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on Insurance Economics |
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Issue of 2019‒03‒25
twenty papers chosen by Soumitra K. Mallick Indian Institute of Social Welfare and Business Management |
| By: | Michael Levere; Sean Orzol; Lindsey Leininger; Nancy Early |
| Abstract: | We assess how increased Medicaid generosity affects participation in SSI. In states where SSI recipients did not automatically receive Medicaid, expansions in public health insurance coverage significantly decreased applications and awards. In the long-term, increased Medicaid eligibility during childhood reduced young adult SSI applications. |
| Keywords: | SSI, CHIP, health insurance, substitution |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:67a953064cf54167b1a9cb5f100fdca2&r=all |
| By: | Jody Schimmel; David C. Stapleton; Jae Song |
| Abstract: | Anecdotal evidence suggests that Social Security Disability Insurance (SSDI) beneficiaries intentionally restrain, or “park,†their earnings at a level below substantial gainful activity to retain cash benefits. |
| Keywords: | Social Security Disability Insurance , Earnings Level , SSI DI Beneficiaries |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:30507ff0bc3a4fc6abbb01646aad3385&r=all |
| By: | Andreeva, Andriyana; Yolova, Galina |
| Abstract: | Резюме. В доклада се анализират особеностите при защитата правата на осигурените лица в доброволното осигуряване, в качеството им на потребители на услуги по застраховане и лично пенсионно осигуряване. Способите за защита на лицата предвид специалният закон – Кодекса за социално осигуряване се анализират на две основни нива. От една страна, с оглед особеностите на осигурителния договор и предоставените от него възможности, а от друга - предвид законовите механизми и методите за въздействие на потребителите при представителност на интересите им в съответните органи. На база на анализа се правят изводи и препоръки по приложението на нормите. Abstract. The report analyzes the peculiarities of the protection of the rights of the insured persons in the voluntary insurance as consumers of insurance and personal pension insurance services. The ways of protecting individuals under the special law - the Social Security Code are analyzed at two main levels. On the one hand, given the particularities of the insurance contract and the opportunities it provides, and on the other hand, given the legal mechanisms and methods of impact of the consumers in the representation of their interests in the respective bodies. On the basis of the analysis, conclusions and recommendations on the application of the norms are made. |
| Keywords: | insurance, voluntary pension insurance, pension insurance companies, insured persons |
| JEL: | K31 |
| Date: | 2018 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:92819&r=all |
| By: | Sheila Hoag; Mary Harrington; Cara Orfield; Victoria Peebles; Kimberly Smith; Adam Swinburn; Matthew Hodges; Kenneth Finegold; Sean Orzol; Wilma Robinson |
| Abstract: | This interim report, the first of two reports to Congress, uses qualitative and quantitative data to document the development of the Children's Health Insurance Program (CHIP), particularly focusing on changes states have made since Congress reauthorized CHIP in 2009. |
| Keywords: | CHIPRA , Children's Health Insurance Program , Health |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:41c9d6ac8ddc4286910305b7ab5caded&r=all |
| By: | Allison Hamblin; James Verdier; Melanie Au |
| Abstract: | This brief explores promising state options for integrating physical and behavioral health services for high-need, high-cost Medicaid populations within a variety of care management delivery systems. |
| Keywords: | Medicaid, Care Coordination, Physical Health Services, Behavioral Health Services |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:389429acbfc14deeb98981634e5adfa9&r=all |
| By: | Michael P. Keane; Jonathan D. Ketcham; Nicolai V. Kuminoff; Timothy Neal |
| Abstract: | We propose new methods to model behavior and conduct welfare analysis in complex environments where some choices are unlikely to reveal preferences. We develop a mixture-of-experts model that incorporates heterogeneity in consumers’ preferences and in their choice processes. We also develop a method to decompose logit errors into latent preferences versus optimization errors. Applying these methods to Medicare beneficiaries’ prescription drug insurance choices suggests that: (1) average welfare losses from suboptimal choices are small, (2) beneficiaries with dementia and depression have larger losses, and (3) policies that simplify choice sets offer small average benefits, helping some people but harming others. |
| JEL: | C25 D9 I13 |
| Date: | 2019–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25652&r=all |
| By: | Abrahamsen, Signe A. (University of Bergen, Department of Economics); Grøtting, Maja Weemes (Norwegian Social Research, Oslo Metropolitan University) |
| Abstract: | Health-care expenditures and the demand for caregiving are increasing concerns for policy makers. Although informal care to a certain extent may substitute for costly formal care, providing informal care may come at a cost to caregivers in terms of their own health. However, evidence of causal effects of care responsibilities on health is limited, especially for long-term outcomes. In this paper, we estimate long-term effects of a formal care expansion for the elderly on the health of their middle-aged daughters. We exploit a reform in the federal funding of formal care for Norwegian municipalities that caused a greater expansion of home care provision in municipalities that initially had lower coverage rates. We find that expanding formal care reduced sickness absence in the short run, primarily due to reduced absences related to musculoskeletal and psychological disorders. In general, we find no effects on long-term health outcomes. |
| Keywords: | Formal and informal eldercare; sickness absence; health |
| JEL: | I10 J14 J22 J38 |
| Date: | 2019–01–25 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:bergec:2019_002&r=all |
| By: | Pierre Cahuc (Département d'économie); Sandra Nevoux (Banque de France) |
| Abstract: | This paper shows that the reforms which expanded short-time work in France after the great 2008-2009 recession were largely to the benefit of large firms which are recurrent short-time work users. We argue that this expansion of short-time work is an inefficient way to provide insurance to workers, as it entails cross-subsidies which reduce aggregate production. An efficient policy should provide unemployment insurance benefits funded by experience rated employers’ contributions instead of short-time work benefits. We find that short-time work entails significant production losses compared to an unemployment insurance scheme with experience rating. |
| Keywords: | Short-time work; Unemployment insurance; Experience rating |
| JEL: | J63 J65 |
| Date: | 2019–03 |
| URL: | http://d.repec.org/n?u=RePEc:spo:wpmain:info:hdl:2441/68ufmnnh3j9vmblf03huqt18qe&r=all |
| By: | Pierre Cahuc (Département d'économie); Sandra Nevoux (Banque de France) |
| Abstract: | This paper shows that the reforms which expanded short-time work in France after the great 2008-2009 recession were largely to the benefit of large firms which are recurrent short-time work users. We argue that this expansion of short-time work is an inefficient way to provide insurance to workers, as it entails cross-subsidies which reduce aggregate production. An efficient policy should provide unemployment insurance benefits funded by experience rated employers’ contributions instead of short-time work benefits. We find that short-time work entails significant production losses compared to an unemployment insurance scheme with experience rating. |
| Keywords: | Short-time work; Unemployment insurance; Experience rating |
| JEL: | J63 J65 |
| Date: | 2019–03 |
| URL: | http://d.repec.org/n?u=RePEc:spo:wpecon:info:hdl:2441/68ufmnnh3j9vmblf03huqt18qe&r=all |
| By: | Youssef Benzarti; Jarkko Harju; Tuomas Matikka |
| Abstract: | This paper estimates the effect of relaxing the social insurance mandate on entrepreneurial activity. We use a unique discontinuity in Finland that allows certain entrepreneurs not to pay social insurance contributions on their income. Using rich administrative data, we find that relaxing the social insurance mandate leads entrepreneurs to significantly reduce their contributions, which they channel instead into their firms. While young firms use this windfall to increase business activity, older ones use it to improve their net lending position by purchasing stocks. Our results imply that the social insurance mandate is binding and its efficiency cost is heterogeneous. |
| JEL: | H25 H32 H55 |
| Date: | 2019–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:25651&r=all |
| By: | Marsha Gold; Gretchen Jacobson; Anthony Damico; Tricia Neuman |
| Abstract: | This Data Spotlight reviews trends in Medicare Advantage plan offerings, choices available to beneficiaries, and the premiums and selected characteristics of the available plans in 2012. |
| Keywords: | Medicare Advantage , Plan Availability , Premiums , Fee-for-Service |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:1a999e2c53fa4b7a9c1d61cf1ef7be68&r=all |
| By: | Helen Levy (University of Michigan); Thomas Buchmueller (University of Michigan); Sayeh Nikpay (Vanderbilt University Medical Center) |
| Abstract: | We analyze whether the Affordable Care Act (ACA) has affected labor supply of older Americans using data that span more than four years after the policy’s implementation in 2014. We find no changes in labor supply of older Americans either in response to subsidized marketplace coverage, which became available nationally in 2014, or in response to the expansion of Medicaid eligibility in some states but not others. We analyze multiple dimensions of labor supply — labor force participation; employment; full-time work conditional on employment — as well as several measures of retirement including self-reported retirement and the receipt of retirement income. We fail to find labor supply effects even for subgroups with less than a high school education or those with fair or poor health, who might have been expected to have a greater labor supply response. The lack of a labor supply response stands in contrast to the large gains in coverage observed in 2014. These results suggest that for Americans approaching retirement the Affordable Care Act achieved its primary goal of increasing coverage without the unintended consequence of reducing labor supply. |
| Date: | 2018–09 |
| URL: | http://d.repec.org/n?u=RePEc:mrr:papers:wp393&r=all |
| By: | Various Authors |
| Abstract: | This final report describes how the AMS is constructed and how the AMS detects meaningful signals of change in access. |
| Keywords: | AMS, Access Monitoring System , Medicare Beneficiaries |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:d7db169763c647acb2e488c7b5b07651&r=all |
| By: | Cristina Belles-Obrero; Antonio Cabrales; Sergi Jimenez-Martin; Judit Vall-Castello |
| Abstract: | We explore the effects of a child labor regulation that changed the legal working age from 14 to 16 over the health of their offspring. We show that the reform was detrimental for the health of the son's of affected parents at delivery. Yet, in the medium run, the effects of the reform are insignificant for both male and female children. The sons of treated mothers are perceived as still having worse health at older ages, even if their objective health status has recovered. These boys are also more likely to have private health insurance, which suggests more concerned mothers. |
| Date: | 2019–01 |
| URL: | http://d.repec.org/n?u=RePEc:fda:fdaddt:2019-02&r=all |
| By: | Ahelegbey, Daniel Felix; Giudici, Paolo |
| Abstract: | We proposes a two-layered tree network model that decomposes financial contagion into a global component, composed of inter-country contagion effects, and a local component, made up of inter-institutional contagion channels. The model is effectively applied to a database containing time series of daily CDS spreads of major European financial institutions (banks and insurance companies), and reveals the importance monitoring both channels to assess financial contagion. The empirical application revealed evidence of a high inter-country and inter-institutional vulnerability at the onset of the global financial crisis in 2008 and during the sovereign crisis in 2011. The result further identifies Belgium and France as central to the inter-country contagion in the Euro area during the financial crisis, while Italy dominated during the sovereign crisis. The French corporates Groupama, Credit Industriel and Caisse d'Epargne were central in the inter-institutional contagion in both crises. |
| Keywords: | Financial Crisis, Graphical Lasso, Inter-Country Contagion, Inter-Institutional Contagion, Sovereign Crisis, Sparse Covariance Selection |
| JEL: | C38 G01 G2 |
| Date: | 2019–01–28 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:92632&r=all |
| By: | Cole, A.; Towse, A.; Segal, C.S; Henshall, C.; Pearson, S.D |
| Abstract: | OHE Research Paper 19/02 - The combination of rising drug costs in the US and increasing financial stress for individual patients has triggered intense national concern. One target has come under particular scrutiny - rebates. This paper describes how alternatives to the current US rebate system offer potential risks or disadvantages as well as potential benefits. It outlines the evidence presented to date, and the key questions that still need to be answered. Rebates are a key negotiating tool for payers and help produce a lower "net" price for drugs that can help reduce the overall costs of drug spending. But for many years the PBM business model has included a revenue stream gained by retaining a percent of the absolute rebate amount they return to plan sponsors. The effect of rebates in lowering net prices may reduce plan sponsor costs and therefore help moderate the cost of insurance premiums for all plan members. However, some plan sponsors have suggested that the profitability of the rebate model provides an incentive for PBMs to prioritize high-rebate drugs that might not have the lowest net cost for the plan sponsor. All would agree that higher list prices hurt many patients who need ongoing drug treatment, since the increase in the use of co-insurance and of high-deductible plans has meant that rising numbers of patients are required to pay their out-of-pocket share for drug coverage in relation to the list price, not the negotiated rebate price. There are three major alternative options to the current rebate model. The first two options represent rebate "reform" and may be implemented separately or, as many have argued, combined, but it is important for policy makers to consider the potential advantages and disadvantages of each element separately. The third option would involve eliminating rebates and moving exclusively to a system of upfront discounts. Taking stock of the options for alternative rebate models, each with its own potential advantages and disadvantages, most stakeholders in the health care system realize that some form of change to the current paradigm of rebates is both needed and inevitable. But the way forward is fraught with risk and uncertainty, with deep trade-offs between short-term feasibility and long-term goals evident at every step. In preparing the paper the authors undertook a focused literature review and evaluated the written responses to the HHS Blueprint on drug pricing from key stakeholders, including all participants in the ICER membership program. Ten interviews were conducted covering PBMs, public and private payers, manufacturers, academics, benefit consultants, and trade associations. An earlier version of this White Paper was sent out as a pre-read for the ICER members Policy Summit. This version of the paper takes account of the discussion at that meeting. Please cite this report as - Cole, A., Towse, A., Segel C.S., Henshall, C., Pearson, S.D. Value, Access, and Incentives for Innovation - Policy Perspectives on Alternative Models for Pharmaceutical Rebates. Institute for Clinical and Economic Review and the Office of Health Economics. Available [here]( https://www.ohe.org/system/files/private /publications/Cole%20et%20al.%20%20ICER% 20OHE%20White%20Paper%20on%20Rebates.pdf ). |
| Keywords: | Other |
| JEL: | I1 |
| Date: | 2019–03–01 |
| URL: | http://d.repec.org/n?u=RePEc:ohe:respap:002139&r=all |
| By: | ALBANESE Andrea; GHIRELLI Corinna; PICCHIO Matteo |
| Abstract: | We study how unemployment benefit eligibility affects the layoff exit rate by exploiting quasi-experimental variation in eligibility rules in Italy. By using a difference-in-differences estimator, we find an instantaneous increase of about 12% in the layoff probability when unemployment benefit eligibility is attained, which persists for about 16 weeks. These findings are robust to different identifying assumptions and are mostly driven by jobs started after the onset of the Great Recession, in the South and for small firms. We argue that the moral hazard from the employer's side is the main force driving these layoffs. |
| Keywords: | Unemployment insurance; layoffs; employer-employee moral hazard; difference-in-differences; heterogeneous effects |
| JEL: | C31 C41 J21 J63 J65 |
| Date: | 2019–03 |
| URL: | http://d.repec.org/n?u=RePEc:irs:cepswp:2019-04&r=all |
| By: | Albanese, Andrea (LISER); Ghirelli, Corinna (Bank of Spain); Picchio, Matteo (Università Politecnica delle Marche, Ancona) |
| Abstract: | We study how unemployment benefit eligibility affects the layoff exit rate by exploiting quasi-experimental variation in eligibility rules in Italy. By using a difference-indifferences estimator, we find an instantaneous increase of about 12% in the layoff probability when unemployment benefit eligibility is attained, which persists for about 16 weeks. These findings are robust to different identifying assumptions and are mostly driven by jobs started after the onset of the Great Recession, in the South and for small firms. We argue that the moral hazard from the employer's side is the main force driving these layoffs. |
| Keywords: | unemployment insurance, layoffs, employer-employee moral hazard, difference-in-differences, heterogeneous effects |
| JEL: | C31 C41 J21 J63 J65 |
| Date: | 2019–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12171&r=all |
| By: | Ashish K. Jha; Matthew F. Burke; Catherine DesRoches; Maulik S. Joshi; Peter D. Kralovec; Eric G. Campbell; Melinda B. Buntin |
| Abstract: | This article found that more than 15 percent of U.S. hospitals have adopted at least a basic electronic health record (EHR), representing nearly 75 percent growth since 2008. |
| Keywords: | Electronic Health Records, Hospitals , HIT , Health |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:d926cb2d284c44088cf4302f4fe9436e&r=all |
| By: | Cesur, Resul (University of Connecticut); Gunes, Pinar Mine (University of Alberta); Tekin, Erdal (American University); Ulker, Aydogan (Deakin University) |
| Abstract: | This paper examines the effect of a nationwide healthcare reform implemented in Turkey on women's fertility decisions. The Family Medicine Program (FMP), introduced in 2005, provided a wide-range of primary healthcare services, free of charge, and achieved universal access by matching each citizen to a specific family physician, who operates at neighborhood clinics, called Family Health Centers, on a walk-in basis. Although reducing fertility was not specified among the goals of the reform, reproductive-health and family-planning services have been covered under the FMP. To establish causality, we exploit the staggered rollout of the FMP implementation across Turkish provinces over time using a difference-in-differences estimation strategy. Our estimates indicate that the FMP significantly reduced childbearing among both teenagers and women ages 20-29. These results can be explained by increased access to and reduced cost of reproductive-health and family-planning services. However, the patterns in which the program effect has evolved over time differs between the two groups of women in a way that provides additional insights about the mechanisms. For teenagers, the FMP had a direct effect on childbearing, reflected by an immediate and rapidly-increasing pattern, which is not surprising given the broad agreement about the negative consequences of teenage childbearing among government and public health officials, including those in Turkey. For women ages 20-29, however, the program had a gradual and slowly-increasing effect, which is consistent with an empowerment channel. This should be interpreted as an unintended consequence of the program because, if anything, Turkey is a country where the government's position is to encourage fertility behavior and discourage birth control practices among women at prime childbearing ages. |
| Keywords: | fertility, childbearing, healthcare, Turkey, health, insurance |
| JEL: | I13 J13 |
| Date: | 2019–02 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp12186&r=all |