Does health insurance promote people's consumption? New evidence from China

In order to change the situation that reimbursement rate of the new rural cooperative medical care system (NCMS) was too low to alleviate farmers medical burden, in August 2012, China began to expand the coverage of the NCMS to include the treatment of critical illnesses. Could more effective health insurance promote the consumption of rural residents? We studied the impact of the critical illness insurance (CII) on rural household consumption, and find that the CII increases per capita household daily consumption by >15%. But healthcare and medical expenditures have not been affected. Our comparison of outcomes for households with different levels of consumption and income shows the CII mainly promote the consumption of rural affluent family, but no incentive for poor family, resulting in deterioration of consumption inequality of rural households. The finding is robust to various alternative hypotheses and specifications.     

Who benefits from household energy transition? A cost-benefit analysis based on household survey data in China

Aiming to alleviate air pollution and carbon emissions from heating, Northern China mandatorily converted household heating energy from coal to electricity (Coal to Electricity), natural gas (Coal to Gas), and clean coal (Clean Coal Replacement). Based on large-scale household survey data in Beijing, this study provides a cost-benefit analysis of the transition program and distinguishes between social and private benefits. The results show that all three programs improve the welfare of society and households. Compared to the Clean Coal Replacement program, Coal to Electricity and Coal to Gas programs provide higher environmental benefits while bringing about larger costs, and thus the benefit-to-cost ratios are lower. We also find that private net benefits are lower than social net benefits, and household satisfaction with the programs is positively determined by private net benefits rather than social net benefits. Furthermore, households with lower income and larger housing areas are more likely to be harmed by the programs by a larger burden from the heating energy transition. These findings call attention to inequity issues during the household energy transition.     

Why do migrant households consume so little?

Exploring data from the migrant and urban household surveys of the Chinese Household Income Project, this paper dissects the underlying causes of the depressing effect of the hukou system on migrant household consumption to two channels. On one hand, migrants' disentitlement to local urban hukou creates financial insecurity through barriers to employment, social welfare, medical insurance, etc., thereby encouraging precautionary saving. On the other hand, it promotes temporary migration, allows divergence in tastes and values from local urban residents to persist, and incentivizes migrant households to save their transitory income. Factors reflecting these two channels, such as medical and pension insurances, the duration of migration, and local homeownership, are specifically modeled, and they are found to contribute to the discrepancies in consumption between migrant and local urban households, among other factors. In addition, the marginal propensity to consume exhibits heterogeneity across migrant households; it is higher with a longer duration of migration, local homeownership, and self-employment. The lack of these attributes further reinforces the reluctance of migrant households to consume.     

Targeting the Poor in Mexico: An Evaluation of the Selection of Households into PROGRESA

In this paper, we conduct an evaluation of the targeting method used by Health Education and Nutrition Program (PROGRESA) of Mexico to identify beneficiary households. We address two key questions: (a) How well does PROGRESA's targeting perform; and (b) How does the program perform in terms of its impact on poverty alleviation relative to other feasible methods and transfer schemes. The first question is accomplished by comparing PROGRESA's method to an alternative selection method based on household consumption, which is our preferred measure of welfare. We employ the concepts of undercoverage and leakage and find that PROGRESA selection method is more effective in identifying the extremely poor localities or households but less so when it comes to distinguishing among localities or households in the middle of the scale. To address the second question, we compare the potential impact of PROGRESA on poverty alleviation against uniform transfers that involve no targeting at all, targeting based on consumption, and geographic targeting (i.e., targeting at the locality level rather than at the household level). We find that PROGRESA's method of targeting households outperforms uniform coverage and targeting at the locality level in terms of reducing the poverty gap and severity of poverty indices, even after taking into account the economic costs of targeting. But, the closeness of PROGRESA's performance to what could be achieved by geographic targeting alone raises some serious questions about the costs and benefits associated with the practice of household targeting within poor localities.     

Who bears the burden of social insurance? Evidence from Japanese health and long-term care insurance data

Using the society-managed health insurance data, which is cross-sectional time-series and covers 1670 health insurance societies for seven years (FY1995–2001), we found for the first time in Japan that the majority of the employers' contribution to health insurance is shifting back onto the employees in the form of wage reduction. On the other hand, we cannot find such evidence for the contribution to long-term care insurance using a two-year (FY2000–2001) panel data set. The difference can be theoretically explained by how employees value the contribution relative to social security benefits they enjoy. J. Japanese Int. Economies 18 (4) (2004) 565–581.     

Mainstreaming health insurance for people with disabilities

Many low- and middle-income countries have introduced public health insurance schemes to increase access to health care and provide financial protection against the costs of care for disadvantaged groups. Using national health household survey data from Vietnam and an appropriate two-part model, this paper examines the targeting effectiveness of public health insurance schemes and their impact on health care utilization for persons with disabilities. Results suggest that current community-based targeting methods are not effective, and that insurance mechanisms are an unsatisfactory buffer for inpatient-related costs to which persons with disabilities are prone. A higher level of disability targeting is recommended, both in terms of eligibility and benefits.     

Health insurance reform and economic growth: Simulation analysis in Japan

This paper evaluates the drastic reforms of Japanese public health insurance initiated in 2006. We employ a computable general equilibrium framework to numerically examine the reforms for an aging Japan in the dynamic context of overlapping generations. Our simulation produced the following results: first, an increase in the co-payment rate, a prominent feature of the 2006 reform, would promote economic growth and welfare by encouraging private saving. Second, the ex-post moral hazard behavior following the increase in co-payment rates, however, reduces economic growth. Third, Japan's trend of increasing the future public health insurance benefits can mainly be explained by its aging population, and increasing the co-payment rate does little to reduce future payments of public health insurance benefits. Fourth, the effect on future economic burdens of reducing medical costs through efficiencies in public health insurance, emphasis on preventive medical care, or technological progress in the medical field is small. Finally, a policy of maintaining public health insurance at a fixed percentage of GDP will require reducing public health insurance benefits, perhaps up to 45% by 2050. Such a policy also reduces economic growth until approximately 2035. Our simulation indicates that the reform does not significantly reduce future public health insurance benefits, but it can enhance economic growth and welfare by encouraging private saving.     

The impact of retirement on household consumption in Japan

Using monthly data from the Japanese Family Income and Expenditure Survey, we examine the impact of retirement on household consumption. We find little evidence of an immediate change in consumption at retirement, on average, in Japan. However, we find a decrease in consumption at retirement for low income households that is concentrated in food and work-related consumption. The availability of substantial retirement bonuses to a large share of Japanese retirees may help smooth consumption at retirement. We find that those households that are more likely to receive such bonuses experience a short-run consumption increase at retirement. However, among households that are less likely to receive a retirement bonus, we find that consumption decreases at retirement.     

医疗保险的福利效应

本文考察在完全信息的市场经济条件下,医疗保险的进入对于社会总福利的影响。分析表明,保险公司的进入可能使得消费者为医疗服务付出更高的代价,但是会提高医院的利润,总的来说保险公司的进入会提升社会总福利。本文还发现,由于保险公司未考虑其合约设计对医院利润的影响,市场均衡的医疗保险水平仍低于社会最优水平。这些结论有助于澄清相关文献对医疗保险的一些负面看法。     

The Wealthy Hand-to-Mouth Households in South Korea

This study establishes the stylized facts on household balance sheets in South Korea and empirically investigates their macroeconomic implications based on the concept of ‘wealthy hand-to-mouth (HtM)’ households that hold little liquid wealth with owning large amount of illiquid assets. Using a household-level panel data for the period of 2000–2014, we find that (1) there are neither deleveraging of household debts nor a sharp decline in house price even during the financial crisis, (2) run-up in household debt in 2000s is led by high-income group, (3) regardless of net worth level, wealth is highly concentrated on illiquid assets such as housing and real estate, (4) the share of wealthy HtM households is very high compared to the cases of other advanced countries. We estimate the marginal propensity to consume out of a transitory shock and find that the consumption response of HtM households is larger compared to the non-credit-constrained group, posing a threat to macroeconomic stability. Using discrete choice models with fixed effects, we also find that a household that acquire more real estate assets is more likely to become wealthy HtM when its income is relatively lower or its indebtedness is relatively higher. We discuss the characteristics of HtM households and the role of macroprudential policy.     

The Influence of Demographics and Household-Specific Price Indices on Consumption-Based Inequality and Welfare: A Comparison of Spain and the United States

Previous research has suggested that inequality is lower in Spain than in the United States when it is based on income. For the present article, both inequality and social welfare are examined, with household consumption expenditures used as a proxy for household welfare. For tractability, equivalence scales depended only on the number of people in the household. Household-specific price indices were used to express the 1990-1991 expenditure distributions in 1981 and 1991 winter prices. Our results reveal that inequality and welfare comparisons are drastically different for smaller and larger households. When all households are considered, the two-country comparison suggests that the income inequality ranking can only be maintained for expenditure distributions when economies of scale are small or nonexistent. However, welfare is always higher in the United States than in Spain. Because inflation during the 1980s in both countries was essentially distributionally neutral, all results appear to be robust to the choice of time period.     

健康冲击、数字普惠金融与家庭消费

基于中国家庭金融调查(CHFS)数据和"北京大学数字普惠金融指数",分析健康冲击对家庭消费的影响,以及数字普惠金融在其中所起的作用。基于固定效应模型的实证结果表明,健康冲击显著降低了家庭的非医疗消费支出,但数字普惠金融能有效地减轻这种影响;同时就分指标而言,数字普惠金融指标体系一级维度中的覆盖广度和使用深度,二级维度中的信贷、保险、货币基金以及支付这四个子指标均显著地平滑了冲击下的家庭消费。就作用机制而言,数字普惠金融主要通过缓解家庭流动性约束和强化非正式社交网络来帮助家庭应对健康冲击对消费的影响。异质性分析的回归结果显示,健康冲击对中西部地区、户主受教育水平较低以及金融素养水平较低的家庭影响更大,同时这种影响还与冲击的程度正相关,进而数字普惠金融的积极作用在这部分家庭中表现得更为明显。文章的研究结论进一步阐述了数字普惠金融发展对改善金融包容性的重要现实意义,并在微观层面上解释了数字普惠金融发展对改善家庭福利、防止因病致贫返贫的积极作用。     

贵州省保险业发展对区域经济增长的影响分析

运用协整分析和误差修正模型，实证分析贵州省保险业发展对区域经济增长的影响态势。结果显示：贵州省GDP与保费收入、固定资产投资、城镇居民人均消费性支出之间存在长期均衡关系；长期中，保费收入对GDP存在显著的正向影响，但力度低于投资和消费；短期内，保费收入滞后一期对GDP有显著影响，投资对GDP无显著影响，消费仍是经济增长的主要动力。贵州省有关部门可积极支持保险业发展．全面提升保险密度和保险深度，为贵州省经济增长提供更强动力。     

Changes in Japanese household consumption and saving behavior before,during and after the Bubble era: empirical analysis using NSFIE micro-data sets

This paper seeks to clarify changes in the Japanese household behavior in the 1980s and 1990s through empirical investigation of available data on consumption and saving using the micro-data sets of the National Survey of Family Income and Expenditure. Our findings are as follows: First, household consumption was stable even during the Bubble period. Second, “bubbly” consumption in the Bubble era was due to consumption relying on corporate expense accounts. And, third, the saving behavior of households changed significantly after the Bubble burst and asset prices imploded. This is indicated by the change in the coefficient of assets in the saving function.     

Gatekeeper incentives and demand inducement: An empirical analysis of care managers in the Japanese long-term care insurance program

This study analyzes the incentives and supplier-induced demand of care managers, who are intermediaries between consumers and service providers in the Japanese social insurance program for long-term care. Care managers can be considered as pure gatekeepers, in that their function is limited to referral people to specialists and they themselves do not provide care. Care managers are rewarded by capitation, which is considered as a cost-effective payment mechanism for insurers. However, many care managers actually work for firms that also operate as service providers. Service providers are rewarded by a fee-for-service payment and can have a motivation to induce excess consumer demand. The violation of the neutrality of care managers might result in a financial burden on social insurance. In this study, we empirically test whether there is a positive correlation between care manager density and care costs, which might imply the existence of supplier-induced demand. Our results show a positive correlation, particularly in the case of care managers who work for firms that jointly operate in service provision sectors. Based on these results, we conduct a quantitative analysis, and show that the demand induced by care managers might produce a considerable financial burden on social insurance.     

Women-headed households and household welfare: An empirical deconstruction for Uganda

Analysis of the first nationally representative household survey of Uganda shows that women-headed households are not poorer when assessed by consumption or income. Nor do they appear consistently disadvantaged on social indicators. Some subgroups of women-headed households do have lower economic welfare, including those headed by widows and those in urban areas. Gender inequalities in educational attainment appears to be the major source of what economic disadvantage such women-headed households do face. High remittances receipts play a key role in maintaining economic parity between women and men-headed households.     

Economic policy uncertainty and household consumption: Evidence from Chinese households

We find that households reduce their consumption in response to higher economic policy uncertainty (EPU). Compared with lower income households, high income group is more severely affected which can be explained by the portfolio choice of illiquid asset and liquid asset. In addition, the uncertainty effect is more pronounced among older, wealthier, well-educated and urban households. The impact of EPU on household consumption is also persistent. Holding more liquid asset and commercial insurance represent important channels in mitigating the negative effect of EPU on household consumption.     

Assortative matching and commercial insurance participation: Evidence from the China Household Finance Survey

We investigated three assortative matching forms, positive assortative matching, women marrying up and men marrying up, and their effects on household commercial insurance participation, the number of family members with commercial insurance and household premium expenditures. Men marrying up has a significantly positive effect on the possibility of household commercial insurance participation and the number of family members having commercial insurance. The effect of men marrying up is larger in health insurance than in life insurance and annuity due to the salience of health risks. Finally, men marrying up interacts with the gender and risk attitude of the household financial decision-maker and may jointly affect household commercial insurance participation. Female decision-makers in marriages are more likely to purchase commercial insurance.     

Living standards and the life cycle: reconstructing household income and consumption in the early twentieth-century Netherlands†

Conventional methods of measuring historical household living standards are often criticized because of the omission of women's and children's wages and non-wage income; the focus on urban centres; and the exclusion of life-cycle changes in household composition, income, and consumption. This article presents a method that accounts for these issues and applies it to agricultural and textile households in the early-twentieth century Netherlands. It uses total household income, as opposed to the husband's wage, as the enumerator for calculating alternative welfare ratios. The results show that welfare ratios were not only structurally higher than those based on the male-breadwinner model, but also followed a different life-cycle trajectory. Furthermore, household portfolios were diversified and depended on local labour market structures. Thus, the study concludes that analyses based on men's wages only reflect the rough outlines of how households functioned.     

WHY IS THE TAKE-UP OF MICROINSURANCE SO LOW? EVIDENCE FROM A HEALTH INSURANCE SCHEME IN INDIA

Insurance for the poor, called microinsurance, has recently drawn the attention of practitioners in developing countries. There are common problems among the various schemes: (1) low take-up rates, (2) high claim rates, and (3) low renewal rates. In the present paper, we investigate take-up decisions using household data collected in Karnataka, India, focusing on prospect theory, hyperbolic preference, and adverse selection. Prospect theory presumes that people behave in a risk-averse way when evaluating gains but in a risk-loving way when evaluating losses. Because insurance covers losses, the risk-loving attitude toward losses might explain the low take-up rates, and we find weak empirical support for this. Households with hyperbolic preference were more likely to purchase insurance, consistent with our theoretical prediction of demand for commitment. We also find some evidence on the existence of adverse selection: households with a higher ratio of sick members were more likely to purchase insurance.