nep-ias New Economics Papers
on Insurance Economics
Issue of 2022‒01‒17
ten papers chosen by
Soumitra K. Mallick
Indian Institute of Social Welfare and Business Management

  1. The Cost of Health Insurance and Entry into Entrepreneurship By Fossen, Frank M.; Hossain, Mobarak; Mukhopadhyay, Sankar; Toth, Peter
  2. Understanding the Local-Level Predictors of Disability Program Flows: New Adult Awards and Beneficiary Work Activity By Jody Schimmel Hyde; Jonathan Schwabish; Paul O’Leary; Dara Lee Luca
  3. Testing for Ethnic Discrimination in Outpatient Health Care: Evidence from a Field Experiment in Germany By Halla, Martin; Kah, Christopher; Sausgruber, Rupert
  4. Access to education and disability insurance claims By Halapuu, Vivika
  5. Did the Affordable Care Act Affect Access to Medications for Opioid Use Disorder among the Already Insured? Evidence from the Rhode Island All-payer Claims Database By Mary A. Burke; Katherine Grace Carman; Riley Sullivan; Hefei Wen; James Frank Wharam; Hao Yu
  6. Robustness, Heterogeneous Treatment Effects and Covariate Shifts By Pietro Emilio Spini
  7. Testing identifying assumptions in fuzzy regression discontinuity designs By Yoichi Arai; Yu-Chin Hsu; Toru Kitagawa; Ismael Mourifié; Yuanyuan Wan
  8. Primary Care Practices Providing a Broader Range of Services Have Lower Medicare Expenditures and Emergency Department Utilization By Eugene Rich; Ann O’Malley; Claire Burkhart; Lisa Shang; Arkadipta Ghosh; Matthew Niedzwiecki
  9. Evaluation of the Independence at Home Demonstration: An Examination of the First Six Years By Laura Kimmey; Michael Anderson; Valerie Cheh; Jason Rotter; Andrea Wysocki
  10. Earnings dynamics of immigrants and natives in Sweden 1985–2016 By Friedrich, Benjamin; Laun, Lisa; Meghir, Costas

  1. By: Fossen, Frank M. (University of Nevada, Reno); Hossain, Mobarak (University of Nevada, Reno); Mukhopadhyay, Sankar (University of Nevada, Reno); Toth, Peter (University of Nevada, Reno)
    Abstract: Unavailable or expensive health insurance may hinder the transition of individuals from paid employment to entrepreneurship. The literature argues that the guaranteed availability of health insurance introduced by the Affordable Care Act (ACA) of 2010 could reduce this barrier to entrepreneurship and thereby increase entrepreneurial activity. In this paper, we investigate how much the cost of health insurance when leaving paid employment—given availability of health insurance—matters for the decision to become an entrepreneur. We use individual-level data from the Current Population Survey (CPS-ASEC) combined with county-level panel data on health insurance costs in local Health Insurance Exchanges (HIX) introduced by the ACA to estimate county-treatment fixed-effects regressions. The results indicate that increasing the premium of the benchmark HIX plan by $100 per month decreases the annual probability of entry into self-employment by 0.25 percentage points, which corresponds to 18% of the average annual entry rate.
    Keywords: entrepreneurship, health insurance, premium, deductible, MOOP
    JEL: I13 I11 J22 J23 L26
    Date: 2021–11
  2. By: Jody Schimmel Hyde; Jonathan Schwabish; Paul O’Leary; Dara Lee Luca
    Abstract: This study examines how local-level factors are associated with work activity and flows into and out of Social Security Disability Insurance and Supplemental Security Income programs.
    Keywords: Disability, Social Security Disability Insurance, Supplemental Security Income, SSI, benefits, work, local-level factors
  3. By: Halla, Martin (University of Linz); Kah, Christopher (Mercedes-Benz AG); Sausgruber, Rupert (Wirtschaftsuniversität Wien)
    Abstract: To test for ethnic discrimination in access to outpatient health care services, we carry out an email-correspondence study in Germany. We approach 3,224 physician offices in the 79 largest cities in Germany with fictitious appointment requests and randomized patients' characteristics. We find that patients' ethnicity, as signaled by distinct Turkish versus German names, does not affect whether they receive an appointment or wait time. In contrast, patients with private insurance are 31 percent more likely to receive an appointment. Holding a private insurance also increases the likelihood of receiving a response and reduces the wait time. This suggests that physicians use leeway to prioritize privately insured patients to enhance their earnings, but they do not discriminate persons of Turkish origin based on taste. Still, their behavior creates means-based barriers for economically disadvantaged groups.
    Keywords: discrimination, immigrants, ethnicity, health care markets, health insurance, inequality, correspondence experiment, field experiment
    JEL: I11 J15 I14 I18 H51 C93
    Date: 2021–11
  4. By: Halapuu, Vivika (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: The paper provides the first causal evidence of how access to education affects disability insurance (DI) claims among low-skilled youths. The research design exploits recent changes in high school eligibility criteria among a set of low-performing compulsory school graduates in Sweden. The results show that the immediate inflow into the DI system increased by 5.1 percentage points among the students who were excluded from standard high school programs. The fact that outflow from DI is very low (half of all young claimants remain in the system after 10 years) together with auxiliary findings indicating that the impact remains high during the short follow-up period suggest that the effect is likely to persist over many years. The results highlight that the design of education systems is a crucial determinant of DI claims among young people and that reforms which limit low-skilled youths’ access to education can have lasting detrimental effects on their labor supply.
    Keywords: Access to education; Disability insurance; Education Policy
    JEL: I24 I26 I28
    Date: 2021–12–03
  5. By: Mary A. Burke; Katherine Grace Carman; Riley Sullivan; Hefei Wen; James Frank Wharam; Hao Yu
    Abstract: Previous research suggests that state Medicaid expansions implemented under the Patient Protection and Affordable Care Act (ACA) helped large numbers of patients suffering from opioid use disorder (OUD) gain access to life-saving medications, including buprenorphine. However, Medicaid expansions could have impeded access to care among individuals already enrolled in Medicaid, as new enrollees would have placed added demands on a limited supply of buprenorphine providers. Using a panel data set of medical claims from Rhode Island, we estimate the causal effects of the state’s January 2014 ACA implementation on buprenorphine receipt among incumbent (pre-ACA) Medicaid enrollees by leveraging geographic variation within Rhode Island in the intensity of treatment under the ACA. Using a difference-in-differences identification strategy, multivariate regression analysis yields no evidence that incumbent Medicaid enrollees experienced added difficulties in accessing buprenorphine as a result of the ACA, despite the fact that both Medicaid and non-Medicaid enrollment increased substantially under the policy. Supply-side factors may have helped to blunt any negative fallout, as we find that the number of buprenorphine prescribers in the state increased fairly steadily during the two years leading up to January 2014 and for at least 15 months after that date. Also, the average number of buprenorphine recipients per prescriber increased rapidly after January 2014, suggesting that providers had unused treatment capacity before the policy went into effect.
    Keywords: Medicaid expansion; opioid use disorder (OUD); methadone; buprenorphine; Rhode Island; all-payer claims database
    JEL: I12 I13 I14 I18
    Date: 2021–10–01
  6. By: Pietro Emilio Spini
    Abstract: This paper studies the robustness of estimated policy effects to changes in the distribution of covariates. Robustness to covariate shifts is important, for example, when evaluating the external validity of quasi-experimental results, which are often used as a benchmark for evidence-based policy-making. I propose a novel scalar robustness metric. This metric measures the magnitude of the smallest covariate shift needed to invalidate a claim on the policy effect (for example, $ATE \geq 0$) supported by the quasi-experimental evidence. My metric links the heterogeneity of policy effects and robustness in a flexible, nonparametric way and does not require functional form assumptions. I cast the estimation of the robustness metric as a de-biased GMM problem. This approach guarantees a parametric convergence rate for the robustness metric while allowing for machine learning-based estimators of policy effect heterogeneity (for example, lasso, random forest, boosting, neural nets). I apply my procedure to the Oregon Health Insurance experiment. I study the robustness of policy effects estimates of health-care utilization and financial strain outcomes, relative to a shift in the distribution of context-specific covariates. Such covariates are likely to differ across US states, making quantification of robustness an important exercise for adoption of the insurance policy in states other than Oregon. I find that the effect on outpatient visits is the most robust among the metrics of health-care utilization considered.
    Date: 2021–12
  7. By: Yoichi Arai (Institute for Fiscal Studies); Yu-Chin Hsu (Institute for Fiscal Studies); Toru Kitagawa (Institute for Fiscal Studies and University College London); Ismael Mourifié (Institute for Fiscal Studies); Yuanyuan Wan (Institute for Fiscal Studies)
    Abstract: We propose a new specification test for assessing the validity of fuzzy regression discontinuity designs (FRD-validity). We derive a new set of testable implications, characterized by a set of inequality restrictions on the joint distribution of observed outcomes and treatment status at the cut-off. We show that this new characterization exploits all of the information in the data that is useful for detecting violations of FRD-validity. Our approach differs from and complements existing approaches that test continuity of the distributions of running variables and baseline covariates at the cut-off in that we focus on the distribution of the observed outcome and treatment status. We show that the proposed test has appealing statistical properties. It controls size in a large sample setting uniformly over a large class of data generating processes, is consistent against all fixed alternatives, and has non-trivial power against some local alternatives. We apply our test to evaluate the validity of two FRD designs. The test does not reject FRD-validity in the class size design studied by Angrist and Lavy (1999) but rejects it in the insurance subsidy design for poor households in Colombia studied by Miller, Pinto, and Vera-Hernandez (2013) for some outcome variables. Existing density continuity tests suggest the opposite in each of the two cases.
    Date: 2021–03–23
  8. By: Eugene Rich; Ann O’Malley; Claire Burkhart; Lisa Shang; Arkadipta Ghosh; Matthew Niedzwiecki
    Abstract: Comprehensiveness is a key element of primary care and is highlighted in several national primary care transformation initiatives.
    Keywords: primary care, Medicare expenditures, emergency department utilization
  9. By: Laura Kimmey; Michael Anderson; Valerie Cheh; Jason Rotter; Andrea Wysocki
    Abstract: This report examines the effects of the Independence at Home payment incentive. It also assesses whether home-based primary care affects spending and hospital use for dually eligible patients and describes the association between home-based primary care use and end-of-life expenditures.
    Keywords: Independence at Home, IAH, home-based primary care, HBPC, home visits; primary care, payment innovation, evaluation, impact findings, payment model, complex patients
  10. By: Friedrich, Benjamin (Northwestern University, Kellogg School of Management.); Laun, Lisa (IFAU - Institute for Evaluation of Labour Market and Education Policy); Meghir, Costas (Yale University)
    Abstract: This paper analyzes earnings inequality and earnings dynamics in Sweden over 1985–2016. The deep recession in the early 1990s marks a historic turning point with a massive increase in earnings inequality and earnings volatility, and the impact of the recession and the recovery from it lasted for decades. In the aftermath of the recession, we find steady growth in real earnings across the entire distribution for men and women and decreasing inequality over more than 20 years. Despite the positive trend, large gender differences in earnings dynamics persist. While earnings growth for men is more closely tied to the business cycle, women face much higher volatility overall. Earnings volatility is also substantially higher among foreign-born workers, reflecting weaker labor market attachment and high risk of large negative shocks for low-income immigrants. We document an important role of social benefits usage for the overall trends and for differences across sub-populations. Higher benefits enrollment, especially for women and immigrants, is associated with higher earnings volatility. As the generosity and usage of benefit programs declined over time, we find stronger earnings growth among low-income workers, consistent with higher self-sufficiency.
    Keywords: Earnings inequality; earnings volatility; immigration; social insurance
    JEL: D31 E24 J15 J31 J61
    Date: 2021–11–09

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