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on Insurance Economics |
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Issue of 2022‒03‒07
23 papers chosen by Soumitra K. Mallick Indian Institute of Social Welfare and Business Management |
| By: | Lombardi, Caitlin; Bullinger, Lindsey Rose; Gopalan, Maithreyi (The Pennsylvania State University) |
| Abstract: | Context: Public health insurance eligibility for low-income adults has improved economic well-being. But whether parental public health insurance eligibility has spillover effects on children’s health insurance coverage and family health-related financial well-being is less understood. Methods: We use the 2016-2020 National Survey of Children’s Health (NSCH) to estimate the effects of Medicaid expansions through the Affordable Care Act (ACA) for parents on child health insurance coverage, parents’ employment decisions, and family health-related financial well-being. We compare children in low-income families in states that expanded Medicaid for parents after 2015 to states that never expanded in a difference-in-differences framework. Findings: We find that the expansions increased children’s public health insurance coverage by 5.5 percentage points and reduced private coverage by 5 percentage points. We additionally find that parents were less likely to avoid changing jobs for health insurance reasons and children’s medical expenses were less likely to exceed $1,000. We find no evidence that the expansions affected children’s dual coverage and uninsurance. Estimates are robust to falsification and sensitivity analyses. Conclusions: These results demonstrate the benefits of public health insurance expansions for families. They suggest that benefits on children’s medical expenses are concentrated in the families with the greatest financial need. |
| Date: | 2022–01–27 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:q7csj&r= |
| By: | Martin Gonzalez-Rozada; Hernan Ruffo |
| Abstract: | Unemployment insurance transfers should balance the provision of consumption to the unemployed with the disincentive effects on the search behavior. Developing countries face the additional challenge of informality. Workers can choose to hide their employment state and labor income in informal jobs, an additional form of moral hazard. To provide evidence about the effects of this policy in a country affected by informality we exploit kinks in the schedule of transfers in Argentina. Our results suggest that higher benefits induce moderate behavioral responses in job-finding rates and increase re-employment wages. We use a sufficient statistics formula from a model with random wage offers and we calibrate it with our estimates. We show that welfare could rise substantially if benefits were increased in Argentina. Importantly, our conclusion is relevant for the median eligible worker that is strongly affected by informality. |
| Date: | 2022–02 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2202.01844&r= |
| By: | Marion Ravit; Anais N'Landu; Martine Audibert (CERDI - Centre d'Études et de Recherches sur le Développement International - CNRS - Centre National de la Recherche Scientifique - UCA - Université Clermont Auvergne); Andrainolo Ravalihasy; Valery Ridde; Emmanuel Bonnet; Bertille Raphalli; Alexandre Dumont |
| Abstract: | Since 2002, Mauritania has gradually introduced an original prepayment scheme, the obstetrical risk insurance scheme, based on voluntary enrolment with the aim of covering care related to pregnancy and childbirth. The impact evaluation of this package shows that a voluntary prepayment system targeting pregnant women can improve the use of health services during pregnancy and childbirth. |
| Abstract: | Depuis 2002, l'État mauritanien a progressivement mis en place un dispositif de prépaiement original, le forfait obstétrical, reposant sur une adhésion volontaire dans le but de couvrir les soins liés à la grossesse et l'accouchement. L'évaluation d'impact de ce forfait montre qu'un système de prépaiement volontaire ciblant les femmes enceintes peut améliorer l'utilisation des services de santé pendant la grossesse et l'accouchement. |
| Keywords: | Afrique sub saharienne,Mauritanie,Mortalité néonatale,Santé maternelle |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-03514031&r= |
| By: | Jill Furzer; Maripier Isabelle; Boriana Miloucheva; Audrey Laporte |
| Abstract: | While the long-term consequences of unmet child mental health needs are well-documented, out-of-pocket costs remain an important barrier to accessing medication in childhood and adolescence. This paper exploits the implementation of a public drug insurance program in Québec, Canada, to estimate the impact of out-of-pocket costs on uptake of pharmaceutical treatment for mental health issues in children. To investigate the potential for low-benefit consumption or moral hazard due to lowered drugs costs, we combine a difference-in-differences estimation framework with novel machine learning techniques to predict the likelihood of diagnosis for ADHD, anxiety or depression across childhood in a nationally representative longitudinal sample of children. Our results suggest that eliminating out-of-pocket costs led to a 3-percentage point increase in treatment uptake and adherence. When adjusting for predicted risk, the effects are concentrated among the top two deciles of risk. For children in the bottom half of the risk distribution, treatment use changes were not statistically different from zero. We find that treatment uptake is driven by changes in stimulants, which are generally prescribed for ADHD. Our results suggest that reductions in out-of-pocket costs could help achieve better uptake of mental health treatment, without leading to low-benefit care among lower-risk individuals. Bien que les conséquences à long terme des besoins non satisfaits des enfants en matière de santé mentale soient bien documentées, les frais remboursables demeurent un obstacle important à l'accès aux médicaments pendant l'enfance et l'adolescence. Cet article exploite la mise en œuvre d'un programme public d'assurance-médicaments au Québec, Canada, pour estimer l'impact des frais remboursables sur l'adoption de traitements pharmaceutiques pour les problèmes de santé mentale chez les enfants. Pour étudier la possibilité d'une consommation à faible bénéfice ou d'un aléa moral dû à la baisse du coût des médicaments, nous combinons un cadre d'estimation de la différence dans les différences avec de nouvelles techniques d'apprentissage automatique pour prédire la probabilité d'un diagnostic de TDAH, d'anxiété ou de dépression au cours de l'enfance dans un échantillon longitudinal d'enfants représentatif au niveau national. Nos résultats suggèrent que l'élimination des frais remboursables a conduit à une augmentation de 3 points de pourcentage de la prise de traitement et de l'observance. Après ajustement du risque prédit, les effets sont concentrés sur les deux déciles supérieurs de risque. Pour les enfants situés dans la moitié inférieure de la distribution du risque, les changements dans l'utilisation du traitement n'étaient pas statistiquement différents de zéro. Nous constatons que l'utilisation du traitement est déterminée par les changements dans les stimulants, qui sont généralement prescrits pour le TDAH. Nos résultats suggèrent que la réduction des frais remboursables pourrait contribuer à une meilleure prise en charge des traitements de santé mentale, sans pour autant conduire à des soins à faible bénéfice chez les personnes à faible risque. |
| Keywords: | Children Health,Public Health Insurance,Mental Health,Prescription Drugs, Santé des enfants,Assurance maladie publique,Santé mentale,Médicaments sur ordonnance |
| JEL: | I10 I13 I18 I19 |
| Date: | 2021–09–21 |
| URL: | http://d.repec.org/n?u=RePEc:cir:cirwor:2021s-34&r= |
| By: | Ihsan Chaoubi; Camille Besse; H\'el\`ene Cossette; Marie-Pier C\^ot\'e |
| Abstract: | Detailed information about individual claims are completely ignored when insurance claims data are aggregated and structured in development triangles for loss reserving. In the hope of extracting predictive power from the individual claims characteristics, researchers have recently proposed to move away from these macro-level methods in favor of micro-level loss reserving approaches. We introduce a discrete-time individual reserving framework incorporating granular information in a deep learning approach named Long Short-Term Memory (LSTM) neural network. At each time period, the network has two tasks: first, classifying whether there is a payment or a recovery, and second, predicting the corresponding non-zero amount, if any. We illustrate the estimation procedure on a simulated and a real general insurance dataset. We compare our approach with the chain-ladder aggregate method using the predictive outstanding loss estimates and their actual values. Based on a generalized Pareto model for excess payments over a threshold, we adjust the LSTM reserve prediction to account for extreme payments. |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2201.13267&r= |
| By: | Cochran, Abigail L. (University of North Carolina at Chapel Hill); McDonald, Noreen; Prunkl, Lauren; Vinella-Brusher, Emma; Wang, Jueyu; Oluyede, Lindsay; Wolfe, Mary |
| Abstract: | Objective: To investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users. Data Sources: Between June 21 and July 23, 2021, primary survey data were collected for a sample of patients in North Carolina. Study Design: The study analyzed the prevalence of arriving late to, delaying, or missing medical care and examined how transportation barriers contributed to negative health care outcomes. Data Collection Methods: A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers. Principal Findings: Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18–64 were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as to personal health. Conclusions: To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs. |
| Date: | 2021–12–22 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:qf7kt&r= |
| By: | Glenn Boyle (University of Canterbury); Roger Stover; Amrit Tiwana; Oleksandr Zhylyevskyy |
| Abstract: | We use a conjoint analysis of 551 subjects to compare the reaction of finance professionals to news of a banking crisis with the reactions of non-finance professionals and graduate students. All three groups make greater deposit withdrawals if deposit insurance protection involves a haircut, but the response of finance professionals is more nuanced: compared to non-finance professionals and students, they seem to care about haircuts mainly when bank capitalization is low and less so when capitalization is high. Both finance and nonfinance professionals are more concerned about the pre-funding of deposit insurance than are students. Overall though, the greater banking sector knowledge and experience presumably possessed by finance professionals does not seem to automatically translate into significantly different crisis-response behavior. |
| Keywords: | Banking crisis, Finance professionals, Deposit withdrawals |
| JEL: | G21 G28 |
| Date: | 2022–02–01 |
| URL: | http://d.repec.org/n?u=RePEc:cbt:econwp:22/03&r= |
| By: | Ismael Choinière-Crèvecoeur; Pierre-Carl Michaud |
| Abstract: | High borrowing costs, limited knowledge and preferences could explain why few Canadians purchase reverse mortgages, an asset decumulation product that is appealing to those who are house-rich but cash-poor. In this paper, we first use an asset pricing model to calculate the actuarial fair costs of guarantees built into reverse mortgage products in Canada and compare those estimates to prevailing interest rates in the market for these products. We also investigate whether Canadians understand reverse mortgages and whether low demand originates on the preference side by conducting a stated-preference experiment with 3000 Canadians. We manipulate characteristics of reverse mortgages, including the interest rate, to tease out how sensitive Canadians are to these characteristics. Our results suggest that observed interest rates are high relative to actuarilly fair rates and that consumers are somewhat price sensitive in addition to demonstrating little knowledge of these products and low demand overall. Les coûts d'emprunt élevés, les connaissances et les préférences limitées pourraient expliquer pourquoi peu de Canadiens achètent des prêts hypothécaires inversés, un produit de décumulation d'actifs qui est attrayant pour ceux qui sont riches en maison mais pauvres en argent. Dans ce document, nous utilisons d'abord un modèle d'évaluation des actifs pour calculer les coûts actuariels équitables des garanties intégrées aux produits de prêts hypothécaires inversés au Canada et nous comparons ces estimations aux taux d'intérêt en vigueur sur le marché pour ces produits. Nous cherchons également à savoir si les Canadiens comprennent les prêts hypothécaires inversés et si la faible demande provient du côté des préférences en menant une expérience de préférence déclarée avec 3000 Canadiens. Nous manipulons les caractéristiques des prêts hypothécaires inversés, notamment le taux d'intérêt, afin de déterminer dans quelle mesure les Canadiens sont sensibles à ces caractéristiques. Nos résultats suggèrent que les taux d'intérêt observés sont élevés par rapport aux taux actuariellement équitables et que les consommateurs sont quelque peu sensibles aux prix, en plus de démontrer une faible connaissance de ces produits et une faible demande globale. |
| Keywords: | reverse mortgages,savings,retirement planning,insurance, prêts hypothécaires inversés,épargne,planification de la retraite,assurances |
| JEL: | G21 R21 |
| Date: | 2021–09–30 |
| URL: | http://d.repec.org/n?u=RePEc:cir:cirwor:2021s-38&r= |
| By: | Anek Belbase; Patrick Hubbard; Alicia H. Munnell |
| Abstract: | Many older Americans will need at least some longterm services and supports (LTSS) as they age. At the same time, a substantial number do not have sufficient resources to provide for LTSS care needs. The questions are whether those who cannot afford care are the same ones who need care; the extent to which Medicaid reduces any shortfalls; and the types of individuals that continue to fall short after Medicaid. This brief is the final in a three-part series examining the need and resources for LTSS among retirees. The first brief looked at the likelihood of a 65-year-old developing minimal, moderate, or severe care needs, while the second examined the resources available to 65-year-olds to cover the different levels of care. This final brief combines the findings from the two earlier studies to determine the share of individuals projected to have inadequate resources for their specific care needs and explores the extent to which Medicaid makes up the difference. The discussion proceeds as follows. The first section projects what share of older Americans may fall short of affording the care they need based on their private resources, which include both family members and the finanical means to cover paid caregivers. The second section explores the role of Medicaid and estimates the extent to which it reduces the share of individuals that fall short. The third section explores the disparities in unmet care needs across sociodemographic groups, taking account of both private resources and Medicaid. The final section concludes that while Medicaid covers a substantial share of the cost of long-term care and reduces disparities, a\ significant minority of retirees will still face varying degrees of unmet needs. |
| Date: | 2021–11 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2021-18&r= |
| By: | Marcin Pitera; Thorsten Schmidt |
| Abstract: | While the estimation of risk is an important question in the daily business of banking and insurance, many existing plug-in estimation procedures suffer from an unnecessary bias. This often leads to the underestimation of risk and negatively impacts backtesting results, especially in small sample cases. In this article we show that the link between estimation bias and backtesting can be traced back to the dual relationship between risk measures and the corresponding performance measures, and discuss this in reference to value-at-risk, expected shortfall and expectile value-at-risk. Motivated by the consistent underestimation of risk by plug-in procedures, we propose a new algorithm for bias correction and show how to apply it for generalized Pareto distributions to the i.i.d.\ setting and to a GARCH(1,1) time series. In particular, we show that the application of our algorithm leads to gain in efficiency when heavy tails or heteroscedasticity exists in the data. |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2201.10454&r= |
| By: | Kristian Blickle (Federal Reserve Bank of New York); Markus Brunnermeier (Princeton University); Stephan Luck (Federal Reserve Bank of New York) |
| Abstract: | We use the German Crisis of 1931, one of the largest bank runs in financial history, to study how depositors behave in the absence of deposit insurance. We find that banks lose on average around 25% of their overall deposit funding during the run and that there is an equal outflow of retail and non-financial wholesale deposits from both ex-post failing and surviving banks. This implies that regular depositors are unable to identify failing banks. In contrast, the interbank market precisely identifies which banks will fail: the interbank market collapses for failing banks entirely but it continues to function for surviving banks, which can borrow from other banks in response to deposit outflows. We argue that since regular depositors appear uninformed it is unlikely that deposit insurance would exacerbate moral hazard. Instead, interbank depositors are best positioned for providing "discipline" via short-term funding. |
| Keywords: | financial crises, banks, Germany |
| JEL: | G01 G21 N20 N24 |
| Date: | 2021–12 |
| URL: | http://d.repec.org/n?u=RePEc:pri:econom:2021-5&r= |
| By: | Tal Gross (Boston University); Adam Sacarny (Columbia University); Maggie Shi (Columbia University); David Silver (Princeton University) |
| Abstract: | We study a 2008 policy reform in which Medicare revised its hospital payment system to better reflect patients’ severity of illness. We construct a simulated instrument that predicts a hospital’s policy-induced change in reimbursement using pre-reform patients and post-reform rules. The reform led to large persistent changes in Medicare payment rates across hospitals. Hospitals that faced larger gains in Medicare reimbursement increased the volume of Medicare patients they treated. The estimates imply a volume elasticity of 1.2. To accommodate greater volume, hospitals increased nurse employment, but also lowered length of stay, with ambiguous effects on quality. |
| Keywords: | Medicare, healthcare |
| JEL: | I12 |
| Date: | 2021–10 |
| URL: | http://d.repec.org/n?u=RePEc:pri:econom:2021-2&r= |
| By: | Olivier Jacques; Alain Noel |
| Abstract: | Public health investments help to prevent mortality and reduce health care costs. Yet very few studies have examined the determinants of preventive care investments across countries and over time. We develop a theory of health spending priorities contrasting preventive and curative care. Preventive care is unlikely to be prioritized by governments since it is a public good that requires the allocation of scarce resources in the present to generate diffuse benefits that unfold only in the long-term. As such, public health is a “quiet” policy that is not supported strongly by interest groups or public opinion. These characteristics have two implications: like other long-term investments, public health programs are particularly vulnerable to fiscal austerity, and prevention expenditures are not influenced by government partisanship since parties cannot attract votes with such low visibility, long term investments. We use a dataset covering 25 OECD countries from 1970 to 2018 to demonstrate that fiscal consolidations are negatively associated with the absolute level of preventive care and with its proportion relative to curative care. We also confirm that left governments are not more likely to invest in public health than right-wing governments. Finally, contributing to the literature on comparative health care analysis, we show that National Health Services systems maintain higher preventive care investments than Social Health Insurance systems. Les investissements en santé publique contribuent à prévenir la mortalité et à réduire les coûts des soins de santé. Pourtant, très peu d'études ont examiné les déterminants des investissements dans les soins préventifs entre les pays et à travers le temps. Nous développons une théorie des priorités en matière de dépenses de santé qui oppose les soins préventifs aux soins curatifs. Il est peu probable que les gouvernements accordent la priorité aux soins préventifs, car il s'agit d'un bien public qui nécessite l'allocation de ressources rares dans le présent pour générer des avantages diffus qui ne se déploient qu'à long terme. En tant que telle, la santé publique est une politique "discrète" qui n'est pas fortement soutenue par les groupes d'intérêt ou l'opinion publique. Ces caractéristiques ont deux implications : comme d'autres investissements à long terme, les programmes de santé publique sont particulièrement vulnérables à l'austérité budgétaire, et les dépenses de prévention ne sont pas influencées par l’idéologie du parti au pouvoir puisque les partis ne peuvent pas attirer les votes avec des investissements à long terme aussi peu visibles. Nous utilisons un ensemble de données couvrant 25 pays de l'OCDE de 1970 à 2018 pour démontrer que les consolidations budgétaires sont négativement associées au niveau absolu de dépenses en soins préventifs et à leur proportion par rapport aux soins curatifs. Nous confirmons également que les gouvernements de gauche ne sont pas plus susceptibles d'investir en santé publique que les gouvernements de droite. Enfin, nous contribuons à la littérature sur l'analyse comparative des soins de santé en démontrant que les systèmes de services nationaux de santé maintiennent des investissements en soins préventifs plus élevés que les systèmes d'assurance sociale. |
| Keywords: | preventive care,austerity,curative care,partisanship,long-term investment, soins préventifs,austérité,soins curatifs,partisanerie,investissement à long terme |
| JEL: | C23 H41 H51 H61 I18 |
| Date: | 2022–01–07 |
| URL: | http://d.repec.org/n?u=RePEc:cir:cirwor:2022s-02&r= |
| By: | Jaeger Nelson |
| Abstract: | This paper builds on previous studies published by the Congressional Budget Office about single-payer health care systems. It uses a general-equilibrium, overlapping-generations model to analyze the economic and distributional implications of five illustrative single-payer health care systems. The systems vary by their payment rates to providers, degree of cost sharing, and inclusion of benefits for long-term services and supports (LTSS). The economic effects of financing a single-payer system are beyond the scope of this paper. However, the results can be paired with some |
| JEL: | E62 H31 I10 |
| Date: | 2022–02–23 |
| URL: | http://d.repec.org/n?u=RePEc:cbo:wpaper:57637&r= |
| By: | Rahal, Charles; Mohan, John |
| Abstract: | The role of external suppliers across statutory health insurance procurement processes varies widely and is a source of political contention throughout the modern world. We comprehensively examine the role of non-profit organisations in public health procurement within publicly funded healthcare which runs parallel to private provision in a 'two-tier' system. We build a unique 'Big Data' based pipeline which scrapes tens of thousands of heterogeneous accounting datasets from across a commissioning hierarchy. These datasets provide granular information on every element of procurement at the micro-level (where the value of a transaction is greater than twenty-five thousand pounds), mandated by transparency requirements introduced by David Cameron in 2010. We develop tools to scrape, parse, and reconcile suppliers with institutional registers. The processed dataset contains over four hundred and forty-five billion pounds worth of commissioning across over 1.9 million rows of clean data. Approximately 1% at each level of procurement comes from institutions listed on the Charity Commission for England and Wales: a number relatively consistent across time, despite contractual patterns. We show a slight regional variation and analyse the 'North-South' divide. Linking to the International Classification of Non-profit Organizations, we show involvement of multiple different types of charity, with more payments going to the 'Social Services' aggregate, but the highest cumulative values going to the 'Health' aggregate. We analyse the distribution across various sizes and ages, from grassroots to 'Super Major' non-profits, and analyse variation over time. We conclude with a re-evaluation of the effects of the controversial Health and Social Care Act of 2012 and the integration of the free market and volunteerism, otherwise known as the 'Big Society'. |
| Date: | 2022–01–27 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:t4x52&r= |
| By: | Jan Rosenzweig |
| Abstract: | We look at optimal liability-driven portfolios in a family of fat-tailed and extremal risk measures, especially in the context of pension fund and insurance fixed cashflow liability profiles, but also those arising in derivatives books such as delta one books or options books in the presence of stochastic volatilities. In the extremal limit, we recover a new tail risk measure, Extreme Deviation (XD), an extremal risk measure significantly more sensitive to extremal returns than CVaR. Resulting optimal portfolios optimize the return per unit of XD, with portfolio weights consisting of a liability hedging contribution, and a risk contribution seeking to generate positive risk-adjusted return. The resulting allocations are analyzed qualitatively and quantitatively in a number of different limits. |
| Date: | 2022–01 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:2201.10846&r= |
| By: | Laura D. Quinby; Gal Wettstein |
| Abstract: | The 2021 Trustees Report projects that the Social Security Old-Age and Survivors Insurance (OASI) program faces a long-term financing shortfall and that the trust fund will deplete its reserves in little more than a decade, after which payroll tax revenues will cover only about three-quarters of scheduled benefits. Yet, news coverage of the Trustees Report often emphasizes the trust fund depletion date and de-emphasizes the importance of the ongoing tax revenues. This emphasis could lead the public to believe that all future benefits are insecure, as many surveys find. The question is, how do workers respond to their misperceptions? On the one hand, they might claim their benefits earlier than originally planned in the belief that future reforms will spare individuals already on the rolls from benefit reductions – even though, if they claim at age 62 today, their monthly benefit will be reduced by 30 percent for claiming early, and their lifetime benefits will likely be lower as well. On the other hand, workers might insure against future reductions in Social Security benefits by saving more on their own, thereby enhancing their retirement prospects. To answer the question, this brief reports on a recent study that used an online experiment to gauge how different headlines about Social Security’s finances affected planned claiming age, benefit expectations, and savings intentions. The discussion proceeds as follows. The first section provides background on Social Security’s actuarial projections and how they are communicated to the public, while the second section explains the experiment. The third section presents results showing that headlines about the trust fund lead to a shift in intended claiming ages and expected benefit levels, but not future savings goals. The final section concludes that media coverage makes many workers fear an unrealistically severe cut to their future Social Security benefits, and this fear could lead people to claim early, locking in lower monthly benefits without increased saving to make up the gap. |
| Date: | 2021–10 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2021-17&r= |
| By: | Daymude, Anna E. C.; Daymude, Joshua J.; Rochat, Roger |
| Abstract: | Background. Obstetric provider coverage in rural Georgia has worsened, with nine rural labor and delivery units (LDUs) closing outside the Atlanta Metropolitan Statistical Area from 2012–2016. Georgia consistently has one of the highest maternal mortality rates in the nation and faces increased adverse health consequences from this decline in obstetric care. Objective. This study explores what factors may be associated with rural hospital LDU closures in Georgia from 2012–2016. Methods. This study describes differences between rural Georgia hospitals based on LDU closure status through a quantitative analysis of 2011 baseline regional, hospital, and patient data, and a qualitative analysis of newspaper articles addressing the closures. Results. LDUs that closed had higher proportions of Black female residents in their Primary Care Service Areas (PCSAs), of Black birthing patients, and of patients with Medicaid, self-pay or other government insurance; lower LDU birth volume; more women giving birth within their PCSA of residence; fewer obstetricians and obstetric provider equivalents per LDU; and fewer average annual births per obstetric provider. Qualitative results indicate financial distress primarily contributed to closures, but also suggest that low birth volume and obstetric provider shortage impacted closures. Conclusions for Practice. Rural LDU closure in Georgia has a disproportionate impact on Black and low-income women and may be prevented through funding maternity healthcare and addressing provider shortages. |
| Date: | 2021–11–10 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:w47ct&r= |
| By: | Alicia H. Munnell; Patrick Hubbard |
| Abstract: | This fall, the U.S. Social Security Administration is likely to announce that benefits will be increased by around 6 percent beginning January 1, 2022. This cost-of-living-adjustment (COLA), which would be the largest in 40 years, is an important reminder that keeping pace with inflation is one of the attributes that makes Social Security benefits such a unique source of retirement income. A spurt in inflation, however, affects two other factors that determine the net amount that retirees receive from Social Security. The first is the Medicare premiums for Part B, which are deducted automatically from Social Security benefits. To the extent that premiums rise faster than the COLA, the net benefit will not keep pace with inflation. The second issue pertains to taxation under the personal income tax. Because taxes are levied on Social Security benefits only for households with income above certain thresholds ($25,000 for single taxpayers and $32,000 for joint returns) and the thresholds are not adjusted for wage growth or inflation, rising benefit levels subject more benefits to taxation – again reducing the net benefit. This brief explores the interaction of inflation and Social Security benefits. The first section describes the nature of the COLA. The second section looks at the interaction of Medicare premiums and the COLA. The third section explores how inflation affects the taxation of benefits. The final section concludes that, while the inflation adjustment in Social Security is extremely valuable, the rise in Medicare premiums and the extension of taxation under the personal income tax limits the ability of beneficiaries to fully maintain their purchasing power. |
| Date: | 2021–08 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2021-14&r= |
| By: | Alicia H. Munnell; Patrick Hubbard |
| Abstract: | The U.S. Social Security Administration recently announced a 2022 cost-of-living adjustment (COLA) of 5.9 percent – the largest since the early 1980s. But critics continue to argue that the Consumer Price Index (CPI-W) currently used for adjusting Social Security benefits does not reflect the spending of older Americans on health care and therefore understates inflation. They urge the adoption of a special price index intended to reflect the spending patterns of Social Security beneficiaries – the experimental CPI-E. While historically the CPI-E, which covers those ages 62 and over, has risen faster than the CPI-W, the old relationship between the two indexes appears to have changed. In fact, if the 2022 COLA had been based on the CPI-E, it would have been 4.8 percent rather than the actual 5.9 percent. This brief explores the changing relationship between the CPI-W and the CPI-E. The discussion proceeds as follows. The first section describes the calculation of the CPI-W, used for Social Security. The second describes the CPI-E and its limitations. The third reports the relationship between the CPI-W and the CPI-E since 1983 and shows how it has changed in recent years. The fourth section identifies the factors that have narrowed the difference between the two measures. The final section concludes that a major reason for the disappearing differential has been the slowdown in the growth of medical care costs over the past two decades. |
| Date: | 2021–11 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2021-19&r= |
| By: | Matthew S. Rutledge; Alice Zulkarnain; Sara Ellen King |
| Abstract: | When women become mothers, their labor market income often takes a substantial hit. This “motherhood earnings penalty” becomes even larger with each additional child and permanently reduces earnings throughout mothers’ worklives. Previous studies have linked the penalty to mothers’ reduced educational attainment, more time out of the workforce, higher job search costs, and poor job matches. What remains unanswered is the extent to which the penalty impacts women’s retirement income. This brief, based on a recent study, answers part of this question by looking at how Social Security provisions address the motherhood penalty. The discussion proceeds as follows. The first section explains how Social Security can impact the motherhood earnings penalty and reduce retirement income shortfalls for mothers. The second section lays out the data and methodology for this analysis. The third section finds that Social Security offsets a substantial portion of the earnings penalty. The final section concludes that – despite the equalizing role played by Social Security – a motherhood earnings penalty will remain without policy intervention, such as earnings credits for caregivers. |
| Date: | 2021–07 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2021-11&r= |
| By: | Anqi Chen; Alicia H. Munnell |
| Abstract: | A major question is how COVID-19 has affected the claiming of Social Security benefits. Preliminary reports indicate that some older workers who lost their jobs or were fearful of the virus did turn to Social Security, but an official accounting will not be available for a year. The purpose of this brief is to provide a baseline against which to assess COVID’s impact. The discussion proceeds as follows. The first section describes the claim-year data published annually by the U.S. Social Security Administration (SSA) and the birth cohort data used in this analysis. The second section presents claiming ages by cohort. The final section concludes that the share of people claiming Social Security retired-worker benefits when they reach age 62 has been falling since the mid-1990s, with only a brief upward tick during the Great Recession. |
| Date: | 2021–05 |
| URL: | http://d.repec.org/n?u=RePEc:crr:issbrf:ib2021-9&r= |
| By: | Robin Benabid Jegaden (UP1 - Université Paris 1 Panthéon-Sorbonne); Jade Lemoine (ENSAE Paris - École Nationale de la Statistique et de l'Administration Économique, UP1 - Université Paris 1 Panthéon-Sorbonne) |
| Abstract: | Income shocks to poorer households may lead parents to withdraw their children from school and enter the labour market when other risk control instruments are insufficient. These responses to short-term shocks can have longer-term consequences for the development of children's human capital. Using data from a household survey in Ethiopia, we examine the impact of rainfall shocks on medium-term human capital investment decisions. The results suggest that climate shocks significantly reduce investment in human capital. In this context, psychological mechanisms play an important role in the household decision-making process behind children's school drop-out. We argue that exposure to income shocks exacerbates the perception of investment in educational capital as relatively risky, all else being equal. The high prevalence of income shocks (natural experiments) or the perception of this prevalence aggravates households' risk aversion, by accentuating the concavity of their utility function. |
| Abstract: | Les chocs de revenus subis par les ménages les plus démunis peuvent inciter les parents à retirer leurs enfants de l'école pour les introduire sur le marché du travail, lorsque les autres instruments de maîtrise des risques sont insuffisants. Ces réponses aux chocs à court terme peuvent entraîner des conséquences à plus long terme sur le développement du capital humain des enfants. En utilisant des données issues d'une enquête ménages en Ethiopie, nous examinons l'impact des chocs pluviométriques sur les décisions d'investissement dans le capital humain à moyen terme. Les résultats suggèrent que les chocs climatiques réduisent significativement l'investissement dans le capital humain. Dans ce contexte, les mécanismes psychologiques jouent un rôle important dans le processus décisionnel des ménages à l'origine d'une déscolarisation des enfants. Nous avançons que l'exposition aux chocs de revenus exacerbe la perception de l'investissement dans le capital éducatif comme relativement risqué, toutes choses égales par ailleurs. La forte prévalence des chocs de revenu (expériences naturelles) ou le ressenti de cette prévalence aggrave l'aversion au risque des ménages, en accentuant la concavité de leur fonction d'utilité. |
| Keywords: | Chocs de revenu,Education des enfants,Marchés imparfaits,Facteurs cognitifs,Ethiopie rurale |
| Date: | 2021–04–30 |
| URL: | http://d.repec.org/n?u=RePEc:hal:wpaper:hal-03527638&r= |