nep-ias New Economics Papers
on Insurance Economics
Issue of 2022‒04‒18
thirteen papers chosen by
Soumitra K. Mallick
Indian Institute of Social Welfare and Business Management

  1. Did the Medicaid Expansion Crowd Out Other Payment Sources for Medications for Opioid Use Disorder? Evidence from Rhode Island By Mary A. Burke; Riley Sullivan
  2. Voluntary health insurance markets in France: . Economic rationales and legal mechanisms By Philippe Batifoulier; Anne-Sophie Ginon
  3. Sickness, Accident, and Maternity Insurance For Farmers: A Need For Change By Podstawka, Marian; Podstawka Łukasz
  4. The welfare effects of unemployment insurance in Argentina. New estimates using changes in the schedule of transfers By Martin González-Rozada; Hernan Ruffo
  5. Why Women Work the Way They Do in Japan: Roles of Fiscal Policies By KITAO Sagiri; MIKOSHIBA Minamo
  6. Universal Credit: Welfare Reform and Mental Health By Mike Brewer; Thang Dang; Emma Tominey
  7. Primary Care Redesign and Care Fragmentation Among Medicare Beneficiaries By Lori Timmins; Carol Urato; Lisa M. Kern; Arkadipta Ghosh; Eugene Rich
  8. The economics of long-term care. An overview By Klimaviciute, Justina; Pestieau, Pierre
  9. Essays on the social and distributional effects of public policies By Lisa Bagnoli
  10. Medicare’s Finances and the Aduhelm Saga By Alicia H. Munnell; Patrick Hubbard
  11. Republic of Kazakhstan: Technical Assistance Report-Risk-Based Supervision Pillar 2 Implementation By International Monetary Fund
  12. Regulating platform delivery work in Argentina. Tensions between regulations and the priorities of workers By Francisca PEREYRA; Lorena POBLETE
  13. The Longer-term Impact of Coinsurance for the Elderly - Evidence from High-access Case - By Norihiro Komura; Shun-ichiro Bessho

  1. By: Mary A. Burke; Riley Sullivan
    Abstract: Using information from the all-payer claims database for Rhode Island covering more than three-quarters of health insurance enrollees in the state from April 2011 through May 2019, this paper offers new measures of the association between the Medicaid expansion and the rate of receipt of buprenorphine and methadone for opioid use disorder (OUD). These robust measures adjust for the extent to which new Medicaid payments for these medications that started in 2014 crowded out payments from either non-Medicaid insurance or from non-insurance subsidies for the treatment of opioid abuse. We find that crowding out was nontrivial but incomplete for either buprenorphine or methadone, such that the Medicaid expansion in Rhode Island appears to have enabled many patients to access medications for OUD for the first time. These findings offer support for the expansion of Medicaid in states that have not already done so.
    Keywords: opiod use disorder; Medicaid expansion; buprenorphine; methadone; crowding out; Rhode Island; all-payer claims database
    JEL: I12 I13 I14 I18
    Date: 2022–04–14
  2. By: Philippe Batifoulier (CEPN - Centre d'Economie de l'Université Paris Nord - UP13 - Université Paris 13 - USPC - Université Sorbonne Paris Cité - CNRS - Centre National de la Recherche Scientifique); Anne-Sophie Ginon
    Abstract: In France, there are two types of health insurance: compulsory public health insurance and voluntary private health insurance which is organized as a market. This paper deals with private health insurance. We define the market place (position and scope) according to two criteria. On the one hand, the standardization or differentiation strategies of the insurance companies, which structure competition through quality and innovation. Secondly, the type of pooling (or mutualisation) at work in insurance contracts, distinguishing between commercial pooling and solidarity-based pooling. We draw up a typology of four "ideal-type" market configurations: residual market, educated market, polarized market and autonomous market.
    Date: 2022–02–22
  3. By: Podstawka, Marian; Podstawka Łukasz
    Abstract: The aim of the study is to present the subjective and objective aspects of sickness, accident, and maternity insurance for farmers. The study deals with the income and expenses of the Contribution Fund and their correlation with the amount of benefits paid. The study uses financial analysis methods, descriptive analysis methods, and logical inference. Results are presented in tabular form. Between 2009 and 2019, there was a decrease in the number of insured persons. The Contribution Fund has been increasingly financing tasks indirectly related to sickness, accident, and maternity insurance. The conducted assessment shows that the currently existing legal regulations concerning the first pillar of insurance risks by the Agricultural Social Insurance Fund (KRUS), i.e., sickness, accident, and maternity risks, specified in the Farmers’ Social Insurance Act, have become obsolete and require changes. The definition of an accident at work in agriculture requires a new regulation. It is about extending the scope of agricultural activity to include activities related to the processing of agricultural raw materials, provision of services, supervision and protection of property, and conducting non-agricultural business activities.
    Keywords: Labor and Human Capital, Public Economics, Risk and Uncertainty
    Date: 2021–09–23
  4. By: Martin González-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.
    Keywords: Unemployment Insurance, Sufficient statistics, Regression kink design, Instrumental Variables.
    JEL: C41 I38 J65
    Date: 2022–02
  5. By: KITAO Sagiri; MIKOSHIBA Minamo
    Abstract: Women work less often and earn significantly less than men in Japan. We use panel data to investigate employment and earnings dynamics of single and married women over the life cycle and build a structural model to study the roles of fiscal policies in accounting for their behavior. We show that eliminating spousal deductions, social insurance premium exemptions and survivors' pension benefits for low-income spouses would significantly raise the labor supply of women and their earnings. More women would opt for regular jobs rather than contingent jobs, accumulate more human capital, and enjoy higher income growth. The government would earn higher net revenues and there is a welfare gain when additional taxes are transferred back.
    Date: 2022–03
  6. By: Mike Brewer (Resolution Foundation); Thang Dang (Norwegian Institute of Public Health); Emma Tominey (University of York)
    Abstract: The UK Universal Credit (UC) welfare reform simplified the benefits system whilst strongly incentivising a return to sustainable employment. Exploiting a staggered roll-out, we estimate the differential effect of entering unemployment under UC versus the former system on mental health. Groups with fewer insurance possibilities - single adults and lone parents – experience a mental health deterioration of 8.4-13.9% sd. For couples, UC partially or fully mitigates mental health consequences of unemployment. Exploring mechanisms, for single adults and lone parents, reduced benefit income and strict job search requirements dominate any positive welfare effects of the reduced administrative burden of claiming benefits.
    Keywords: welfare reform, mental health, mediation, decomposition, universal credit
    JEL: D61 I10 I14 I38
    Date: 2022–03
  7. By: Lori Timmins; Carol Urato; Lisa M. Kern; Arkadipta Ghosh; Eugene Rich
    Abstract: This article examines the association between a large-scale primary care redesign—the Comprehensive Primary Care Plus Initiative—and ambulatory care patterns of Medicare beneficiaries with highly fragmented care.
    Keywords: Primary care, care fragmentation, Medicare beneficiaries, comprehensive primary care plus
  8. By: Klimaviciute, Justina (Vilnius University); Pestieau, Pierre (Université catholique de Louvain, LIDAM/CORE, Belgium)
    Abstract: With the rapid increase in long-term care (LTC) needs, it is important to assess the expected contributions of the traditional providers of LTC: the state, the market and the family. We first survey the literature devoted to the family and the market. Then, given the declining role of family caregiving and the negligible role of the market, we look at a number of studies exploring the design of public policies in support of the dependent elderly, particularly those who cannot count on the assistance from their family and those who lack basic means. Those public policies are conceived in such a way that they also rely on both the market and the family.
    Keywords: Long-term care ; dependence ; social insurance ; family solidarity ; social norm
    JEL: I11 I12 I18 J14
    Date: 2022–01–22
  9. By: Lisa Bagnoli
    Abstract: This Ph.D. thesis focuses on the social and distributional effects of public policies, whether these are intended or not. To address the topic, I categorize public policies along two dimensions. First, I distinguish between policies with explicit social objectives and those without. Second, I distinguish between policies targeting specific vulnerable groups and those covering the whole population. The thesis consists of three empirical evaluations in three different contexts and sectors. The first chapter analyzes the introduction of a public policy with explicit social objectives and an explicit targeting of the most vulnerable. I focus on the impact of a social subsidy on electricity prices on the likelihood of energy poverty of vulnerable households in Spain. The second chapter assesses a public policy with social objectives but not directly targeted to the most vulnerable population. I investigate the heterogeneous health impact of the introduction in Ghana of free health insurance for all children. Finally, the third chapter analyzes the case of a policy without explicit social objectives or targeting. In this case I evaluate the unintended distributional effects of the introduction of a railroad in Kazakhstan through its effects on trade by the local population.
    Abstract: Chapter 1: How effective has the electricity social rate been in reducing energy poverty in Spain? This chapter analyzes whether the introduction of an electricity social rate was effective in reducing the likelihood of energy poverty. We focus on the Bono Social de Electricidad, introduced in 2009 in Spain's electricity market, a policy aimed at increasing the affordability of electricity by entailing a discount on prices for vulnerable consumers. Using data from the family budget surveys from 2006 to 2017, we rely on a difference-in-differences approach to measure its causal impact on energy poverty. We show that, on average, the introduction of the policy has reduced the likelihood of energy poverty. However, the magnitude of the effect is quite modest in practice as it takes only 59,000 households out of energy poverty out of the 2.8 million households still in that situation in 2018. It is noteworthy that the results also show that the lower effective prices do not lead an increase of the beneficiaries consumption of electricity. Overall this chapter provides new evidence on the institutional determinants of energy poverty and highlights the importance of assessing the magnitude of the effects as well as the targeting strategy of public policies to make the most of the resources allocated to social policies.
    Abstract: Chapter 2: Does health insurance improve health for all? Heterogeneous effects on children in Ghana. This chapter investigates the extent to which the impact of a policy depends on the characteristics of the beneficiaries but also on the institutional capacity of the decentralized implementing agencies. To do so, I analyze the case of Ghana’s National Health Insurance Scheme (NHIS) that provides free coverage for all children. I exploit the Multiple Indicator Cluster Survey of 2011 and I use propensity score matching to account for selection in the scheme. The study finds that, even though the NHIS is successful on average in improving health outcomes among insured children in Ghana, gains are not shared equally across regions. The positive impact of health insurance is entirely concentrated among the lower-income households in regions with a high quality of public health care. This chapter sheds a new light on the mixed results of the literature on the impact of health insurance on health outcomes. It provides an understanding of the sources of the heterogeneous impact of a National Health Insurance Scheme and highlights the importance of context and implementation as drivers of its effectiveness.
    Abstract: Chapter 3: Distributional effects of colonial railroads: Evidence from Kazakhstan. This chapter analyzes how the gains from a major public investment in railways undertaken without any explicit social objectives are shared among the population. More specifically, we study the distributional effect of Orenburg-Tashkent railroad constructed by the Russian Empire through Kazakh steppes in 1905-1906. The analysis is based on a unique historical dataset allowing us to provide evidence from a quasi-natural experiment to compare economic outcomes of households of varying wealth located in districts close and far from the railroad. We focus on the impact of the investment on the trading activities of households.We find that wealthier households benefited disproportionately more in trading activities from railroad closeness, whereas the trading activity of the poorer strata located closer to the railroad decreased. The colonial railroad appears affecting the indigenous population mostly through bringing in Russian peasant settlements rather than by reducing costs of long-distance trade. This paper provides novel evidence of the distributional effects of transportation infrastructure within regions. It further stresses the short and medium term social risks associated with failures to consider explicitly all the welfare impact of major public investments rather than just focusing on their long term growth payoffs.
    Abstract: Conclusion: The analysis of these three case studies documents the diversity of social and distributional concerns arising from public policies. By studying different contexts with different methodological approaches, this thesis points to the importance of: (1) assessing ex-ante the size of the effects to reduce the risk of misuse of resources; (2) matching the targeting of beneficiaries with the stated policy objectives; (3) matching implementation strategies with institutional capacity; (4) considering the likely heterogeneity of direct impacts and their causes; and (5) considering explicitly the possibility of unintended or indirect social and distributional effects of policies to adopt mitigating solutions as needed. Overall, such evidence is relevant for both the evaluation and monitoring of existing policies as well as for the implementation of new policy reforms.
    Keywords: Public policies, social effects, distributional effects, energy, health, transport
    Date: 2022–02–21
  10. By: Alicia H. Munnell; Patrick Hubbard
    Abstract: The Centers for Medicare & Medicaid Services (CMS) created headlines last fall when it increased the Medicare Part B premium for 2022 by 14.5 percent. A significant portion of the increase was aimed at creating “contingency reserves†in the event that Medicare ended up covering Aduhelm – the controversial and expensive new drug for early-stage Alzheimer’s disease. In January, the decision was made to limit the coverage of Aduhelm to those in clinical trials. While the CMS decision will hold Medicare costs in check for the short run, it highlights the program’s financial vulnerability to high-priced, potentially valuable drugs when CMS has no ability to negotiate prices. The discussion proceeds as follows. The first section provides a brief overview of Medicare financing. The second section describes the 2021 Trustees Report projections that use current-law assumptions and projections based on alternative assumptions that involve higher payments for hospital and medical services. The third section turns to payments for drugs, an expenditure component not considered in the alternative assumptions, and explores the implications of Aduhelm for Medicare and its beneficiaries. The final section concludes that the Aduhelm saga has highlighted the risk to the system’s finances if very valuable and very expensive drug should become available and Medicare remains unable to negotiate prices. Hopefully, the lessons from Aduhelm will rekindle Congressional interest in giving Medicare some authority to do so.
    Date: 2022–02
  11. By: International Monetary Fund
    Abstract: This virtual technical assistance (TA) mission supported the Agency in strengthening certain elements of its risk based supervisory framework. The mission focused on assisting the Agency with its development of internal supervisory methodologies for assessing a bank’s ICAAP, and for setting individual Pillar 2 supervisory capital requirements. The mission provided recommendations and targeted training. The priorities for the next TA missions were discussed with the Agency (strengthening banking supervision and cybersecurity, and diagnostic TA of insurance sector supervision will be considered). The mission benefited from simultaneous translation.
    Date: 2022–03–01
  12. By: Francisca PEREYRA; Lorena POBLETE
    Abstract: The quarantine imposed in March 2020 shed light on the essential labour performed by digital delivery platforms’ workers and their precarious labour conditions. In order to protect them, seven draft bills were proposed to Congress in Argentina, oscillating between a salaried/independent classification of these workers. This article uses qualitative and quantitative data to analyse how these regulatory proposals deal with three dimensions that are at the center of workers’ own concerns when it comes to the regulation of the activity: the preservation of flexible schedules, the continuity of income self-regulation – even though this often means overworking – and the need to access effectively social protection – where the absence of occupational hazards insurance stands out.
    Keywords: Argentine
    JEL: Q
    Date: 2022–03–01
  13. By: Norihiro Komura (Institute of Economic Research, Kyoto University); Shun-ichiro Bessho (Faculty of Economics, University of Tokyo)
    Abstract: We estimate the longer-term impact of coinsurance for the elderly by RDD using administrative data, focusing on the increase in coinsurance in Japan, from 10% to 20%, for those aged 70-74, born after April 1944. The reduction of utilization in the longer term is similar to, or slightly larger than, in the short term. Patients reduce potentially wasteful care more; we do not find discernible impacts on health outcome and health-related behaviors. For the moderate change of prices for the elderly, distinctive characteristics associated with medical services, like behavioral hazard and ex-ante moral hazard, seem not largely affect consumer responsiveness.
    Keywords: Fiscal
    JEL: I11 I12 I13 I18 J14
    Date: 2022–02

This nep-ias issue is ©2022 by Soumitra K. Mallick. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.