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on Insurance Economics |
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Issue of 2022‒01‒31
twenty papers chosen by Soumitra K. Mallick Indian Institute of Social Welfare and Business Management |
| By: | Indra Kurniawan, Muhammad (Monash University) |
| Abstract: | This essay studies the national health insurance system’s impacts on health awareness in Indonesia. I estimate the effects of the insurance enrolment on health knowledge and health behaviour changes after the launch of compulsory social health insurance. Individuals who are less aware of their health may contribute to moral hazard in health insurance. I apply the difference-in-differences method to compare treatment and control groups and the before-after period of the intervention in 2014. Data from the Indonesia Demographic and Health Survey is utilised in this study. Results indicate that social health insurance is negatively correlated with the propensity of knowing certain diseases and contraceptive methods. The scheme adversely affects individuals’ smoking behaviour. Therefore, improving promotive and preventive programs throughout the insurance’s benefits is essential. |
| Keywords: | National Health Insurance Scheme (NHIS) ; Health behaviour ; Insured and uninsured ; Indonesia JEL Classification: H51 ; I12 ; I13 ; I18 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:wrk:wrkesp:14&r= |
| By: | Jean-Gabriel Lauzier |
| Abstract: | We design the insurance contract when the insurer faces arson-type risks. The optimal contract must be manipulation-proof. It is therefore continuous, it has a bounded slope, and it satisfies the no-sabotage condition when arson-type actions are free. Any contract that mixes a deductible, coinsurance and an upper limit is manipulation-proof. We also show that the ability to perform arson-type actions reduces the insured's welfare as less coverage is offered in equilibrium. |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2112.06817&r= |
| By: | Elira Kuka; Bryan A. Stuart |
| Abstract: | This paper studies differences in receipt and take-up of unemployment insurance (UI) benefits among white and Black individuals. We combine state-level UI regulations with data containing detailed information on individuals’ work history and UI receipt. Black individuals who separate from a job are 24% less likely to receive UI than whites. The UI receipt gap stems primarily from lower take-up of UI benefits among likely eligible individuals, as opposed to differences in benefit eligibility. Statistical decompositions indicate that about one-half of the take-up gap is explained by Black workers’ lower pre-unemployment earnings and higher tendency to live in the South. |
| JEL: | H5 I38 J15 J65 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29595&r= |
| By: | Paul B. Kirby; Anna Christensen; Louise Bannister; Valerie Konar |
| Abstract: | This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children’s Health Insurance Program). |
| Keywords: | patient centered medical home, emergency department visits, Massachusetts |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:b36a43da94124c15807acf90c5d05efd&r= |
| By: | Defina, Ryan; Van Roosebeke, Bert; Manga, Paul |
| Abstract: | E-money is widespread in Kenya, especially through MPESA, a form of e-money stored on mobile phones and issued by Safaricom, a mobile network operator (MNO). Integration between the MPESA platform and the traditional banking system is increasing. Given the very high use-grade of MPESA throughout the population, it has reached critical importance in Kenya. In Kenya, e-money issuers must back their e-value with bank balances at commercial banks (float), through trust accounts. Deposit insurance does not cover a default of the e-money issuer. However, the Kenya Deposit Insurance Corporation aims at offering pass-through coverage in case of a default of the deposit-taking commercial bank holding the trust accounts. Pass-through coverage is confronted with a number of challenges, including regarding data on the identity of e-money users and their balances held. Also, the critical importance of MPESA raises questions as to how to deal with a potential default of the MNO and the role of deposit insurance in such a scenario. Looking forward, there is merit in further coordination amongst safety net participants as well as in the management of trust accounts and the strengthening of data-availability requirements to e-money issuers. |
| Keywords: | deposit insurance; bank resolution |
| JEL: | G21 G33 |
| Date: | 2021–12–09 |
| URL: | http://d.repec.org/n?u=RePEc:pra:mprapa:111007&r= |
| By: | Kettlewell, Nathan (University of Technology, Sydney); Zhang, Yuting (University of Melbourne) |
| Abstract: | Penalty mandates are used in many countries to encourage people to purchase health insurance. But are they effective? We use a large administrative dataset for a 10% random sample of all Australian tax-filers to study how people respond to a step-wise age-based mandate, and whether this has changed over time. The mandate creates discontinuities in the incentive to insure by age, which we exploit to estimate causal effects. People who do not insure before the penalty dates face higher premiums in the future, which should encourage them to bring forward purchases. We find that people respond as expected to the initial age-penalty, but not to subsequent penalties. The 2% premium loading results in a 1-4% increase in take-up, with effects increasing after an annual government letter campaign that reminds people approaching the penalty deadline about the policy. We discuss the impact of the mandate on the overall efficiency of the market, and implications of potential reforms. |
| Keywords: | health insurance, age-based mandate, regression discontinuity, Australia |
| JEL: | I13 I18 I12 |
| Date: | 2021–11 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14901&r= |
| By: | Anelli, Massimo (Bocconi University); Koenig, Felix (Carnegie Mellon University) |
| Abstract: | This paper develops a revealed-preference approach that uses budget constrain discontinuities to price workplace safety. We track hourly workers who face the decision of how many hours to work at varying levels of Covid-19 risk and leverage state-specific discontinuities in unemployment insurance eligibility criteria to identify the labor supply behavior. Results show large baseline responses at the threshold and increasing responses for higher health risks. The observed behavior implies that workers are willing to accept 34% lower incomes to reduce the fatality rate by one standard deviation, or 1% of income for a one in a million chance of dying. |
| Keywords: | hazard pay, workplace safety, non-wage amenities, partial unemployment insurance, COVID-19, labor supply, value of life |
| JEL: | J17 J22 J28 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp14919&r= |
| By: | Massimo Anelli; Felix Koenig |
| Abstract: | This paper develops a revealed-preference approach that uses budget constrain discontinuities to price workplace safety. We track hourly workers who face the decision of how many hours to work at varying levels of Covid-19 risk and leverage state-specific discontinuities in unemployment insurance eligibility criteria to identify the labor supply behavior. Results show large baseline responses at the threshold and increasing responses for higher health risks. The observed behavior implies that workers are willing to accept 34% lower incomes to reduce the fatality rate by one standard deviation, or 1% of income for a one in a million chance of dying. |
| Keywords: | hazard pay, workplace safety, non-wage amenities, partial unemployment insurance, Covid19, labor supply, value of life |
| JEL: | J17 J22 J28 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_9469&r= |
| By: | Martin Halla (Johannes Kepler University Linz); Christopher Kah (Mercedes-Benz AG); Rupert Sausgruber (Department of Economics, Vienna University of Economics and Business) |
| 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: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:wiw:wiwwuw:wuwp319&r= |
| By: | Zarko Kalamov |
| Abstract: | This paper develops a new sufficient statistic approach for estimating the marginal internality from sin good consumption. It models a biased consumer who faces uncertain health harms and receives mandatory health insurance. I show that the marginal internality can be identified by observing how sin good demand reacts to changes in health insurance coverage. The method does not require to recover the true willingness to pay for the sin good or to elicit consumers’ biases using surveys. I calibrate the model to sugary drinks consumption. My results are consistent with studies that use survey-based measures of biases. |
| Keywords: | marginal internality, self-control, biased beliefs |
| JEL: | D11 D62 H21 H31 I12 I13 I18 |
| Date: | 2021 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_9476&r= |
| By: | Halla, Martin; Kah, Christopher; Sausgruber, Rupert |
| 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 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:wiw:wus005:8527&r= |
| By: | Shenshen Yang |
| Abstract: | I examine the common problem of multiple missingness on both the endogenous treatment and outcome variables. Two types of dependence assumptions for missing mechanisms are proposed for identification, based on which a two-step AIPW GMM estimator is proposed. This estimator is unbiased and more efficient than the previously used estimation methods. Statistical properties are discussed case by case. This method is applied to the Oregon Health Insurance Experiment and shows the significant effects of enrolling in the Oregon Health Plan on improving health-related outcomes and reducing out-of-pocket costs for medical care. There is evidence that simply dropping the incomplete data creates downward biases for some of the chosen outcome variables. Moreover, the estimator proposed in this paper reduced standard errors by 6-24% of the estimated effects of the Oregon Health Plan. |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2201.01010&r= |
| By: | Michael E. Chernew; Jessica Carichner; Jeron Impreso; J. Michael McWilliams; Thomas G. McGuire; Sartaj Alam; Bruce E. Landon; Mary Beth Landrum |
| Abstract: | Claims data, which form the foundation of risk adjustment in payment for health care services, may reflect efforts to capture more—or more severe—clinical conditions rather than true changes in health status. |
| Keywords: | Accountable care organizations, Risk adjustment, Medicare, Consumer Assessment of Healthcare Providers and Systems, Costs and spending, Medicare savings programs, Medicare Advantage, Traditional Medicare, Cost growth, Payment |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:5e0a7e170dcb46579fbea592b07dca16&r= |
| By: | Martial Bop; Kossivi Akoetey (CERDI - Centre d'Études et de Recherches sur le Développement International - CNRS - Centre National de la Recherche Scientifique - UCA - Université Clermont Auvergne, École d'économie - Clermont Auvergne - UCA - Université Clermont Auvergne); Boubacar Gueye; Cheikh Diop (TELEM - Textes, littératures, écritures et modèles - Université Bordeaux Montaigne); Papa Sow (LPL - Laboratoire de Physique des Lasers - UP13 - Université Paris 13 - CNRS - Centre National de la Recherche Scientifique); Ouseynou Ka; Abdoulaye Diop; Fatou Sow; Martial Coly Bop |
| Abstract: | Access to health services is a concern around the world. Different strategies were developed, but Africa's rate remains the lowest. This article aims to contribute to the population's access to healthcare, and to assess the determinants of the use of mutual health insurance by the population of the Ziguinchor region in Senegal. Methods: The study is transversal and descriptive, carried out from July to August 2018. Through the quota method we defined the number of patients to be interviewed. Thus, by a geographic stratification according to the departments and a second-degree stratification taking into account the staff of the different hospital departments, 392 patients were selected. Results: 73% at the Regional Hospital Center and 27% at the Regional Peace Hospital. Response rate: 97%, women 60% and men 40%. The enrollment for women (24%) is slightly higher than that for men (21%). Socioeconomic factors. The rate of adherence is the highest of for patients with university level, followed by high school; income: the highest rate for patients with a monthly income between 200,000 and 500,000 FCFA, followed by patients with an income monthly between 100,000 and 200,000 FCFA. Factors linked to the provision of care: the rate of Mutual Health Insurance adherence follows distances from patients' homes. Concerning the relation to satisfaction, education, distance and information are more determining than adherence rate. Recommendations: 1) State: actions on education and distance; 2) Sensitizing the population on mutual health insurance; 3) Urging healthcare providers to reduce waiting times and respect schedules as well as appointments. |
| Keywords: | Mutual health insurance,Membership factors,insurance,universal coverage,care services access,healthcare providers,Senegal |
| Date: | 2021–04–25 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03474615&r= |
| By: | William Encinosa; Avi Dor; PhuongGiang Nguyen |
| Abstract: | We examine the impacts of physician-hospital integration on care fragmentation and other measures of care-coordination using a dynamic model of movers and stayers in commercially insured plans. Although recent growth in the share of practicing physicians belonging to these vertical organizations has sparked considerable policy debate, there is a paucity of evidence on the merits of vertical integration in the private segment of the market. We fill the gap by focusing on care-coordination in the relatively open plans that dominate commercial insurance, namely Preferred Provider Organizations (PPOs). We exploit the fact that physician-hospital integration levels vary dramatically across MSA and focus on orthogonal employment-based transfers for identification. We track 415,000 beneficiaries with 17 million claims between 2010 and 2016. We find that standard two-way fixed effect mover-stayer models produce biased estimates since there are heterogeneous effects of integration. Extending the dynamic event study design of Sun and Abraham (2021) to mover-stayer analyses, we are able to avoid these biases. We find that a move from the 10th to 90th percentile of physician integration level causes a 20% relative decrease in a care fragmentation index; similar declines are found in independent markers of fragmentation such as use of out-of-network and single-service facilities. Vertical integration of either primary care physicians or specialists reduced fragmentation significantly. However, only vertical integration of specialists led to significant reductions in medical spending. Our results are robust when adjusting for moves associated with alternative contractual arrangements among providers that do not require outright ownership. |
| JEL: | I11 L11 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29599&r= |
| By: | Marcus C. Christiansen |
| Abstract: | Current reporting standards for insurers require a decomposition of observed profits and losses in such a way that changes in the insurer's balance sheet can be attributed to specified risk factors. Generating such a decomposition is a nontrivial task because balance sheets generally depend on the risk factors in a non-linear way. This paper starts from an axiomatic perspective on profit and loss decompositions and finds that the axioms necessarily lead to infinitesimal sequential updating (ISU) decompositions, provided that the latter exist and are stable, whereas the current practice is rather to use sequential updating (SU) decompositions. The generality of the axiomatic approach makes the results useful also beyond insurance applications wherever profits and losses shall be additively decomposed in a risk-oriented manner. |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2112.11265&r= |
| By: | Julian Diaz Saavedra (Department of Economic Theory and Economic History, University of Granada.); Ramon Marimon (European University Institute, UPF - Barcelona GSE, CEPR and NBER.); Joao Brogueira de Sousa (Nova School of Business and Economics.) |
| Abstract: | In an overlapping generations economy with incomplete insurance markets, the introduction of an employment fund – akin to the one introduced in Austria in 2003, also known as ‘Austrian backpack’– can enhance production efficiency and social welfare. It complements the two classical systems of public insurance: pay-as-you-go (PAYG) pensions and unemployment insurance (UI).We show this in a calibrated dynamic general equilibrium model with heterogeneous agents of the Spanish economy in 2018. A ‘backpack’ (BP) employment fund is an individual (across jobs) transferable fund, which earns the economy interest rate as a return and is financed with a payroll tax (a BP tax). The worker can use the fund when becomes unemployed or retires. In Spain, as an open economy, to complement the existing PAYG pension and UI systems with a welfare maximising 6% BP tax would raise welfare by 0.96% of average consumption at the new steady state, and would be preferred to the status quo by most economic and demographic groups. We also analyze, as a reference, Spain as a closed economy. There are important general equilibrium effects and, as a result, the social value of introducing the backpack is substantially greater; 16.14%, with a BP tax of 18%. Our model also provides a framework where to study reforms of existing social protection systems supported by the introduction of the BP. |
| Keywords: | Computable general equilibrium, welfare state, social security reform, retirement. |
| JEL: | C68 H55 J26 |
| Date: | 2021–12–04 |
| URL: | http://d.repec.org/n?u=RePEc:gra:wpaper:21/16&r= |
| By: | Anna Josephson |
| Abstract: | In models of intra-household resource allocation, the earnings from joint work between two or more household members are often omitted. Accounting for income earned jointly by multiple household members, in addition to income earned individually by men and women, I test the assumption of complete pooling of resources within a household. By explicitly including intra-household collaboration, I find evidence of partial income pooling and partial insurance within the household. Pooling is an intentional behavior, in which households pool income for essential and regular expenditures. This indicates that households operate differently and more collaboratively than previous empirical findings suggest. |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2112.12766&r= |
| By: | Joseph J. Doyle Jr.; Becky Staiger |
| Abstract: | Treatment intensity varies remarkably across physicians, yet the key drivers are not well understood. Meanwhile, the organization of healthcare is undergoing a secular transformation as physicians increasingly work in groups. This paper tests whether physicians' group affiliation matters for practice styles and patient health. Using Medicare inpatient claims data, we compare these outcomes before and after physicians switch between groups of varying treatment intensity while remaining in the same hospital to control for practice setting. Event studies show that internists who join more-intensive groups immediately increase their own treatment intensity, with an elasticity of approximately 0.3; the opposite is found for internists who switch to groups that are less intensive. This change in Medicare spending largely stems from greater quantities of care provided, with some evidence of a change in coding behavior. We do not detect a change in health outcomes, suggesting that treatment intensity induced by group affiliation may not be productive. |
| JEL: | I10 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:29613&r= |
| By: | Monica O'Reilly-Jacob; Penny Mohr; Moriah Ellen; Carolyn Petersen; Catherine Sarkisian; Sharon Attipoe; Eugene Rich |
| Abstract: | Digital health advances offer a multitude of possibilities to improve public health and individual well-being. |
| Keywords: | Digital health, mHealth, Low-value care |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:0789eceed36e4889ada66a96b436b378&r= |