Statistical Implications of the Revenue Transfer Methodology in the Affordable Care Act

The Affordable Care Act (ACA) includes a permanent revenue transfer methodology that provides financial incentives to health insurance plans that have higher than average actuarial risk. In this article, we derive some statistical implications of the revenue transfer methodology in the ACA. We treat as random variables the revenue transfers between individual insurance plans in a given marketplace, where each plan’s revenue transfer amount is measured as a percentage of the plan’s total premium. We analyze the means and variances of those random variables and deduce from the zero-sum nature of the revenue transfers that there is no limit to the magnitude of revenue transfer payments relative to plans’ total premiums. Using data provided by the American Academy of Actuaries and by the Centers for Medicare & Medicaid Services, we obtain an explanation for empirical phenomena that revenue transfers were more variable and can be substantially greater for insurance plans with smaller market shares. We show that it is often the case that an insurer that has decreasing market share will also have increased volatility in its revenue transfers.     

社会互动与健康保险购买意愿关系研究

本文系统检验了社会互动对受访者购买健康保险意愿的影响。结果表明:网络互动和传统互动均显著提高消费者为自己购买健康保险的意愿,而且网络互动的影响力更大;网络互动对为父母健康保险的购买意愿没有解释力,传统互动则显著提高了消费者为父母购买健康保险的意愿。本文在检验影响健康保险购买意愿的传统因素之外,重点关注社会互动的影响,为分析个体的保险决策提供新的视角。     

医疗保障与老年医疗消费的实证分析

老年人的生活质量与医疗保障密切相关.本文运用Logistics回归和两步估计样本选择模型考察了医疗保险对老人医疗消费的影响.结果显示医疗保险能增加老年人的医疗利用水平但未能减轻医疗支出水平;人口禀赋因素是影响老年人购买商业医疗保险的决定因素,并通过交互作用影响老人的消费行为;老人医疗消费的健康效应强于收入效应.在实践中应首先从制度安排上为医疗保险提供明确的政策信号其次应为商业医疗保险的发展创造有利条件;最后应为老人营造温馨的氛围,从而减少医疗消费.     

U.S. tax policy and health insurance demand: Can a regressive policy improve welfare?

The U.S. tax policy on health insurance is regressive because it subsidizes only those offered group insurance through their employers, who also tend to have a relatively high income. Moreover, the subsidy takes the form of deductions from the progressive income tax system giving high income earners a larger subsidy. To understand the effect of the policy, we construct a dynamic general equilibrium model with heterogenous agents and an endogenous demand for health insurance. A complete removal of the subsidy may lead to a partial collapse of the group insurance market, reduce the insurance coverage and deteriorate welfare. There is, however, room for improving the coverage and welfare by extending a refundable credit to the individual insurance market.     

不确定性与中国城镇居民储蓄率的实证研究

本文从不确定性收入、社会保险的参与情况对中国城镇居民面临的不确定性进行了界定,并使用2006年中国综合社会调查数据(CGSS2006)检验了不确定性对城镇居民储蓄率的影响。基于稳健OLS和可行广义最小二乘法(FGLS)的估计结果表明:不确定性收入与城镇居民储蓄率之间存在着显著的正相关关系,参加养老保险和医疗保险可以显著降低城镇居民的储蓄率。分位数回归的结果进一步显示:在各分位处,不确定性收入均对城镇居民储蓄率产生了显著的正向影响,并且影响强度随着储蓄率分位的上升而下降;而在储蓄率分布的0.5及以上中高分位处,参加养老保险可以显著降低城镇家庭的储蓄率;在储蓄率分布的顶端,参加医疗保险也与城镇居民储蓄率之间表现出显著的负相关关系。     

健康险赔付与医院收入长期联动效应分析——基于VAR和VEC模型的实证

近年来我国健康险发展较快,但其高赔付率成了进一步发展的"瓶颈",这主要源于医险市场中的道德风险。本文运用计量经济学方法,对保险赔付和医院收入的关系进行了实证分析。结论:医院医疗收入、门诊收入和住院收入是导致保险赔付上升的原因,健康险赔付对医院收入的影响作用不显著,健康险业务的健康发展离不开医方的紧密协作。建议:保险公司需重视与医院和医生的合作,突出合作重点、改革合作方式和革新合作内容。     

The Asymmetric Information Problem in Taiwan's Cancer Insurance Market

This paper investigates the problem of asymmetric information in Taiwan’s cancer insurance market. Through the survey data, we find evidence of adverse selection existing in this market. Furthermore, we collect additional information on the individual, and find that the individual’s family cancer history contains additional valuable information. It can not only more accurately predict the probability of contracting cancer, as well as predict the willingness to purchase extended cancer insurance, but it can also help to mitigate the severity of adverse selection in the insurance market.     

我国农村居民健康风险影响因素研究

随着经济的增长,收入的提高,健康成为日益关注的话题,特别是农村居民的健康状况,受到各种风险的制约,更是引起了学者和政策制定者的重视。利用2006年中国健康与营养调查(CHNS)截面数据,描述了农村居民的健康状况,采用OrderedProbit模型分析了农村居民的健康风险影响因素,包括家庭因素、工作因素、生活习惯、就医决策、医疗保险等。研究结果证明了提高农村教育水平,增加农民收入,加大医疗事业的投入,完善新农合制度,逐步实现医疗保障制度的"城乡一体化"和城乡统筹等对农村居民健康有显著的正的影响。检验了Grossman健康需求模型在中国农村的适用程度,并在研究结论的基础上,提出了相应的思考。     

商业健康险税收优惠政策的效果分析--基于需求价格弹性的测算

本文基于经典商业健康险需求理论的价格弹性模型,分别利用天津市调研数据和中山大学劳动力动态调查数据库测算了按收入分层的商业健康险需求价格弹性及商业健康险的消费结构。并基于上述测算结果,通过数据库对接推算了全国商业健康险的需求价格弹性和税优政策的预期效果。测算结果表明,我国商业健康险的需求价格弹性为-0.22,在当前的税优政策下,个税税改前后,税优健康险的预期年保费规模分别为16.54亿元、6.09亿元,由此带来的年税式支出预计将分别达到2.47亿元、0.69亿元。最后,基于实证分析结果,本文对税优健康险未来的政策调整方向提供了建议。     

Medicaid coverage expansions and liability insurance

Do changes in the population covered by health insurance affect liability insurers, who compensate billions of dollars in medical claims each year? We examine this question by exploiting the selective rollout across states of Medicaid expansions under the Affordable Care Act. Using data on insurer losses across a range of insurance lines, and employing a triple‐difference research design that contrasts states, years, and lines of insurance, we demonstrate that coverage expansions reduce auto liability and workers’ compensation outlays by 6–11 percent, but do not measurably impact other lines of insurance. Our analysis provides some of the first evidence regarding the use of the tort system particularized to the low‐income population and is the first to consider the impacts of health insurance on medical professional liability and commercial auto insurance claims.     

Investigating the significance of insurance and income on health service utilization across generational cohorts

Ensuring access to health services is critical to consumers’ well-being across generational cohorts. Based on pre-disposing characteristics (that is, gender, ethnicity) and financial resources (that is, insurance and income) certain consumers may face barriers to access. In attempt to improve access to health care, this article presents an empirical investigation into how health service utilization can be affected by enabling variables, namely insurance and income. Utilizing proprietary secondary data from a major metropolitan hospital in the United States, the article investigates the following questions: How does insurance and income enable service utilization? How do pre-disposing characteristics of a consumer hinder service access? How does the effect of income and insurance moderate the effect of pre-disposing factors on service utilization? Finally, how do these effects on service utilization vary across generational cohorts? Results indicate that insurance and income may enable access to service, yet this effect is varied among different demographic cohorts and generational groups. The article concludes by offering implications for marketers and policymakers.     

Why the Development of Health Insurance Is Regionally Imbalanced: Evidence from China

As China adopted an imbalanced development strategy to obtain rapid economic growth, it is getting more and more urgent to find out a feasible way to balanced development of social safety network. This study measures the degree of regional disparities in China’s health insurance industry and explores the rationales by a thorough examination of health insurance purchasing behavior. An empirical analysis is conducted, based on a panel data of 31 provinces from 2004 to 2014, to test the hypothesis. We find that the regional disparities would be significantly affected by the variables including age structure, education, income, availability of health resources, density of population, and substitutes.     

Social Implications of Genetic Testing

This paper examines the social implications of predictive genetic testing and its impact on the insurance industry. Although the Human Genome Project has the potential to improve the health of our nation, it also may serve as a means of highlighting genetic differences among individuals and ethnic groups. Thus, if we are to reach the full promise of the Project, society must address the public’s fears of genetic discrimination in insurance and employment contexts. Following an analysis of state and federal legislation on genetic privacy and discrimination, the paper concludes with a challenge to the insurance industry to work with the medical community and health care advocates to formulate a public policy approach that promotes informed consent and the fair use of genetic information.     

商业保险对居民消费影响研究——基于中国省级面板数据的经验证据

当前中国经济社会处于快速转型期,伴随着改革进程的不确定性风险日趋凸显,成为制约居民消费进一步扩张的重要因素。本文采用2003~2017年中国省级面板数据,考察了商业保险对居民消费行为的影响效应及其作用机制。研究发现,以商业保险密度和保险强度为表征的商业保险发展对居民消费有着显著正向影响,相较于农村居民消费,商业保险对城镇居民呈现更强的消费效应,同时财产保险消费效应明显高于人身保险对居民消费影响,进一步地,中介效应检验发现,不确定性缓解可能是商业保险影响居民消费的一个重要机制。基于此,本文认为,构筑完善的商业保险服务体系对于启动居民消费具有重要意义。     

物联网时代的健康保险与健康管理

随着我国社会发展与人们生活水平的提高,健康管理和健康保险将成为未来社会管理和保险市场需求的重要领域。目前健康保险和健康管理面临着由于信息不对称引起的道德风险的困境,同时,受到经营管理效率的制约。物联网技术的出现、发展与普及,为解决上述问题提供了可能。解决的基本思路是围绕存在的问题,有针对性地利用物联网的“更加透彻的感知...     

地理分散化降低了多少保险经营风险?

本文定量分析了地理分散化对中国保险公司经营风险的影响。收集我国1998~2017年间各省市区的财产保险业和人身保险业的收入和支出数据,基于投资组合原理,比较了三种地理布局战略下保险公司的赔付风险。研究发现:无论是财产保险业还是人身保险业,各省区市之间赔付风险的差异性较大,在华北、东北、华东、中南、西南和西北这六大区域内部经营并不能显著地分散风险,但扩大到全国范围内经营,便能够较好地分散风险。进一步,采用Bootstrap随机模拟方法分析发现:财产保险公司在约10个省区市经营能够分散掉约80%的赔付风险,而人身保险公司在约5个省区市经营能够分散掉约40%的赔付风险。鉴于财产保险公司经营的各条产品线之间的风险差别较大,本文还发现:农业保险的地理分散化效果最强,短期健康险的地理分散化效果最弱。研究结果既支持保险公司跨地域经营以降低风险,也为监管资本设计中考虑地理分散化效应提供了经验证据。     

吉林市中低收入群体医疗服务需求的调查分析

对吉林省吉林市315户中低收入家庭进行问卷调查的结果表明：部分中低收入群体的医疗费用负担沉重;城镇居民基本医疗保险的实效性较差;居民对医保政策缺乏了解;社区卫生服务机构没有充分发挥作用。强化政府责任,加大宣传力度,加强社区基础医疗卫生服务机构建设,提高居民医疗保障待遇,是完善我国中低收入群体医疗需求的有效途径。     

Banks’ earnings: Empirical evidence of the influence of economic and financial market factors

The structure of income is a foremost address within research on banks’ performance, especially with regard to effects on the resilience of banks’ earnings. Indeed, given their central position in the economy, banks shall thrive to generate sustainable earnings and control for their potential volatility. Existing studies mostly consider the weight of non‐net interest income (nonNII) as opposed to the traditional NII income source. Such aggregated nonNII is found to increase earnings risk but more granular studies conflict. We propose an original investigation of the influence of economic and financial conditions on various income types, assuming that performance may actually be driven by both the income structure and external conditions. We focus European banks, which have long been allowed to diversify beyond retail banking. Out of a straight panel framework, we question if the influence of external conditions spreads to earnings components other than credit losses and trading income and if it does allow for diversification benefits among components. We find that each component actually evolves owing to its own equation. Furthermore, effects of single variables may cumulate over different components of earnings (e.g. GDP) or provide with diversification benefits. These effects are all the more important since they are not mitigated by operating expenses. Hence, over a regarded period, banks’ performance depends upon their structure of income and upon volatilities and correlations of influential variables. Besides controlling for ex‐ante volatility, our approach shows that a given structure of income is not necessarily more resilient than others but that selected non‐banking income may support a higher stability of Earnings     

不同收入等级农村居民基本医疗保险受益公平性研究

公平普惠是我国卫生和健康事业建设的目标,基本医疗保险是实现目标的制度保障。本文基于安德森医疗服务利用行为理论,采用三阶段随机抽样方法采集湖北省少数民族贫困县965个农村参保者的调查数据,通过收入五等分法、二元选择模型和两部分模型对基本医疗保险受益公平性进行分析。结果发现:均等化的医疗保险政策不仅实现了规则公平,实践中也提高了低收入参保者的医疗服务利用行为,即低收入组与高收入组有相似的就诊行为,且最低收入组比最高收入组还有更高的报销可能性。但是从医疗服务利用结果和疾病经济负担来看,低收入者仍然处于劣势。最低收入组和较低收入组均比最高收入组有更高的慢性病患病可能性和更差的自我健康评价,同时低收入组有着更重的疾病经济负担。此外,少数民族居民、失业者、年长者、有配偶的居民可能有更差的医疗服务利用结果。因此,中国在实现全民医保的基础上,未来还要进一步提高医保受益公平性。