preference and expectations parameters of a structural model of the employment and medical care decisions of older men in order to evaluate the role of health insurance. The budget constraint incorporates detailed cost-sharing characteristics of private health insurance and Medicare as well as rules and requirements associated with Social Security and private pensions. Simulations imply that changes in health insurance, including access and restrictions to retiree health insurance and Medicare, have a modest impact on employment behavior among older males, with the greatest effect on men in bad health.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"118639716","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 article examines the relationship between adverse selection and the capped premium subsidy in the Federal Employees Health Benefit Program (FEHBP). Understanding this relationship is important, not only because the FEHBP is the largest employer-sponsored health program in the United States, but also because it has been proposed as a market-based model for the reform of both Medicare and the market for nongroup private coverage. We present a theoretical model of the FEHBP that we then test using enrollee data. In particular, we exploit the natural experiment that arises from variation in the premium subsidy cap across Metropolitan Statistical Areas (MSAs). Although the nominal subsidy cap is constant across MSAs, its real value varies greatly across MSAs with different price levels. The empirical analysis herein supports the contention that the premium subsidy in the FEHBP helps reduce adverse selection.
{"title":"Adverse Selection and the Capped Premium Subsidy in the Federal Employees Health Benefits Program","authors":"B. Gray, T. Selden","doi":"10.1111/1539-6975.00015","DOIUrl":"https://doi.org/10.1111/1539-6975.00015","url":null,"abstract":"This article examines the relationship between adverse selection and the capped premium subsidy in the Federal Employees Health Benefit Program (FEHBP). Understanding this relationship is important, not only because the FEHBP is the largest employer-sponsored health program in the United States, but also because it has been proposed as a market-based model for the reform of both Medicare and the market for nongroup private coverage. We present a theoretical model of the FEHBP that we then test using enrollee data. In particular, we exploit the natural experiment that arises from variation in the premium subsidy cap across Metropolitan Statistical Areas (MSAs). Although the nominal subsidy cap is constant across MSAs, its real value varies greatly across MSAs with different price levels. The empirical analysis herein supports the contention that the premium subsidy in the FEHBP helps reduce adverse selection.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"119524411","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}
Pub Date : 1995-06-01DOI: 10.7208/9780226241906-009
J. Gruber, J. Poterba
This paper investigates the current tax subsidy to employer- provided health insurance, and presents new evidence on the economic effects of various tax reforms. It argues that previous analyses have overstated the tax subsidy to employer-provided insurance by neglecting the substantial and growing importance of after-tax employee payments for employer-provided insurance, as well as the tax subsidy for extreme medical expenses, which discourages insurance purchase. Even after considering these factors, however, the net tax subsidy to employer-provided insurance is substantial, with tax factors generating an average reduction of approximately thirty percent in the price of this insurance. Reducing the tax subsidy, either by capping the value of employer-provided health insurance that could be excluded from taxation, or eliminating the exclusion entirely, would have substantial effects on the level of employer- provided insurance and on tax revenues.
{"title":"Tax Subsidies to Employer-Provided Health Insurance","authors":"J. Gruber, J. Poterba","doi":"10.7208/9780226241906-009","DOIUrl":"https://doi.org/10.7208/9780226241906-009","url":null,"abstract":"This paper investigates the current tax subsidy to employer- provided health insurance, and presents new evidence on the economic effects of various tax reforms. It argues that previous analyses have overstated the tax subsidy to employer-provided insurance by neglecting the substantial and growing importance of after-tax employee payments for employer-provided insurance, as well as the tax subsidy for extreme medical expenses, which discourages insurance purchase. Even after considering these factors, however, the net tax subsidy to employer-provided insurance is substantial, with tax factors generating an average reduction of approximately thirty percent in the price of this insurance. Reducing the tax subsidy, either by capping the value of employer-provided health insurance that could be excluded from taxation, or eliminating the exclusion entirely, would have substantial effects on the level of employer- provided insurance and on tax revenues.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1995-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127758345","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 Medicaid program can improve the access of Medicaid patients in nursing home care by raising the rate of return on Medicaid patients care. However, increases in the return also induce nursing homes to lower quality. To quantify this tradeoff, the author derives expressions for three elasticities: (1) the elasticity of access with respect to Medicaid expenditures, (2) the elasticity of access with respect to quality, and (3) the elasticity of Medicaid expenditures with respect to the rate of return. Using New York State data, he finds that a 10 percent increase in Medicaid expenditures induces a 4.1 percent increase in Medicaid patient care and a reduction in nursing home expenditures on services provided patients by about 3.4 percent. Copyright 1992 by MIT Press.
{"title":"Medicaid and the Cost of Improving Access to Nursing Home Care","authors":"P. Gertler","doi":"10.2307/2109668","DOIUrl":"https://doi.org/10.2307/2109668","url":null,"abstract":"The Medicaid program can improve the access of Medicaid patients in nursing home care by raising the rate of return on Medicaid patients care. However, increases in the return also induce nursing homes to lower quality. To quantify this tradeoff, the author derives expressions for three elasticities: (1) the elasticity of access with respect to Medicaid expenditures, (2) the elasticity of access with respect to quality, and (3) the elasticity of Medicaid expenditures with respect to the rate of return. Using New York State data, he finds that a 10 percent increase in Medicaid expenditures induces a 4.1 percent increase in Medicaid patient care and a reduction in nursing home expenditures on services provided patients by about 3.4 percent. Copyright 1992 by MIT Press.","PeriodicalId":237817,"journal":{"name":"HEN: Insurance (Topic)","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1989-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117004714","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}
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