The Impact of Regret on the Demand for Insurance

We examine optimal insurance purchase decisions of individuals that exhibit behavior consistent with Regret Theory. Our model incorporates a utility function that assigns a disutility to outcomes that are ex post suboptimal, and predicts that individuals with regret‐theoretical preferences adjust away from the extremes of full insurance and no insurance coverage. This prediction holds for both coinsurance and deductible contracts, and can explain the frequently observed preferences for low deductibles in markets for personal insurance.     

An Analysis of the Effect of Tax Policy on Health Insurance Purchases by Risk Group

There is an extensive body of literature dealing with the welfare loss associated with generous levels of health insurance as a function of the tax subsidy. The theoretical discussion in this study considers the effect of the tax subsidy on pooling within plans, and suggests the hypotheses that the tax subsidy will have a disproportionately positive effect on the likelihood that a high‐risk worker will be eligible for and participate in employment‐based coverage, while the effect of the tax subsidy on plan generosity will be greatest for low‐risk employees. If coverage of high‐risk individuals enhances social welfare, this result may offset, at least in part, the welfare loss associated with generous plans. Data from the 1987 National Medical Expenditure Survey are used to test these hypotheses. The results provide evidence that the subsidy works to expand risk pools in the employment‐based health insurance market.     

Intergenerational Transfers and Insurance Policy Design

Abstract

Group health insurance policies offering an identical benefit package to every member of the group result in lower expected health benefits for younger cohorts than older cohorts. The dispersion in insurance benefits across age groups differs among insurance policies. Simulation results presented in this paper demonstrate that a shift from comprehensive health insurance to high-deductible health insurance decreases the share of expected benefits going to younger cohorts. An estimated 81.5% of the 23-to-32-year-old cohort is expected to receive less than $500 in health benefits during a year for one prototypical high-deductible health plan. Low expected benefits for younger relatively healthy cohorts could increase the number of younger individuals who eschew health coverage. Age-rated premiums are probably the most straightforward way to stimulate demand for high-deductible health plans among younger healthier individuals.     

Regret and Regulation

We analyse the welfare effect of governmental regulation for individuals who consider anticipated regret in their decision-making process. Although governmental policies by directing choice, distort individual decisions in the private market, they can alleviate individuals’ pain associated with the feeling of regret. We analyse this trade-off and provide conditions under which the implied reduction of regret justifies regulation. Furthermore, we demonstrate our findings on tax deduction for non-insured losses, a well-studied social policy in insurance. Last, we consider heterogenous individuals and alternative social welfare functions and show that our results hold in these extended settings.     

The Health Insurance Reform Debate

This article provides an overview of the U.S. health care reform debate and legislation, with a focus on health insurance. Following a synopsis of the main problems that confront U.S. health care and insurance, it outlines the health care reform bills in the U.S. House and Senate as of early December 2009, including the key provisions for expanding and regulating health insurance, and projections of the proposals' costs, funding, and impact on the number of people with insurance. The article then discusses (1) the potential effects of the mandate that individuals have health insurance in conjunction with proposed premium subsidies and health insurance underwriting and rating restrictions, (2) the proposed creation of a public health insurance plan and/or nonprofit cooperatives, and (3) provisions that would modify permissible grounds for health policy rescission and repeal the limited antitrust exemption for health and medical liability insurance. It concludes by contrasting the reform bills with market-oriented proposals and with brief perspective on future developments.     

Natural Disaster Insurance and the Equity-Efficiency Trade-Off

This article investigates the role of private insurance in the prevention and mitigation of natural disasters. We characterize the equity‐efficiency trade‐off faced by the policymakers under imperfect information about individual prevention costs. It is shown that a competitive insurance market with actuarial rate making and compensatory tax‐subsidy transfers is likely to dominate regulated uniform insurance pricing rules or state‐funded assistance schemes. The model illustrates how targeted tax cuts on insurance contracts can improve the incentives to prevention while compensating individuals with high prevention costs. The article highlights the complementarity between individual incentives through tax cuts and collective incentives through grants to the local jurisdictions where risk management plans are enforced.     

Spillover effects of increased health insurance enrollment on workers’ compensation insurance

The Patient Protection and Affordable Care Act (ACA) was designed to increase the accessibility and affordability of health insurance. While the ACA did not contain direct provisions related to workers’ compensation (WC), because health‐related coverage is a significant portion of WC costs, the ACA could have unintentionally impacted the WC market. Specifically, expanded health insurance enrollment could reduce WC losses and result in higher performance among insurers participating in the WC market. Using insurer‐state level data, we consider the impact of increased health insurance enrollment on the performance of property‐casualty (PC) insurers. Utilizing multiple measures of performance, we find that the post‐ACA period is generally associated with greater profitability for PC insurers operating in the WC market, a positive unintended consequence of this federal regulation.     

Why small businesses don't have health insurance: results of a Florida survey

While most of the insured population has health insurance under an employer-sponsored group plan, the majority of the working uninsured are employed by small firms. Increasing the number of small firms that provide health insurance plans to their employees is important for decreasing the number of uninsured. This article summarizes the results of a survey designed to study characteristics of the firms that do not have health insurance, the obstacles to their getting insurance, and small business owners' interest in having a group health plan.     

Financing long-term care: employee needs and attitudes, and the employer's role.

Because of increasing life expectancies, high costs for nursing home and home health care, declining levels of informal family care, and the stated policy of the federal and state governments to foster self-reliance, individuals are increasingly exposed to the risk of financial ruin from long-term care (LTC) expenses. Yet, because of psychological barriers and aversions, particularly to thinking about residing in a nursing home, most individuals have not purchased LTC insurance. Hence, it may be the responsibility of employers to provide education to employees about LTC and to sponsor either individual or group plans of LTC insurance. Educational efforts may be particularly effective at the time of retirement when employees are in a more serious mood to consider the contingencies of retired life. A formal and perhaps more economical response for employers would be to offer combined life annuity and LTC insurance benefits through the retirement plan, provided certain regulatory and tax barriers can be removed.     

An Insurance Market Simulation With Both Adverse and Advantageous Selection

The theory of adverse selection predicts that high‐risk individuals are more likely to buy insurance than low‐risk individuals if asymmetric information regarding individuals’ risk type is present in the market. The theory of advantageous selection predicts the opposite—a negative relationship between insurance coverage and risk type can be obtained when hidden knowledge in other dimensions (e.g., the degree of risk aversion) is present in addition to the risk type. Using the heterogeneity of insurance buyers in either risk type or risk aversion, we first introduce a classroom‐based insurance market simulation game to show that adverse selection and advantageous selection can coexist. We then explain the underlying concepts using two methods: a mathematical framework based on expected utility theory and an empirical framework based on the results of the game itself. The game is easy to implement, reinforces textbook concepts by providing students a hands‐on experience, and supplements current textbooks by bringing their content up to date with current research.     

Health and Mortality Delta: Assessing the Welfare Cost of Household Insurance Choice

We develop a pair of risk measures, health and mortality delta, for the universe of life and health insurance products. A life‐cycle model of insurance choice simplifies to replicating the optimal health and mortality delta through a portfolio of insurance products. We estimate the model to explain the observed variation in health and mortality delta implied by the ownership of life insurance, annuities including private pensions, and long‐term care insurance in the Health and Retirement Study. For the median household aged 51 to 57, the lifetime welfare cost of market incompleteness and suboptimal choice is 3.2% of total wealth.     

A Game‐Theoretical Interpretation of Guaranteed Renewability in Health Insurance

A game‐theoretical model is developed here that can explain why the premiums of the health insurance contracts in the individual health insurance market do not vary that much over time, even in absence of any legal restriction on premiums. In this model the insurer and the individuals interact for an infinite number of periods, and the threats of punishments in case of deviations force both the insurer and the individuals to stay on a constant premium path. This model, unlike the other models of guaranteed renewability, does not presume commitment of the insurer.     

中国农业居民医疗保险需求及其影响因素分析

本文基于2006年的微观横截面数据,运用似不相关二维probit模型与工具变量,分析了我国农业居民医疗保险需求及其影响因素,并着重考察了新型农村合作医疗保险与商业医疗保险之间的关系。研究的主要结论:一是参加新型农村合作医疗对乡村农业居民购买商业医疗保险有较显著的刺激作用;二是教育水平、年龄、居住省份、职业对乡村农业居民是否参加新型农村合作医疗有显著影响;职业、家庭规模和地区经济发展水平对乡村农业居民是否购买商业医疗保险有显著影响;三是在乡村农业居民是否参加新型农村合作医疗的决策中观测到逆向选择的行为。     

The Effects of Uncertainty on the Demand for Health Insurance

This article analyzes the effects of uncertainty and increases in risk aversion on the demand for health insurance using a theoretical model that highlights the interdependence between insurance and health care demand decisions. Two types of uncertainty faced by the individuals are examined. The first one is the uncertainty in the consumer's pretreatment health and the second is the uncertainty surrounding the productivity of health care. Comparative statics results are reported indicating the impact on the demand for insurance of shifts in the distributions of pretreatment health and productivity of health care in the form of first‐order stochastic dominance, Rothschild–Stiglitz mean‐preserving spreads, and second‐order stochastic dominance. The demand for insurance increases in response to a Rothschild–Stiglitz increase in risk in the distribution of the pretreatment health provided that the health production function is in a special class and the price elasticity of health care is nondecreasing in the pretreatment health. Provided also that the demand for health care is own‐price inelastic, the same conclusion is obtained when the uncertainty is about the productivity of health care.     

医保制度改革：从城镇保障到城乡统筹——医疗保障“马鞍山模式”研究

安徽省马鞍山市医疗保险制度改革,一直以其创新性和样本性被各级政府、媒体及公众广为关注,被称为“医疗保险马鞍山模式”。本文通过对马鞍山医保制度改革从城镇保障发展到城乡统筹过程的调查,介绍该市医疗保险制度的发展历程,总结、分析统筹城乡医保制度的主要内容、特点及成效,探究存在问题及对策,以期为研究中国当前的医疗保险制度改革提供参考,为广大中西部地区中小型城市的医疗保险工作提供借鉴。     

CEO Compensation and Fair Value Accounting: Evidence from Purchase Price Allocation

This study investigates the impact of CEO compensation structure on post‐acquisition purchase price allocation, an accounting procedure that involves fair value estimation of various assets and liabilities. We find that CEOs whose compensation packages rely more on earnings‐based bonuses are more likely to overallocate the purchase price to goodwill, the largest asset recorded post‐acquisition. Because goodwill is not amortized, the overallocation likely increases post‐acquisition earnings and bonuses. We also find that, when the acquirer's CEO bonus plan includes performance measures that are not affected, or are less affected, by the overstatement of goodwill, such as cash flows, sales, or earnings growth, the overallocation to goodwill motivated by bonus plans diminishes.     

保险业发展对居民消费行为研究——基于VEC模型的实证分析

促消费、扩内需是现阶段中国经济面临的主要任务,这意味着要减少居民的未来风险,提升其消费信心。保险业作为防范个体及家庭风险的有效手段,有助于保障消费计划的长期性和稳定性。利用1985年-2009年保险市场和居民消费层面的年度数据,利用向量误差修正模型实证分析了保险业发展对居民消费的现实作用,研究表明：保险业发展对居民消费...     

社会医疗保险、自我保护与商业健康保险

基于消费者保险需求理论,采用中国家庭金融调查（CHFS）数据,分析了社会医疗保险、自我保护与商业健康保险之间的关系。结果表明：社会医疗保险抑制了商业健康保险的发展,显著减少了自我保护支出;自我保护促进了商业健康保险的发展。鉴于此,政府应制定合理的封顶线及报销比例以提供适度的基本医疗保险保障水平,商业保险公司应提供差异化的健康保险以补充社会医疗保险,政府及保险公司应鼓励自我保护投资以促进商业健康保险发展。     

How universal health care would influence decisions about work and retirement

The current U.S. health care system distorts individual decisions about work and retirement. After a brief explanation of how the current health care system works, this article reviews those distortions and considers how individuals would respond to the implementation of a universal health care system. The author argues that the likely adverse impacts of an employer health insurance mandate on low-skilled workers could be more than offset by a well-designed system of government subsidies.     

On the design of optimal health insurance contracts under ex post moral hazard

We analyze the design of optimal medical insurance under ex post moral hazard, i.e., when illness severity cannot be observed by insurers and policyholders decide for themselves on their health expenditures. The trade-off between ex ante risk sharing and ex post incentive compatibility is analyzed in an optimal revelation mechanism under hidden information and risk aversion. The optimal contract provides partial insurance at the margin, with a deductible when insurers’ rates are affected by a positive loading, and it may also include an upper limit on coverage. The potential to audit the health state leads to an upper limit on out-of-pocket expenses.