Estimating willingness to pay for medicare using a dynamic life-cycle model of demand for health insurance

Medicare is the largest health insurance program in the US. This paper uses a dynamic random utility model of demand for health insurance in a life-cycle human capital framework with endogenous production of health to calculate the individual willingness to pay (WTP) for Medicare. The model accounts for the feature that the demand for health insurance is derived through the demand for health, which is jointly determined with the production of health over the life-cycle. The WTP measure incorporates the effects of Medicare insurance on aggregate consumption through effects on medical expenditures and mortality, and consumption utility of health. The model is estimated using panel data from the Health and Retirement Study. The average WTP or change in lifetime expected utility resulting from delaying the age of eligibility to 67 is found to be $ 24,947 in 1991 dollars ($ 39,435 in 2008 dollars). However, there is considerable variation in the WTP, e.g., in 1991 dollars the WTP of individuals who have less than a high school education and are white is $ 28,347 ($ 44,810 in 2008 dollars), while the WTP of those with at least a college degree and who are neither white nor black is $ 15,584 ($ 24,635 in 2008 dollars). More generally, the less educated have a higher WTP to avoid a policy change that delays availability of Medicare benefits. Additional model simulations imply that the primary benefits of Medicare are insurance against medical expenditures with relatively smaller benefits in terms of improved health status and longevity. Medicare also leads to large increases in medical utilization due to deferring of medical care prior to eligibility.     

“新农合”对农村居民耐用品消费的影响

本文利用中国营养健康调查（CHNS）数据,基于改进的Probit模型检验了新型农村合作医疗保险对农村居民耐用品消费的影响。研究发现：“新农合”能有效提高农村家庭的耐用品消费水平,且农村家庭上一期参保行为对耐用品消费的刺激作用更显著。另外,“新农合”对存在中、高健康风险居民的耐用品消费刺激作用明显,且上期参保行为对健康高风险居民的耐用品消费促进作用更强。     

Externalities in a life cycle model with endogenous survival

We study socially vs individually optimal life cycle allocations of consumption and health, when individual health care curbs own mortality but also has a spillover effect on other persons’ survival. Such spillovers arise, for instance, when health care activity at aggregate level triggers improvements in treatment through learning-by-doing (positive externality) or a deterioration in the quality of care through congestion (negative externality). We combine an age-structured optimal control model at population level with a conventional life cycle model to derive the social and private value of life. We then examine how individual incentives deviate from social incentives and how they can be aligned by way of a transfer scheme. The age-patterns of socially and individually optimal health expenditures and the transfer rate are derived. Numerical analysis illustrates the working of our model.     

Heterogeneity in risk aversion and risk sharing regressions

Heterogeneity in risk attitudes, if not properly accounted for, may induce a bias on the income coefficient of standard consumption insurance regressions. We show that, extending the theoretical analysis and empirical findings in Schulhofer‐Wohl (Journal of Political Economy, 2011, 119, 925–958), the sign of the bias is ambiguous, and depends on cycle‐related variables and on the covariances of both aggregate and idiosyncratic risk with individual risk aversion.     

The demand for deductibles in private health insurance: A probit model with sample selection

In this paper we analyse the decision to prefer a health insurance with a deductible to one with complete coverage. We focus on health, medical consumption, and on socio-economic characteristics like age, income, education and family size. The analysis is based on a sample of 8000 privately insured families; about 60 percent of them did not wish to have a health insurance policy with a deductible. A corrective method for sample selectivity, analogous to Heckman's (1979) method, has been applied in probit analysis; the estimation results are compared with the maximum-likelihood estimates. Health, medical consumption and income are found to have a significant influence on the decision with respect to the type of insurance. Our results give an indication of the degree of adverse selection that may take place if health insurance policies are offered with the option to take a deductible in exchange of a premium reduction.     

Age-dependent investing: Optimal funding and investment strategies in defined contribution pension plans when members are rational life cycle financial planners

A defined contribution pension plan allows consumption to be redistributed from the plan member's working life to retirement in a manner that is consistent with the member's personal preferences. The plan's optimal funding and investment strategies therefore depend on the desired profile of consumption over the lifetime of the member. We investigate these strategies under the assumption that the member is a rational life cycle financial planner and has an Epstein–Zin utility function, which allows a separation between risk aversion and the elasticity of intertemporal substitution. We also take into account the member's human capital during the accumulation phase of the plan and we allow the annuitisation decision to be endogenously determined during the decumulation phase.We show that the optimal funding strategy involves a contribution rate that is not constant over the life of the plan but is age-dependent and reflects the trade-off between the desire for current versus future consumption, the desire for stable consumption over time, the member's attitude to risk, and changes in the level of human capital over the life cycle. We also show that the optimal investment strategy during the accumulation phase of the plan is ‘stochastic lifestyling’, with an initial high weight in equity-type investments and a gradual switch into bond-type investments as the retirement date approaches in a way that depends on the realised outcomes for the stochastic processes driving the state variables. The optimal investment strategy during the decumulation phase of the plan is to exchange the bonds held at retirement for life annuities and then to gradually sell the remaining equities and buy more annuities, i.e., a strategy known as ‘phased annuitisation’.     

Health insurance and retirement of married couples

Most health insurance in the USA is provided by employers until eligibility for public health insurance (Medicare) begins at age 65. Retiring before 65 exposes workers who lack retiree health insurance coverage to the risk of catastrophic medical expenditure. We solve and estimate a dynamic model of the employment behavior of older married couples that includes risky medical expenditure and health insurance. Parameter estimates imply that the risk‐reducing feature of health insurance can account for about half of the observed association between retiree health insurance and employment for married men, but can account for only one tenth of the much larger observed association for married women. Policy simulations imply very small effects on employment of changing the age of eligibility for Medicare from 65 to 67. Copyright © 2006 John Wiley & Sons, Ltd.     

农业保险需求问题的一个理论研究及实证分析

本文对农业保险的需求从三个层面进行了经济分析,并运用田野调查的方法进行了实证研究。发现中国农业保险需求不旺盛的原因,主要源于农业自然风险在影响农户正常生活的各种因素中并不显著等因素。因而,在农村开展商业性农业保险的时机并不成熟。但是,在规模较大的自然灾害风险条件下,农业保险可以补充农民利用传统风险分散的能力,有助于迅速恢复再生产,因此,政策性农业保险在农业生产过程中,能够起到一定的作用。     

Opt Out or Top Up? Voluntary Health Care Insurance and the Public vs. Private Substitution

We investigate whether in a mixed insurance system, people enrolled into voluntary health care insurance (VHI) substitute public consumption with private (opt out) or just enlarge their private consumption without reducing reliance upon public provisions (top up). We specify a joint model for public and private specialist visits counts, allowing for different degrees of endogenous supplementary insurance coverage. We find evidence of opting out: richer and wealthier individuals consume more private services and concomitantly reduce those services publicly provided through selection into for‐profit VHI. Accounting for VHI endogeneity in the joint model of the two counts is crucial to this conclusion.     

Extended risk classification in insurance industry

Recently extended risk classification has become an important issue in life insurance and annuity markets. Using various risk factors, one can construct various risk classes. This enables insurers to provide more equitable life insurance and annuity benefits for individuals in different risk classes and to manage mortality/longevity risk more efficiently. This article discusses the development of a mortality model that reflects the impact of various risk factors on mortality. The model uses Markov process combined with generalized linear models. The model is used to illustrate how the various risk factors influence actuarial present values of life insurance and annuity benefits.     

UNEMPLOYMENT,HUMAN CAPITAL DEPRECIATION,AND UNEMPLOYMENT INSURANCE POLICY

This paper presents a structural estimation of a life cycle model with unemployment risk. The model allows for human capital depreciation during unemployment. It is estimated using German and US household‐level data. The data suggest that the adverse impact of unemployment on individual productivity is important in both countries, but quantitatively more relevant in Germany. Moreover, simulations show that the combination of skill depreciation with the generous unemployment insurance system that was in place in Germany until recently is a key factor in explaining the differences in labour market performance between these countries. Copyright © 2012 John Wiley & Sons, Ltd.     

Equilibrium mean–variance reinsurance and investment strategies for a general insurance company under smooth ambiguity

This work investigates the equilibrium investment and reinsurance strategies for a general insurance company under smooth ambiguity. The general insurance company holds shares of an insurance company and a reinsurance company. The claims of the insurer follow a compound Poisson process. The insurer can divide part of the insurance risk to the reinsurer. Besides, the insurer and reinsurer both participate in the financial market and invest in cash and stock. However, the general insurance company is ambiguous about the insurance and financial risks and is an ambiguity-averse manager (AAM). The uncertainties over the insurance and financial risks are described by second-order distributions. The AAM aims to maximize the average performance of the weighted sum surplus process of the insurer and reinsurer under the mean–variance criterion and smooth ambiguity. We present the extended Hamilton–Jacobi–Bellman (HJB) system for the optimization problem combining the mean–variance criterion and smooth ambiguity. In the case that the second-order distributions are Gaussian, we obtain the closed-forms of the equilibrium reinsurance and investment strategies. At the end of this work, sensitivity analyses are presented to show the economic behaviors of the AAM.     

Risk aversion in a model of endogenous growth

Despite the evidence on incomplete financial markets and substantial risk being borne by innovators, current models of growth through creative destruction predominantly model innovators’ as risk neutral. Risk aversion is expected to reduce the incentive to innovate and we might fear that without insurance innovation completely disappears in the long run. The present paper introduces risk averse agents into an occupational choice model of endogenous growth in which insurance against failure to innovate is not available. We derive a clear negative relationship between the level of risk aversion and long run growth. Surprisingly, we show that in an equilibrium there exists a cut-off value of risk aversion below which the growth rate of the mass of innovators tends to a strictly positive constant. In this case, innovation persists on the long run and consumption per capita grows at a strictly positive rate. On the other hand, for levels of risk aversion above the cut-off value, the economy eventually stagnates.     

基层寿险公司公共危机成因及应对策略研究

寿险业是一个承担着巨大风险的行业,这就要求它对危机要具有很强的敏感性。寿险业的诞生、成长和发展历程,证明了它在不断地应对危机和规避风险。近年来,基层公司面临的公共危机日益增多,对寿险从业人员特别是基层管理者提出严峻的挑战。文章分析了基层寿险公司产生公共关系危机的原因,阐述了正确认识公共危机的重要意义,提出处理公共危机一般性策略。     

Prevention incentives in long‐term insurance contracts

Long‐term insurance contracts are widespread, particularly in public health and the labor market. Such contracts typically involve monthly or annual premia which are related to the insured's risk profile. A given profile may change, based on observed outcomes which depend on the insured's prevention efforts. The aim of this paper is to analyze the latter relationship. In a two‐period optimal insurance contract in which the insured's risk profile is partly governed by her effort on prevention, we find that both the insured's risk aversion and prudence play a crucial role. If absolute prudence is greater than twice absolute risk aversion, moral hazard justifies setting a higher premium in the first period but also greater premium discrimination in the second period. This result provides insights on the trade‐offs between long‐term insurance and the incentives arising from risk classification, as well as between inter‐ and intragenerational insurance.     

我国住房抵押贷款保险问题及对策

住房抵押贷款保险，对于化解银行信贷风险、刺激个人住房消费发挥着重要作用。在我国，由于这个险种开办时间较短，在险种的开发、保险金额及费率的厘定等方面存在诸多问题。本文提出应该从确定合理的保险金额和费率、建立风险防范机制等方面完善住房抵押贷款制度。     

论寿险公司资产投资风险的监管

按照国际惯例,寿险公司监管的核心是偿付能力监管,而偿付能力监管体系中的重点则是确定资产投资风险的风险值。构建对资产投资风险运用参数进行测算的模型,以确定偿付能力额度中资产投资风险的大小。     

Durable Purchases over the Later Life Cycle

We investigate life‐cycle patterns of demand for services from household durables using UK panel data. We take careful account of prices, demographics, labour supply and health. Demand for consumer electronics rises with age, while the demand for household appliances is flat. These findings contrast with the well documented decline in non‐durable consumption at older ages, and suggest that studies that estimate the overall discount rate from nondurable consumption may underestimate consumer patience and the savings required to fund retirement. We also find important non‐separabilities between the demand for durables, labour supply and health status.     

An evaluation of financial institutions: Impact on consumption and investment using panel data and the theory of risk-bearing

The theory of the optimal allocation of risk and the Townsend Thai panel data on financial transactions are used to assess the impact of the major formal and informal financial institutions of an emerging market economy. We link financial institution assessment to the actual impact on clients, rather than ratios and non-performing loans. We derive both consumption and investment equations from a common core theory with both risk and productive activities. The empirical specification follows closely from this theory and allows both OLS and IV estimation. We thus quantify the consumption and investment smoothing impact of financial institutions on households including those running farms and small businesses. A government development bank (BAAC) is shown to be particularly helpful in smoothing consumption and investment, in no small part through credit, consistent with its own operating system, which embeds an implicit insurance operation. Commercial banks are smoothing investment, largely through formal savings accounts. Other institutions seem ineffective by these metrics.     

我国寿险业运营风险实证研究

基于承保、投资和偿付等三个业务环节的相关指标,构建了我国寿险运营绩效评价指标体系,运用因子分析方法对我国寿险业2005年-2007年运营状况进行分析并揭示其风险,结果表明:我国寿险业具有明显的垄断竞争格局,且这一趋势逐年弱化;三年中大部分寿险公司运营绩效有所提升,特别是2007年各寿险公司运营状况均有所改善,整个行业运营风险有较为显著的降低,究其原因,可能与我国寿险业承保业务的平稳增长和投资领域的扩大等诸多因素有关。