THE EFFECT OF PARENTAL MEDICAID EXPANSIONS ON CHILDREN'S HEALTH INSURANCE COVERAGE

Research on public health insurance expansions has typically focused on those targeted by the expansions; we estimate the spillover effects of parental Medicaid expansions on the insurance coverage of their children. Expanding parental Medicaid eligibility may increase participation by already‐eligible, uninsured children by increasing the value of Medicaid enrollment for the entire family. However, parental expansions may also generate crowd out from private coverage. Using the Survey of Income and Program Participation during a period of major parental Medicaid expansions, we find substantial effects of the expansions on the Medicaid participation of children, with evidence of crowd out among some subsamples. (JEL H51, I13, I38)     

Why is the market for long-term care insurance so small?

Long-term care represents one of the largest uninsured financial risks facing the elderly in the United States. We present evidence of supply side market failures in the private long-term care insurance market. In particular, the typical policy purchased exhibits premiums marked up substantially above expected benefits. It also provides very limited coverage relative to the total expenditure risk. However, we present additional evidence suggesting that the existence of supply side market failures is unlikely, by itself, to be sufficient to explain the very small size of the private long-term care insurance market. In particular, we find enormous gender differences in pricing that do not translate into differences in coverage, and we show that more comprehensive policies are widely available, if seldom purchased, at similar loads to purchased policies. This suggests that factors limiting demand for insurance are also likely to be important in this market. Our evidence also sheds light on the likely nature of these demand-side factors.     

Club convergence analysis of regional ecological efficiency in China

This paper adopts a network data envelopment analysis (DEA) model combined with a window analysis approach to evaluate the ecological efficiency (eco‐efficiency) of 30 regions in China over 2000–2015. We also investigate the existence of eco‐efficiency convergence clubs among these regions and analyse the important factors that drive eco‐efficiency club formation. Our results reveal that, overall, Chinese regional eco‐efficiency deteriorated from 2000 to 2015. We find that there is a significant regional disparity in eco‐efficiency. Our convergence analysis indicates that Chinese regions converge into three eco‐efficiency clubs, suggesting that common economic and environment policies might have a limited impact on promoting regional eco‐efficiency and regionally‐tailored policies need to be designed. Finally, we find that forest coverage, R&D expenditure and pollution punishment are important determinants of convergence club membership.     

Convergence patterns in financial development: evidence from club convergence

This article analyzes the degree of convergence of financial development for a panel of 50 countries. We apply the methodology of Phillips and Sul (Econometrica 75:1771?C1855, 2007) to various indicators of financial development to assess the existence of convergence clubs. We consider ten alternative indicators of financial development that various researchers use to proxy for the degree of financial development in countries. Overall, the results do not support the hypothesis that all countries converge to a single equilibrium state in financial development. Nevertheless, strong evidence exists of club convergence. Countries demonstrate a high degree of convergence in the sense that in the majority of financial indexes they form only two or three convergence clubs, depending on the measure of financial development used. We also apply the Phillips and Sul method to two real variables, per capita output and fixed capital investment to GDP, and find strong evidence of five and four distinct convergence clubs, respectively. Finally, we compare the various convergence clubs associated with financial development indicators to those clubs for per capita output and fixed capital investment to GDP. We conclude that strong evidence supports the correspondence between the convergence clubs for financial development and those two real variables.     

Club Convergence in Carbon Dioxide Emissions

We examine convergence in carbon dioxide emissions among 128 countries for the period 1960–2003 by means of a new methodology introduced by Phillips and Sul (Econometrica 75(6):1771–1855, 2007a). Contrary to previous studies, our approach allows us to examine for evidence of club convergence, i.e. identify groups of countries that converge to different equilibria. Our results suggest convergence in per capita CO₂ emissions among all the countries under scrutiny in the early years of our sample. However, there seem to be two separate convergence clubs in the recent era that converge to different steady states. Interestingly, we also find evidence of transitioning between the two convergence clubs suggesting either a slow convergence between the two clubs or a tendency for some countries to move from one convergence club to the other.     

The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP

We examine Medicaid enrollment and private coverage loss following expansions of Medicaid eligibility. We attempt to replicate Cutler and Gruber's [Q. J. Econ. 111 (1996) 391.] results using the Survey of Income and Program Participation (SIPP), and find smaller rates of take-up and little evidence of crowding out. We find that some of the difference in results can be attributed to different samples and recall periods in the data sets used. Extending the previous literature, we find that take-up is slightly increased if a child's siblings are eligible and with time spent eligible. Focusing on children whose eligibility status changes during the sample, we estimate smaller take-up effects. We find little evidence of crowding out in any of our extensions.     

A dynamic analysis of the demand for health insurance and health care

We find that asymmetric information is important for the uptake of supplementary private health insurance and health care utilization. We use dynamic panel data models to investigate the sources of asymmetric information and distinguish short-run selection effects into insurance from long-run selection effects. Short-run selection effects (i.e. responses to shocks) are adverse, but small in size. Also long-run effects driven by differences in, for example, preferences and risk aversion, are small. But we find some evidence for multidimensional asymmetric information. For example, mental health causes advantageous selection. Estimates of health care utilization models suggest that moral hazard is not important.     

Health insurance and lifestyles

This article contributes to the discussion surrounding the existence of ex ante moral hazard and propitious selection in a voluntary private health insurance scenario. Moreover, it provides an estimation of the determinants of lifestyle choices and of private health insurance demand. A multivariate probit is estimated for health insurance demand and lifestyle decisions to take into account the potential endogeneity of these decisions. The results indicate that there is evidence of ex ante moral hazard in deciding to do sports and eating healthy snacks. Hence, no propitious selection has been found for these decisions. Another relevant result shows that there is no individual heterogeneity for the lifestyle choices, except for smoking, and private health insurance choice. Evidence from the results also supports the idea that there are nonobservable variables playing a role in the lifestyle decisions. These results provide some directions for policymakers, such as the promotion of precautionary behaviours and the use of implicit lifestyle drivers to promote healthy choices by people.     

Public insurance and child hospitalizations: access and efficiency effects

The 1983-1996 period saw enormous expansions in access to public health insurance for low-income children. We explore the impact of these expansions on child hospitalizations. While greater access to inpatient care may increase hospital utilization, improved efficiency of care for children who are also newly eligible for primary care could lower hospitalization rates. We use a large sample of child discharges from the National Hospital Discharge Survey (NHDS) to assess the net impact of Medicaid expansions on hospitalizations during this period. We find that total hospitalizations increased significantly, with each 10 percentage-point rise in eligibility leading to an 8.4% increase in hospitalizations. Thus, the access effect strongly outweighs any efficiency effect produced by expanded coverage. However, we find some support for an efficiency effect: the increase in hospitalizations for unavoidable conditions is much larger than that for avoidable conditions that are most sensitive to outpatient care. Indeed, the increase in avoidable hospitalizations is less than half that of unavoidable hospitalizations, and it is not statistically significant. We also find that expanded Medicaid eligibility reduced the average length of stay, but increased the utilization of inpatient procedures, so that the net impact on total costs per stay is ambiguous.     

中国居民医疗保险购买行为研究-基于商业健康保险的角度

本文通过健康保险市场供需双方行为分析,构建居民医疗保险购买行为模型,利用中国健康与营养调查数据(2000—2006),运用部分观测的二元Probit估计方法(Bivariate Probit with partial observability),从实证的角度分析商业健康保险市场中供需双方各自的风险选择行为,以及城乡地区居民对商业健康保险的潜在需求行为及其宏微观影响因素。本文发现:(1)城乡居民都存在显著的逆向选择行为;(2)城乡社会医疗保障对居民商业健康保险需求行为有显著的促进作用;(3)影响居民商业健康保险行为的其他因素还包括,个人的风险偏好和经济购买力。     

Why Subsidise Private Health Insurance?

What are the economic rationales for the public subsidy of private health insurance? Inducing more people to purchase private cover has the potential to create a positive fiscal externality, as it frees up the limited public beds and other public resources for people who cannot afford private health insurance. Investigating this quantitatively, based on short‐run demand estimates, we find that the subsidy cannot be justified on the basis of this externality effect alone. We estimate that the optimal subsidy is actually negative, that is, a tax on private health insurance premiums. On the other hand, the externality does finance some of the costs. We then consider a long‐run dynamic version, consistent with the government's stated rationales for the reforms. In this context, the subsidy might be justified, or at least largely offset, by the fiscal externality. We then discuss other rationales for a subsidy and implementation issues.     

The impact of public capital on the US private economy: new evidence and analysis

This paper presents new evidence on the impact of public capital on the productivity of the US private sector. Using a production function approach, we estimate the impact of public investment on private capital productivity, specifically addressing the empirical critiques of earlier studies. We find evidence of a cointegrating relationship in a dynamic specification of an empirical model that includes public infrastructure as a factor of production, indicating the existence of a long‐run relationship between the US public capital stock and the productivity of the private capital stock. The results are used to explore how the decline in the growth rate of the public capital stock would have affected the performance of the private sector.     

Convergence in US house prices

This paper analyses the convergence of US house prices. Our results confirm the existence of some degree of segmentation in the US housing market. We also provide robust evidence that the bursting of the housing price bubble has altered this market, observing different results when the sample includes information posterior to 2010. However, we appreciate different effects depending on the geographical level of disaggregation that is employed.     

Robust determinants of health care expenditure growth

Our aim is to disclose robust explanatory variables for health care expenditure (HCE) growth by introducing to this field of research a method that is especially well suited for situations of ‘model uncertainty’: the Extreme Bounds Analysis (EBA). We analyse data for 33 OECD countries over the period 1970–2010 and include – as far as it is statistically feasible – all macroeconomic and institutional determinants of HCE growth in the EBA that have been suggested in the literature. Furthermore, we analyse to what extent outliers in the data influence the results. Our results confirm earlier findings that GDP growth and a variable representing Baumol’s ‘cost disease’ theory emerge as robust and statistically significant determinants of HCE growth. Depending on whether or not outliers are excluded, we find up to six additional robust drivers: the growth in expenditure on health administration, the change in the share of inpatient expenditure in total health expenditure, the (lagged) government share in GDP, the change in the insurance coverage ratio, the growth in land traffic fatalities and the growth in the population share undergoing renal dialysis.     

Convergence,divergence, or multiple steady states? New evidence on the institutional development within the European Union

Convergence in institutions and in per capita income across the European Union (EU) Member States are key goals of the European integrations process. Especially in the course of the various EU enlargement waves starting in 2004, it was intensively discussed whether institutional and structural homogeneity are necessary preconditions for real convergence and the smooth functioning of the EU or whether a (further) catching up in the institutional and economic development will endogenously occur after the EU accession. Our paper is dedicated to the analysis of these institutional dynamics within the EU. In particular, we analyze the formation of institutional convergence clusters using Phillips and Sul's (2007, 2009) log t-test over the period 2002 to 2018. Our results indicate the existence of multiple institutional clubs with various countries being stuck in a poor institutional trap. Moreover, we find that institutional convergence clubs are formed mainly on the basis of geographic region; in particular, we identify a northwest-southeast divide. When analyzing per capita income clubs, a rather similar picture emerges, suggesting that the underlying institutional clusters might drive the formation of income clubs. We also study the factors that determine institutional club membership by using an ordered probit model. Most importantly, we find that the initial levels of human capital and institutional quality are decisive for determining whether a country is on a high or low institutional growth path.     

Real convergence in Europe: A cluster analysis

In this paper we analyse real convergence in GDP per worker in the EU member states. The aim is to test whether there is evidence of club convergence in the EU, i.e. divergence in GDP per worker. Evidence in favour of cluster or club convergence may be an indication of significant productivity divergences between countries, which may also explain the current turmoil in the euro zone. The results show evidence of different economic growth rates within Europe, which also converge to different steady states, implying divergence in the EU-14. Within the EU-14 member states we observe two convergence clubs, which are not related to the fact that some countries belong to the euro area. Furthermore, Eastern European countries are also divided in two clubs, with a more direct effect of belonging to the euro zone in the composition of the clubs.     

The effect of non-employment-based health insurance program on firm's offering of health insurance: Evidence from the social health insurance system in China

To achieve universal health insurance coverage, many developing countries have established a segmented health insurance system, which contains separate programs for workers with formal employment and residents without formal employment. A potential concern with such a segmented system is that the establishment of a non-employment-based insurance program may generate a disincentive for firms to provide health insurance benefits to workers. In this study, we empirically examine this crowd-out effect of a non-employment-based insurance program, the Urban Residents Basic Medical Insurance (URBMI), in China. Exploiting city-by-year variations in the roll-out process of the program and utilizing a unique administrative dataset on Chinese firms, we find that the enactment of URBMI reduced a firm's offering of an employment-based health insurance program by a statistically significant 0.94-1.29 percentage point. This crowd-out effect was stronger among domestic private firms, new firms, and firms that are individual-owned.     

Delivering Public Health Care Services: Substitutes,Complements, or Both?

In this article we investigate how the availability of public health care providers increases (complement) or decreases (substitute) the likelihood of having public or private health insurance. The probability of each of three insurance alternatives (uninsured, Medicaid, private insurance) is modeled as a function of the availability of public programs in the respondents'community along with individual characteristics including family income, health status, and family structure. Using population-based estimates, public hospitals are associated with a crowd-out rate of 3.5 percent to 8.6 percent. Federally qualified health centers were associated with a net complementary effect (additional public insurance take-up) of 7.1 percent. (JEL I11 , I18 , I38 )     

Corruption clubs: empirical evidence from kernel density estimates

A common finding of many analytical models is the existence of multiple equilibria of corruption. Countries characterized by the same economic, social and cultural background do not necessarily experience the same levels of corruption. In this article, we use Kernel Density Estimation techniques to analyse the cross-country distribution of corruption. Particular emphasis will be given to the question whether the distribution of corruption shows more than one peak. We find that most of the estimated densities exhibit twin peaks. We also provide some evidence on the intra-distribution dynamics and the persistence of corruption. We find the group of countries classified within the two ‘clubs’ to be very stable. Corruption is a highly persistent phenomenon. Substantial changes in the economic, political and cultural environment of countries within the ‘corruption club’ are required before a significant decline of corruption is to be expected.