Uncertainty,inequality and consumption preferences in urban China

In this paper we present an uncertainty–inequality–consumption model and empirically investigate the effect of uncertainty on the consumption behaviors of urban households with varying levels of socio-economic status in China. We observe that the condition of households that suffered from socio-economic inequality with respect to total consumption, educational expenditures, medical expenditures, and durable consumption worsened relative to other households when faced with income uncertainty. Income uncertainty did not affect the housing consumption of households that suffered from socio-economic inequality, but it substantially decreased their ability to consume other durables. As a result of the introduction of the modern enterprise system and the reform of the housing distribution system, households with a member employed in a management position suffer larger shocks of income uncertainty in total consumption, educational expenditures, medical expenditures, and housing consumption relative to household with all members employed in worker positions in 2002. Uncertainty with respect to medical and educational expenditures had more substantial effects on the non-durables consumption of low-income households than that of other households in 2002.     

The impact of the correlation between health expenditure and survival probability on the demand for insurance

This paper studies the effects of health shocks on the demand for health insurance and annuities, along with precautionary saving in a dynamic life-cycle model. I argue that when the health shock can simultaneously increase health expenses and reduce longevity, rational agents would neither fully insure their uncertain health expenses nor fully annuitize their wealth because the correlation between health expenses and longevity provides a self-insurance channel for both uncertainties. That is, when the agent is hit by a health shock (which simultaneously increases health expenses and reduces longevity), she can use the resources originally saved for consumption in the reduced period of life to pay for the increased health expenses. Since the two uncertainties partially offset each other, the precautionary saving generated in the model should be smaller than in a standard model without the correlation between health expenses and longevity. In a quantitative life-cycle model calibrated using the Medical Expenditure Panel Survey dataset, I find that the health expenses are highly correlated with the survival probabilities, and this correlation significantly reduces the demand for actuarially fair health insurance, while its impact on the demand for annuities and precautionary saving is relatively small.     

Social Security Income and Health Care Spending: Evidence from the Social Security Notch

In this paper, I exploit Social Security legislation changes to identify the causal effect of Social Security income on out‐of‐pocket medical expenditures of the elderly. Using the 1986–1994 Consumer Expenditure Survey and an instrumental variables strategy, the empirical results show that health care expenditures are responsive to changes in Social Security income for elderly individuals with less than a high‐school education. The estimated income elasticities are between 1.41 and 3.47, depending on the outcome measures, and are statistically significant at conventional levels. The findings are in contrast to existing studies that find a small income elasticity at the individual/household level.     

Consumer Expenditures and Home Production at Retirement – New Evidence from Germany

Abstract. This paper investigates consumer expenditures of German households pre‐ and post‐retirement. The widely observed distinct drop in spending upon retirement entry poses an empirical puzzle since life cycle theory predicts smoothing of the marginal utility of consumption over time. As one explanation, I explore the role of home production as a substitute for consumer expenses. Taking a combined look at consumer expenditures and time use pre‐ and post‐retirement, I find a significant drop of about 17% of pre‐retirement expenses at retirement which coincides with an increase in time spent on home production of an additional 89 minutes per day, accounting for 21% of average home production.     

New evidence on factors affecting the level and growth of US health care spending

The dual problems of high and rising medical care expenditures and substantial differences in spending across geographic regions have long plagued the US health care system. We provide new evidence to explain why some states and regions of the country spend much more on medical care than others, and why health care spending for the nation as a whole has been growing rapidly over the last several decades. To do this, we estimate a health care spending panel data model using annual data on all 50 states for the period 1993–2009. Our model includes a number of socio-economic, health care provider, lifestyle and environmental variables that past studies indicate may affect the level or growth of aggregate health care spending. We exploit the time effect component of our model to obtain an upper-bound estimate of the effect of advances in medical technology. Our findings indicate that the most important factors influencing the level of spending are availability of providers, income, excessive alcohol consumption, Medicaid coverage, HMO health plans and the proportion of the population elderly and African-American. The principal drivers of growth have been the continual introduction of new medical technologies, and the growth of providers and income.     

Public provision of health insurance and aggregate saving in an overlapping generations model with endogenous health risk: The South Korean case

This paper examines the effect of expanding public health insurance in South Korea on medical expenditures and aggregate saving using an overlapping generations model with endogenous health risk. South Korea had a substantial underinsured population, which is aging rapidly. Higher public health insurance benefits reduce individual medical expenditure and health risks but lead to a modest decline in individual and aggregate saving. Even after the expansion, the medical care coverage remains incomplete, and the elderly face a substantial risk of out-of-pocket medical expenditures.     

INSURANCE‐INDUCED MORAL HAZARD: A DYNAMIC MODEL OF WITHIN‐YEAR MEDICAL CARE DECISION MAKING UNDER UNCERTAINTY

This study quantifies the moral hazard effect of health insurance on medical expenditure by estimating a dynamic model of within‐year medical care consumption that allows for insurance selection, endogenous health transitions, and individual uncertainty about medical care prices in an environment where insurance has nonlinear cost‐sharing features. The results suggest that moral hazard accounts for 53.1%, on average, of total annual medical expenditure when insured. This estimate is significantly different, and generally larger, than that produced by an alternative model that is representative of the annual medical care decision‐making models commonly found in the literature.     

我国健康体检的现状和问题:老龄社会发展的-点思考

人口老龄化的加速发展给我国医疗保障体系带来了极大挑战,全社会医疗费用负担日益加重,健康体检的重要性凸显。分析了我国健康体检的发展现状和问题,并基于两种不同假设方案实证模拟了实施健康体检对降低未来全社会老年医疗费用的绩效。健康体检对降低我国老年医疗费用具有较为显著的成效,健康体检的逐步普及可有效缓解将来的深度人口老龄化对我国医疗保障体系造成的巨大压力。年龄层次越高,健康体检对节省医疗费用支出的成效越显著。提出了促进我国健康体检科学发展的对策建议。     

EXPLAINING THE DECLINE OF THE U.S. SAVING RATE: THE ROLE OF HEALTH EXPENDITURE

The U.S. saving rate declined by 8% between 1980 and 2009. We document that the decline can be explained by rising health expenditures. Using exogenous variation in medical expenses generated by Food and Drug Administration drug approvals, we document that a 1 percentage point increase in health expenditure generated a decline in saving rate of 0.9 percentage points. We then estimate a model of household decisions to evaluate the mechanisms behind the decline. We find that the rise in health expenses and drop in saving rate are driven by progress in health technology, reduction in copayment rates, and improvements in income processes.     

经济转轨、不确定性与城镇居民消费行为

本文利用中国社会科学院经济研究所收入分配课题组 1 995、1 999及 2 0 0 2年的城镇住户调查数据分析收入不确定性、失业风险、医疗支出不确定性及教育支出等因素对城镇居民消费行为的影响。研究结果表明这些不确定性因素对城镇居民消费水平具有显著的负效应 ,但效应的大小也因这些因素的可预期性的变化而变化。因此增强政策的可预见性、完善社会保障制度等措施对化解居民收支风险将具有重要作用。     

GROWTH OF U.S. HEALTH CARE SPENDING

The share of output allocated to health care has more than doubled since 1960. This paper models the growth in this ratio and finds that the increase in the elderly population whose medical spending is heavily subsidized is a key factor behind this growth. Technological change is a symptom of the medical market structure rather than a cause of medical spending growth. The econometric model in the analysis here is based on a micro model composed of two groups. The first group is a healthier group that makes income transfers in order to finance the sicker group's health insurance premiums. In this model, a technical constraint places an upper bound on the healing ability of the medical good. This upper bound changes through an unobservable endogenous process. Estimating the health care model involves using estimation techniques that bypass the need to make any a priori assumptions about the functional form of the regressions or about the distribution of the residuals. The results suggest that technical change cannot indefinitely induce health care spending growth if no subsidies exist that provide full health care coverage with premiums fully paid by the subsidy. If subsidies provide full coverage and pay the entire premium, then new technical discoveries can induce constantly expanding medical expenditures.     

The effect of environmental uncertainty on the tragedy of the commons

We model a common pool resource game under environmental uncertainty, where individuals in a symmetric group face the dilemma of sharing a common resource. Each player chooses a consumption level and obtains a corresponding share of that resource, but if total consumption exceeds a sustainable level then the resource deteriorates and all players are worse-off. We consider the effect of uncertainty about the sustainable resource size on the outcome of this game. Assuming a general dynamic for resource deterioration, we study the effect of increased ambiguity (i.e., uncertain probabilities pertaining to the common resourceʼs sustainable size). We show that whereas increased risk may lead to more selfish behavior (i.e., to more consumption), increased ambiguity may have the opposite effect.     

Determinants of healthcare spending: a state level analysis

Within the high and rising level of healthcare spending for the US as a whole is substantial variation in spending across states. Yet relatively little attention has been given to the empirical analysis of interstate differences in aggregate healthcare expenditures, and therefore little empirical evidence exists at the state level to guide policymakers. Using data for all 50 states for the year 1998, we estimate an empirical model that includes structural and reduced-form healthcare spending equations and a health production function to assess the significance, size and relative importance of factors that prior research indicates, may play an important role in explaining interstate variation in medical care expenditures, and the main pathways through which they operate. Our results indicate higher levels of healthcare spending for state populations with higher income, less education, fewer uninsured residents, less healthy lifestyles, larger proportion of elderly residents, greater availability of medical care providers and less urbanization. Our findings suggest that the most effective cost containment measures may be those that increase education and promote healthy lifestyles. Not only do these actions lead to reductions in healthcare spending, they also improve the health status of the population, and may help to achieve other important social policy goals.     

新型农村合作医疗保险对农村居民食物消费的影响分析

始于2003年的新型农村合作医疗保险可以在一定程度上减少农村居民面对的未来不确定性。根据预防性储蓄理论,未来不确定性的降低可以增加居民当前消费。通过对比2004年、2006年参合家庭与未参合家庭各营养物质摄入量,本文得出新型农村合作医疗保险将显著增加居民热量、碳水化合物以及蛋白质等营养摄入量;以货币计算,2004年新型农村合作医疗保险将使居民食品消费支出人均增加约81元,相当于2004年人均财政投入的3.06倍。该结论对缓解我国有效需求不足的现状具有很强的政策意义。     

Health care spending and hidden poverty in India

India has a high level of out-of-pocket (OOP) health care spending, and lacks well developed health insurance markets. As a result, official measures of poverty and inequality that treat medical spending symmetrically with consumption goods can be misleading. We argue that OOP medical costs should be treated as necessary expenses for the treatment of illness, not as part of consumption. Adopting this perspective, we construct poverty and inequality measures for India that account for impoverishment induced by OOP medical costs. For 2011/12 we estimate that 4.1% of the population, or 50 million people, are in a state of “hidden poverty” due to medical expenses (based on official poverty lines). Furthermore, while poverty in India fell substantially from 1999/00 to 2011/12, the fraction of the remaining poverty that is due to medical costs has risen substantially. Economic growth appears less “pro-poor” if one accounts for OOP medical costs, especially since 2004/05, and especially in rural areas. Finally, we look beyond poverty rates to show how OOP health costs affect the entire shape of the consumption distribution.     

The effect of social security,health, demography and technology on retirement

This article studies the determinants of the labor force participation of the elderly and investigates the factors that may account for the increase in retirement in the second half of the last century. We develop a lifecycle general equilibrium model with endogenous retirement that embeds Social Security legislation and Medicare. Individuals are ex ante heterogeneous with respect to their preferences for leisure and face uncertainty about labor productivity, health status and out-of-pocket medical expenses. The model is calibrated to the U.S. economy in 2000 and is able to reproduce very closely the retirement behavior of the American population. It reproduces the peaks in the distribution of Social Security applications at ages 62 and 65 and the observed facts that low earners and unhealthy individuals retire earlier. It also matches very closely the increase in retirement from 1950 to 2000. Changes in Social Security policy – which became much more generous – and the introduction of Medicare account for most of the expansion of retirement. In contrast, the isolated impact of the increase in longevity was a delaying of retirement.     

The incidence of Medicare

The Medicare program transfers nearly $300 billion annually from taxpayers to beneficiaries. This paper considers the incidence of such transfers in the context of a life cycle model with uncertainty about future health care expenditures. We find the distributional consequences of the Medicare program are roughly neutral in dollar terms; households living in high income neighborhoods pay more in taxes, but they also receive more in benefits. These dollar flows, however, ignore the insurance value of the Medicare system. Given the incomplete insurance coverage of lower income elderly households prior to the Medicare program, the money-metric benefits to lower income groups exceed the dollar flows, suggesting that Medicare redistributes more than a simple accounting exercise would suggest.     

Identification, screening and stereotyping in labour market discrimination

According to social-psychological research, feelings of uncertainty in decision-making evoke two opposite responses: (i) reduction of uncertainty by information search, leading to less stereotyping of people, and hence less discrimination; (ii) social identification with an ingroup, inducing more reliance on stereotypic perceptions and prejudices, and hence more discrimination against an outgroup. We integrate both responses in a microeconomic model of hiring and pay decisions by an employer. Increasing competition in the product market makes the employer feel more uncertain about his profits, but also raises the opportunity cost of screening expenditures. This elicits substitution of ingroup identification for screening expenditures, and hence enhances discrimination.     

Aging,growth and the allocation of public expenditures on health and education

In this paper, I develop an overlapping generations endogenous growth model in which both public education and health are sources of growth by affecting the accumulation rate of the human capital stock and the savings rate over life expectancy. I first find that dynamic complementarities of public expenditures lead to minimum threshold levels of public education and health expenditures that ensure sustainable growth. I then show how governments can use the allocation of public expenditures as an alternative policy instrument to maximize growth without increasing the tax rate or the retirement age, as usually happens in aging economies.     

Public financing of health expenditures,insurance, and health outcomes

The effects of public financing of health expenditures, insurance coverage and other factors on health outcomes are examined within health production models estimated using 1960–1992 data across 20 OECD countries. Mortality rates are found to depend on the mix of health care expenditures and the type of health insurance coverage. Increases in the publicly financed share of health expenditures are associated with increases in mortality rates. Increases in inpatient and ambulatory insurance coverage are associated with reduced mortality. The effects of GDP, health expenditures and age structure on mortality are similar to those in previous studies. Tobacco use, alcohol use, fat consumption, female labour force participation, and education levels are also significantly related to overall mortality rates. Increases in income inequality are associated with lower mortality rates, suggesting that the negative relationship between inequality and health outcomes suggested by some previous studies does not remain when a more complete model is estimated. The result that increases in public financing increase mortality rates is robust to a number of changes in specifications and samples. Thus, as countries increase the level of their health expenditures, they may want to avoid increasing the proportion of their expenditures that are publicly financed.