医疗保险与消费:来自新型农村合作医疗的证据

本文利用农村引入新型农村合作医疗这一政策变化来研究医疗保险的获得对农村居民消费的影响。结果表明,新农合使得非医疗支出类的家庭消费增加了约5.6个百分点。这一正向作用随医疗保险保障水平的提高而增强,而且在没有医疗支出的家庭中仍然存在。同时,新农合对消费的正向影响在收入较低或健康状况较差的家庭中更强。这些结果都与医疗保险减少了预防性储蓄的假说相一致。另外本文发现,新农合的效果随农户在这个项目中的经历而变化。实际上只有在那些有村民获得保险补偿的村子,保险对消费的正向影响才显著,而且在这些村子中,新农合对新加入农户的消费的影响明显小于对参合一年以上农户的消费的影响。     

Community-based development and poverty alleviation: An evaluation of China's poor village investment program

We conduct the first systematic evaluation of the world's largest community-based development program—China's flagship poverty alleviation program began in 2001 which finances public investments in designated poor villages based on participatory village planning. We use matching methods and a panel household and village data set with national coverage to compare changes from 2001 to 2004 in designated poor villages that began plan investments and in designated poor villages that had yet to begin plan investments. We find that the program significantly increased both government- and village-financed investments. While the program did not increase the income or consumption of poorer households, it did increase the income and consumption of richer households by 6.1 to 9.2%. We also find suggestive evidence that governance matters in the distribution of program benefits. Relative gains were greater for richer households in villages with more educated leaders, and higher quality village committees delivered greater benefits to both richer and poorer households.     

Insurance of Household Risks and the Rebalancing of the Chinese Economy: Health Insurance,Health Expenses and Household Savings

This paper studies the effects of a public insurance system, the New Cooperative Medical Scheme (NCMS) on household savings in rural China. We develop a theoretical model in which we explain the impact of health insurance on savings through the impact of health insurance on out‐of‐pocket (OOP) health expense given the household level of wealth and seriousness of illness. We test the model empirically using data from the China Health and Nutrition Survey. We run endogenous and exogenous quantile regressions to evaluate the effects of NCMS participation on the distributions of household savings and OOP health expense. The impact of NCMS varies with the seriousness of illness. The NCMS induces an increase in OOP health expense for mild illness and, inversely, a decrease in health payments for more serious illnesses. The NCMS also leads to a higher incidence of catastrophic healthcare spending. The impact of the NCMS, given a certain state of illness, also varies with the household level of wealth. Poor households face health expense for both mild and serious illnesses. As the NCMS has opposite effects on the OOP expense for these two kinds of illness, we observe no effect on poor households’ precautionary savings. Because the decrease in OOP health expense for mild illness is larger for less poor households, the NCMS induces a decrease in their savings. For the most affluent households, the higher decrease in OOP spending on most moderate illness is dominated by a sharp increase in catastrophic expense, causing an increase in savings. To significantly reduce household savings and enhance household consumption, the NCMS has to offer better coverage against both serious and catastrophic health risks.     

Health shocks and consumption smoothing in rural households: Does microcredit have a role to play?

This paper estimates, using a large panel data set from rural Bangladesh, the effects of health shocks on household consumption and how access to microcredit affects households’ response to such shocks. Households appear to be fairly well insured against health shocks. Our results suggest that households sell livestock in response to health shocks and short term insurance is therefore attained at a significant long term cost. However microcredit has a significant mitigating effect. Households that have access to microcredit do not need to sell livestock in order to insure consumption. Microcredit organizations and microcredit therefore have an insurance role to play, an aspect that has not been analyzed previously.     

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.     

EASY MONEY OR HARD TIMES? HEALTH AND 401(k) LOANS

Rising health care costs and declining personal savings rates are nearly synonymous with household medical debt. For some, defined contribution (DC) retirement savings plans provide a ready source of funds to meet these medical debts. We examine whether health status and health insurance coverage predict the likelihood of having a DC loan using data from the Federal Reserve's triennial Survey of Consumer Finances (SCF) from 1989 to 2007. We find that poor health raises the likelihood that a household will borrow from their DC plans, even controlling for other forms of debt, access to credit, and whether households are covered by health insurance. Our estimates of the amount of the DC loan, taking selection effects into account, indicate that DC loan amounts are also influenced by health status; those with poor health borrow more from their DC plans. Apart from health status, once a household decides to borrow from their retirement funds, race and education also influence how much to borrow. We argue that public policy can improve the long‐term financial retirement security of households by offering more opportunities to save for medical emergencies, while cautiously maintaining the opportunity to borrow from DC plans. (JEL D12, D14, D91)     

Gender Disparity in Access to the Rwandan Mutual Health Insurance Scheme

While there is a body of research on the gendered penalties of user fees within health systems in low-income countries, what is less well understood is the gendered experience of community-based health insurance (CBI) programs, which have replaced user fees for basic healthcare. This study examines the uptake of a Rwandan CBI scheme five years after the program was scaled up nationwide. Using the Enquete Intégrale sur les Conditions de Vie des ménages de Rwanda (EICV2) for 2005–6, the study finds evidence that members of female-headed households are less likely than those of male-headed households to be enrolled in the CBI program. Additionally, it finds strikingly different patterns of equity effects of CBI by gender of household head by examining consumption income and wealth. These findings suggest the need for greater attention to equity, particularly gender equity, concerning the way in which voluntary CBI programs are initially implemented and evaluated.     

老龄化如何影响我国家庭消费支出——来自中国综合社会调查的证据

基于中国综合社会调查（CGSS)的数据，本文谨慎定义老龄家庭后实证检验了老龄化对我国家庭消费支出的影响。研究发现，老龄化将使家庭消费支出显著下降并对大多数消费分项支出产生较大负面影响，同时会大幅提升家庭医疗服务支出；收入是老龄化影响家庭消费的重要中间变量。基于城乡分类子样本研究发现，乡村家庭受老龄化冲击异常严重，乡村医疗服务供给存在较大缺口。基于分层的城镇子样本回归发现，老龄化对城镇家庭消费的冲击集中体现在较低分位家庭。     

健康风险冲击对农户收入的影响

本文基于中国8个省份、1354个农户、跨度15年的微观面板数据,测算了大病冲击对于农户长期收入的影响以及健康风险冲击持续的时间。我们发现:(1)大病冲击在随后的12年里对于农户人均纯收入都有显著的负面影响;(2)大病冲击对于农户的短期与中期影响使得患病户人均纯收入平均降低5%—6%;(3)健康风险冲击的长期影响可持续大约15年,并且冲击对于中低收入农户的影响更为严重。     

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.     

医疗保险与城乡反贫困:1989-2006

文章利用中国健康与营养调查(CHNS)数据,估计了1989-2006年医疗保险对中国城乡家庭的反贫困效应。结果发现:发生灾难性卫生支出的城乡家庭比例较高,最穷的群体其医疗费用超过收入的比例增加,医疗保险对减少收入不平等只起到微弱作用。TIP贫困曲线表明,近几年,医疗保险补偿后,城乡患病家庭的贫困并没有减轻,医疗保险在减少贫困上的作用很小。分析贫困特征的多元回归模型显示,家庭成员数量、教育程度、抚养比率、参保人数等都影响了贫困,而条件多元回归模型则显示,医疗保险对贫困的变动没有影响。     

The effect of rural labor migration on poverty alleviation: a village-level study in China

The construction of the new socialist countryside is being carried out in China nowadays. Although lots of successful experience has been gotten, different problems occur in various regions yet. To analyze the relationships among rural labor migration, poverty alleviation and characteristics of migrants is important in considering the effect of rural labor migration on the construction of the new socialist countryside. Available sampling and typical case study are adopted and 236 questionnaires are collected from[bur villages in northwest GuangxL China, Daxin Lixin, Longhe and Yongchang. We analyze the rural labor migration status, characteristics of migrants, remittance situation and income, household income and the ratio of remittance income to total household income. A bout 2/3 of the households have migrants in surveyed villages. And nearly half of the migration households have only one fam- ily member as migrants in the four villages. The migrants mainly comprise male and the younger, with the education level of junior middte school and higher More than half of the migrants are employed in Guangdong Province. But the characteristics of migrants in Yongchang are more diverse. The rural labor migration in the village is extremely active and extensive. And over 60% of the household with family members as migrants have remittance income. The rate in Yongchang is extremely high (80%). And the income of households with migrants getting remittance income significantly higher than their counterparts. More than half of their income comes from remittance as far as the former kind of household is concerned And in Yongchang, the rate is nearly 80%. The conclusion is that rural labor migration is popular and extensive in lots of villages. And the migration and remittance play an important role in rural household income, especially in some poor villages. For this kind of village, the rural labor migration may be some "compulsory course" in rural development. And the rural labor emigration is an essential way in poverty al-leviation. This is the first step in the construction of the new socialist countryside.     

Non-farm Income and Consumption Expenditures in Rural Bangladesh: Empirical Evidence from Multilevel Regression Modelling

This study examines the effects of non-farm income on household consumption expenditures in rural Bangladesh. A two-stage endogenous treatment effect model is built on data from a nationally representative Household Income Expenditure Survey (HIES) 2010 to control selection bias. The HIES follows a hierarchical data structure because the survey is based on two-stage stratified sampling. A multilevel mixed-effects linear regression model is used to capture the unobserved heterogeneity between clusters (PSUs) along with revealing important factors. Results reveal that non-farm income has a significant positive effect on household’s consumption expenditures and non-farm income recipient households spend about 29% more than their counterparts. In addition, higher level of per capita income, education, smaller family size and lower dependency ratio are found to be more effective in increasing consumption expenditures of rural households. Significant cluster-level variations are observed in the analyses. This study recommends that non-farm income generating activities should be encouraged among rural households as this would raise their consumption expenditures and hence, improve welfare and living standards among them.

     

Health insurance and precautionary saving: A structural analysis

Starr-McCluer (1996) documented an empirical finding showing that US households covered by health insurance saved more than those without coverage, which is inconsistent with the standard consumption–saving theory. This study conducts a structural analysis and suggests that institutional factors, particularly, a social insurance or safety net system and an employment-based health insurance system, can account for this puzzling finding. A dynamic equilibrium model is built that combines these two institutions with heterogeneous agents making endogenous decisions regarding saving, the labor supply and health insurance when they are young. The model, in which agents save in a precautionary manner, can generate Starr-McCluer?s empirical finding. The result implies that Starr-McCluer?s results are not inconsistent with the standard theory of saving under uncertainty, but it does indicate that the standard saving regression model is unable to reveal the precautionary saving motive. Counterfactual experiments are performed to provide implications for empirical analyses.     

Medicare for all or medicare for none? A macroeconomic analysis of healthcare reform

In this study, I develop a novel general equilibrium life cycle model composed of finitely-lived households that differ according to age, skill level, and access to employer-provided health insurance. After introducing a “Medicare for all” health insurance system to the model, I examine how the welfare response to this policy change will differ according to household characteristics. Then, I compare this system to a completely privatized health insurance system that achieves universal health insurance coverage through the creation of utilization-based premium subsidies. In general, both systems tend to improve the welfare of young households at the expense of old households. However, when using average value-of-life as the primary measure of welfare, Medicare for all either benefits unskilled households at the expense of skilled households, or makes both worse off. In contrast, the privatized system improves the average value-of-life of all household groups, regardless of skill level or prior access to employer-provided health insurance.     

DOES COBRA'S RETROACTIVE COVERAGE FEATURE ENCOURAGE DELAYED ENROLLMENT?

The Consolidated Omnibus Reconciliation Act (COBRA) of 1985, which aimed to protect individuals experiencing employment separation from losing employer‐provided health insurance, contains a feature that is unusual among health insurance markets. Individuals eligible for COBRA have 60 days following employment separation to elect coverage, and if they elect, coverage is retroactive back to the date of employment separation. This paper investigates whether employment separators take advantage of COBRA's retroactive coverage provision by delaying enrollment until after incurring medical expenses. Results indicate that an individual whose household incurs medical expenses during the months after employment separation is approximately 1?10 percentage points more likely to subsequently enroll in COBRA, depending on the magnitude of expenses. (JEL I18, I11)     

城镇低保户医疗服务利用和医疗保障制度设计对就医行为的影响——基于兰州、西宁和白银城镇家庭调查数据的分析

解决低保户看病难问题事关社会底线公平。文章基于2005年三个西北城市的17 690个样本对低保户就医问题展开实证研究,分析结果表明,由于中国医疗机构扭曲的激励机制和偏重住院报销的给付结构,低保户和非低保户两个群体都倾向于自己购药处理日常病患,而减少了门诊利用,经常面临生存危机的低保户由此拖延病情直至病情严重;个人账户既不能横向分散不同人群的疾病风险,也不能纵向分散个人在生命周期不同阶段的疾病风险;职工基本医疗保险能够显著增加中青年低保户对住院服务的利用,但对老龄低保户没有效果。     

Investigating household choice for health and life insurance

The objective of this article is to investigate the joint determination of household choice for health and life insurance. Using the 2008–2009 Consumer Expenditure Survey data, we model household choice for health and life insurance assuming households consider purchasing them to manage financial risks in their life, after accounting for household characteristics, insurance characteristics, health status, and disability status. The model allows assessing the impact of health insurance choice on the choice of life insurance and the correlation between these two choices. The result suggests that health insurance choice positively affects the choice of life insurance and these two choices are positively correlated indicating complementary nature of these insurances in the basket of households’ risk minimising goods.     

Precautionary Saving and Health Insurance: A Portfolio Choice Perspective

This paper analyzes the impact of health insurance on household portfolio choice. Using the U.S. Survey of Consumer Finance and Health Retirement Survey databases, it finds that insured households are more likely to own stocks and invest a larger proportion of financial assets in stocks than uninsured households do. The results remain strong even after controlling for household characteristics and reverse causality. Further, the results are robust across different survey years and data sources. It suggests that a precautionary motive is strong in household portfolio choice decisions.