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on Insurance Economics |
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Issue of 2017‒05‒07
eight papers chosen by Soumitra K. Mallick Indian Institute of Social Welfare and Business Management |
| By: | Johanna Catherine Maclean; Brendan Saloner |
| Abstract: | We examine the early effects of U.S. state Medicaid expansions under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization. We couple administrative data on admissions to specialty SUD treatment and prescriptions for medications used to treat SUDs in outpatient settings with a differences-in-differences design. We find no evidence that admissions to specialty treatment changed in expanding states relative to non-expending states. However, post expansion, Medicaid-reimbursed prescriptions for medications used to treat SUDs in outpatient settings increased by 33% in expanding states relative to non-expanding states. Among patients admitted to specialty SUD treatment, we find that in expanding states Medicaid insurance and use of Medicaid to pay for treatment increased by 58% and 57% following the expansion. In an extension to the main analyses we find no evidence that the expansions affected fatal alcohol poisonings or drug-related overdoses. Overall, our findings provide evidence on the early effects of the ACA on SUD treatment utilization with the newly-eligible Medicaid population. |
| JEL: | I1 I13 I18 |
| Date: | 2017–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23342&r=ias |
| By: | Courtemanche, Charles (Georgia State University); Marton, James (Georgia State University); Ukert, Benjamin (University of Pennsylvania); Yelowitz, Aaron (University of Kentucky); Zapata, Daniela (Impaq International) |
| Abstract: | The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre-ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both Medicaid expansion and non-expansion states, with the gains being larger in expansion states along some dimensions. No statistically significant effects on risky behaviors or self-assessed health emerge for the full sample. However, we find some evidence that the ACA improved self-assessed health among older non-elderly adults, particularly in expansion states. |
| Keywords: | Affordable Care Act, health insurance, Medicaid, health, obesity, smoking, drinking |
| JEL: | I12 I13 I18 |
| Date: | 2017–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp10649&r=ias |
| By: | Lansigan, Felino P.; Reano, Consorcia E.; Comia, Liza N.; Tandang, Nancy A.; Collado, Roselle V.; Reyes, James Roldan S.; Arana, Rachelyn S.; Roldan, Ronald Jr. R.; Marcelino, Rocky T.; Mendoza, Jared Jorim O.; Talento, Mara Sherlin D.; Gayosa, Edrun R.; Almero, Leonard Alan F. |
| Abstract: | The evaluation of the impact of agricultural insurance program of the Philippine Crop Insurance Corporation on coconut farmers in Region IV-A (CALABARZON) was conducted from October 2015 to July 2016. The main instrument for conducting impact evaluation was the Coconut Farmers Survey which covered the provinces of Batangas, Cavite, Laguna, and Quezon with a random sample of 500 coconut farmers. The 500 samples comprised the random sample of 250 matched pairs of coconut farmers. Each pair was composed of a farmer with insurance and a farmer without insurance. Farmers with insurance were classified further into two groups, namely, those with claims and those without claims. A proportional allocation scheme with groups and farm size as stratification variables was used. For each of the two insurance groups, three strata were formed defined according to farm size: Stratum 1 - 0.5 ha and below; Stratum 2 – greater than 0.5 to 1 ha; and Stratum 3 - greater than 1 ha. Farmer, farm, and household characteristics were obtained by interviewing the farmers using a structured survey questionnaire. The farmers cited the following: 1) adverse weather conditions, 2) low farm gate prices, and 3) pests and diseases as the three most important problems. Although the study was conducted to assess the impact of agricultural insurance, it was worth noting that a significant proportion of coconut farmers were not aware of existing programs such as crop insurance. The study revealed that lack of awareness among coconut farmers on the availability of insurance products was a big problem. Some of the farmers who have been granted free insurance were not aware that they were insured. Among the most common and important reasons for non-availment of crop insurance were the lack of awareness on the availability of crop insurance products, lack of information on how to process insurance documents, and the belief that there was no need for insurance. No significant differences in mean income from coconut production were observed between the two groups with insurance, with claims and without claims, across farm sizes 0.5 ha and below and greater than 0.5 to 1 ha. Significant differences were detected only for farmers with farm sizes greater than 1 ha. The results were consistent across 2014 and 2015. When pooled, no differences were obtained between the group with insurance and the group without insurance. Results showed that the only characteristic associated with whether or not the farmer is insured is if the farmer is keen on joining farmers' organizations. Although the farmers think that having insurance is advantageous, most farmers were not willing to pay any premium. |
| Keywords: | Philippines, impact evaluation, , Philippine Crop Insurance Corporation, crop insurance, agricultural insurance, coconut, PCIC, CALABARZON, coconut farmers |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2017-15&r=ias |
| By: | Fella, Giulio; Frache, Serafin; Koeniger, Winfried |
| Abstract: | We use the Italian Survey of Household Income and Wealth, a rather unique dataset with a long time dimension of panel information on consumption, income and wealth, to structurally estimate a buffer-stock saving model. We exploit the information contained in the joint dynamics of income, consumption and wealth to quantify the degree of insurance against income risk. The estimated model implies that Italian households can insure between 89 and 95 percent of a transitory and between 7 and 9 percent of a permanent income shock. Compared to existing empirical estimates for the same dataset, our findings suggest that Italian households do not have access to significant insurance beyond self-insurance. |
| Keywords: | Consumption,Wealth,Incomplete markets,Insurance |
| JEL: | D91 E21 |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:cfswop:570&r=ias |
| By: | Conrado, Vilma; Tuscano, Jocelyn; Oñate, Beatriz; Torio, Erwin; Umengan, Jane; Paat, Nina Klare |
| Abstract: | This study aims to evaluate the impact of agricultural insurance of the Philippine Crop Insurance Corporation (PCIC) on corn farmers in the Cagayan Valley Region, Philippines. A total of 500 corn farmers were classified into the following treatments: 250 corn farmers with insurance (118 with indemnity claims and 132 without indemnity claims) randomly taken from PCIC agricultural insurance subscribers for 2014 and 2015 matched with 250 without insurance from the Registry System for Basic Sectors in Agriculture list. These treatment groups were further divided according to farm size groups. Regression analysis was used to determine the demand on agricultural insurance and the t-test was used to test the difference on net farm income on corn production between treatment groups. The results show that the factors affecting the probability of PCIC insurance availment by corn farmers are farm size, government transfer income, adoption of hybrid variety, land tenure, and the distance of farmer to PCIC office. Farmers with crop insurance tend to have significantly higher adoption rate of hybrid variety than farmers without crop insurance. The larger the farm size, the higher the probability of getting insurance for their corn farms. Corn farmers who do not own the land they farm and those who received higher government transfers tend to have higher probability of getting agricultural insurance. Farmers with insurance with claim have significantly higher net incomes per hectare than those without insurance. When farmers were not grouped by farm size, farmers with insurance with claims have higher net incomes than farmers with insurance but without indemnity claims in 2014 and 2015. Similar result was found in large farms (greater than 1.0 ha) when farmers were grouped according to farm size. Therefore, there is significant impact of receiving indemnity claims on the net farm income of farmers in corn production. Hence, it is recommended that policies, programs, and efforts of the government and the PCIC be directed toward enhancing the factors that increase the availment of and review of indemnity coverage of agricultural insurance. |
| Keywords: | Philippines, impact evaluation, Philippine Crop Insurance Corporation, crop insurance, agricultural insurance, corn, PCIC, corn production, Cagayan Valley, Registry System for Basic Sectors in Agriculture |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:phd:dpaper:dp_2017-12&r=ias |
| By: | Conesa, Juan Carlos (Stony Brook University); Costa, Daniela (Federal Reserve Bank of Minneapolis); Kamali, Parisa (Federal Reserve Bank of Minneapolis); Kehoe, Timothy J. (Federal Reserve Bank of Minneapolis); Nygard, Vegard (Federal Reserve Bank of Minneapolis); Raveendranathan, Gajen (Federal Reserve Bank of Minneapolis); Saxena, Akshar (Harvard University) |
| Abstract: | This paper develops an overlapping generations model to study the macroeconomic effects of an unexpected elimination of Medicare. We find that a large share of the elderly respond by substituting Medicaid for Medicare. Consequently, the government saves only 46 cents for every dollar cut in Medicare spending. We argue that a comparison of steady states is insufficient to evaluate the welfare effects of the reform. In particular, we find lower ex-ante welfare gains from eliminating Medicare when we account for the costs of transition. Lastly, we find that a majority of the current population benefits from the reform but that aggregate welfare, measured as the dollar value of the sum of wealth equivalent variations, is higher with Medicare. |
| Keywords: | Medicare; Medicaid; Overlapping generations; Steady state; Transition path |
| JEL: | E21 E62 H51 I13 |
| Date: | 2017–04–27 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedmsr:548&r=ias |
| By: | Boyd Gilman; Laura Ruttner; Michaella Morzuch |
| Abstract: | The goal of this study was to assess the impact of providing enhanced Medicare payments to frontier clinics for extended stay services on the use and cost of emergency care. |
| Keywords: | Medicare, Rural Health, Ambulatory/Outpatient Care, Health Care Costs |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:2a69b7310a134a47b6671a767ce78f85&r=ias |
| By: | Margherita Borella (Institute for Fiscal Studies); Mariacristina De Nardi (Institute for Fiscal Studies and UCL, Federal Reserve Bank of Chicago, and NBER); Eric French (Institute for Fiscal Studies and IFS and UCL) |
| Abstract: | Medicaid is a government program that also provides health insurance to the old who have little assets and either low income or catastrophic health care expenses. We ask how the Medicaid rules map into the reality of Medicaid recipiency and what other observable characteristics are important to determine who ends up on Medicaid. The data show that both singles and couples with high retirement income can end up on Medicaid at very advanced ages. We find that, conditioning on a large number of observable characteristics, including those that directly relate to Medicaid eligibility criteria, single women are more likely to end up on Medicaid. So are non-whites, but, surprisingly, their higher recipiency is concentrated in the higher income percentiles. We also find that low-income people with a high school diploma or higher are much less likely to end up on Medicaid than their less educated counterparts. All of these effects are large and depend on retirement income in a very non-linear way. |
| Keywords: | Medicaid, elderly, permanent income |
| JEL: | H51 I13 I1 |
| Date: | 2017–04–12 |
| URL: | http://d.repec.org/n?u=RePEc:ifs:ifsewp:17/04&r=ias |