How do low-income enrollees in the Affordable Care Act marketplaces respond to cost-sharing?

The Affordable Care Act requires insurers to offer cost-sharing reductions (CSRs) to low-income consumers on the marketplaces. We link 2013–2015 All-Payer Claims Data to 2004–2013 administrative hospital discharge data from Utah and exploit policy-driven differences in the actuarial value of CSR plans that are solely determined by income. This allows us to examine the effect of cost-sharing on medical spending among low-income individuals. We find that enrollees facing lower levels of cost-sharing have higher levels of healthcare spending, controlling for past healthcare use. We estimate demand elasticities of total health care spending among this low-income population of approximately −0.12, suggesting that demand-side price mechanisms in health insurance design work similarly for low-income and higher-income individuals. We also find that cost-sharing subsidies substantially lower out-of-pocket medical care spending, showing that the CSR program is a key mechanism for making health care affordable to low-income individuals.     

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.     

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。     

Optimal Loss Mitigation and Contract Design

This work examines the interaction between the premium rates set by an insurer and the incentives of an individual to purchase market insurance and undertake mitigation to reduce the size of a potential loss. A risk‐neutral monopolistic insurer prices insurance according to the price‐elasticity of demand for coverage. The elasticity of demand is affected by the presence of both mitigation and government intervention. The availability of loss reduction activities increases the consumer's elasticity of demand and lowers the optimal rate charged by the monopolist. Government intervention reduces both expenditures on mitigation and the rate charged by the monopolistic insurer.     

The Price Elasticity of Demand for Whole Life Insurance

In this study a real price index is created for whole life insurance sold in the United States from 1953 to 1979. New purchases of whole life insurance are shown to be negatively related to changes in this cost index, contrary to what has been widely accepted in the insurance literature, but consistent with economic theory. The existence of strong price elasticity of demand for whole life insurance does not ensure, however, that the insurance industry manifests a high degree of price competition.     

保险市场结构与非规范竞争

本文运用产业组织理论和简单的博弈论原理证明,保险企业采用给予折扣等非规范竞争是保险企业经营者的一种理性选择。而具体的非规范竞争行为又与市场需求弹性、保险企业管理水平、承保企业的所有制性质相关。根据对保险市场折扣行为的分析,笔者的结论是监管机构除了对相关行为进行有效监管以外,还要逐步放开费率厘定权、鼓励保险企业进行险种创新并进一步开放保险市场。     

人身险需求对物价波动的非对称响应——基于中国2000-2010年季度数据的实证研究

基于中国人身险市场2000-2010年季度数据的实证分析表明,人身险需求增长率对于物价波动的反应是非对称的。首先与物价明显上涨的情况相比较,人身险需求对物价明显下跌的反应更加强烈。其次,适当提高名义利率的通货膨胀弹性将有助于人身险市场的快速发展。第三,目前温和的通货膨胀可以促进人身险需求的增长,人身险企业应该抓住扩大内需的有利时机。第四,由于市场需求模式在门限值附近出现较大改变而有可能冲击人身险行业,所以当通货膨胀率接近门限值时,人身险行业应该及时地调整营销策略。     

中国长期护理保险财政负担能力研究

本文通过测算城乡居民和城镇职工长期护理保险需求,构建医疗保险精算模型,对中国长期护理保险财政负担能力展开研究。结果发现:依托城乡居民医疗保险建立的长期护理保险会增加财政支出,但是支出规模在可控范围内;依托城镇职工医疗保险建立的长期护理保险会威胁职工医疗保险统筹基金的安全,因而不可持续,但是该问题可以通过改革职工医疗保险个人账户来解决;中国长期护理保险应该采用“个人缴费+医疗保险基金补助+财政补助”的模式,且个人缴费最高不超过15%;中国长期护理保险财政负担水平总体较低,财政有能力维持长期护理保险的运行。对此,我国应尽快正式建立全国性的长期护理保险制度和财政对长期护理保险的投入机制。     

Flood Insurance Coverage in the Coastal Zone

We explore determinants of flood insurance demand in the coastal zone using micro‐data for nine Southeastern counties. Overall estimates indicate price inelastic demand, though subsidized policyholders have greater coverage and are more price sensitive. Mortgage borrowers exhibit no greater coverage; only 12 percent in 100‐year flood zone indicate flood insurance was required by their lender. Flood insurance demand is increasing in the levels of flood and erosion risk. We find a positive correlation between household income and coverage, but the effect is not monotonic. Community‐level erosion hazard mitigation projects influence flood insurance coverage, with beach replenishment acting as a complement.     

The demand for stocks: an analysis of IPO auctions

We analyze a unique dataset that includes the full demand schedulesof 27 Israeli IPOs that were conducted as nondiscriminatory(uniform price) auctions. To the best of our knowledge, thisis the first time the whole demand schedule for any asset isdescribed. The demand schedules are relatively flat around theauction clearing price: The average elasticity is 27. The elasticityis low when the return distribution contains a large uniquecomponent. We also find a significant average abnormal returnof 4.5% on the first trading day and a positive correlationbetween the abnormal return and the elasticity of demand.     

我国人均卫生总费用增长的实证分析

本文利用2001-2010年的统计数据,通过SPSS统计软件,构建了人均卫生总费用供需模型,对人均卫生总费用增长进行了实证回归分析.结果发现:卫生费用增长快于国内生产总值增长,但弹性相对较小,仅为1.026;卫生支出主要受到人口调整数、城镇居民人均可支配收入的影响;城镇居民医疗保健价格指数、卫生机构数目则不能稳定地解释卫生费用增长;卫生费用增长问题应在供需相统一的关系中加以讨论.     

Insurance demand and country risks: A nonlinear panel data analysis

This paper investigates the impact of country risks, including political, financial, and economic risks, on the income elasticity of insurance demand. Using the panel smooth transition regression model, we find that there is a significant regime-switching effect concerning the impact of country risks on the income elasticity of insurance demand. A full-sample analysis shows that the income elasticity of insurance demand decreases when country risks diminish. In a subsample analysis based on income level, legal origin, and restriction on banks' participation in insurance activities, we find that the elasticity diminishes in general when economic risk drops. When political risk is lower, the elasticity decreases in countries with high-income, common law origin, and insurance activities permitted by banks, whereas a clear pattern cannot be identified in the case of financial risk.     

Medical Insurance Coverage and Health Production Efficiency

Conventional economic theory predicts that medical insurance coverage causes an inefficient production of health because of  ex ante  and  ex post  moral hazard effects. However, no research has empirically examined the magnitude of the inefficiency. This study empirically examines the impact of medical insurance on the technical efficiency of health production at the metropolitan level. The underlying health production function allows for preventive care, curative care, and behavioral factors. Data envelopment analysis determines relative technical efficiency. The multiple regression results indicate that insurance coverage generates inefficiency but the efficiency loss appears to be relatively small on the extensive margin.     

Examining the Marginal Access Value of Private Health Insurance

According to a new theory advanced by Nyman (1999, 2003) , an important access motivation underlies the demand for health insurance. However, little empirical research has attempted to quantify and explain changes in the access value of health insurance. By assuming the demand for health insurance is derived from the demand for good health, this article shows mathematically that the marginal access value of private health insurance can be reasonably indexed by dividing the price of health insurance by a composite measure of medical prices. For the period from 1960 through 2002, national data for the United States suggests that the marginal access value of private health insurance has tended to increase over time. Based upon multiple regression analysis, marginal access value is shown to have increased over time in response to rising income, more generous benefit coverage, new medical technologies, and, in recent years, the backlash against health maintenance organizations (HMOs). In addition, expansions in the Medicaid program are shown to have slowed the growth of the marginal access value of private health insurance.     

Adverse Selection, Moral Hazard, and Outlier Payment Policy

In this article, we analyze the rationale for introducing outlier payments into a prospective payment system for hospitals under adverse selection and moral hazard. The payer has only two instruments: a fixed price for patients whose treatment cost is below a threshold     and a cost-sharing rule for outlier patients. We show that a fixed-price policy is optimal when the hospital is sufficiently benevolent. When the hospital is weakly benevolent, a mixed policy solving a trade-off between rent extraction, efficiency, and dumping deterrence must be preferred. We show how the optimal combination of fixed price and partially cost-based payment depends on the degree of benevolence of the hospital, the social cost of public funds, and the distribution of patients severity.     

Insurer pricing and consumer welfare: evidence from Medigap

This article examines the welfare impact of imperfect competition in the Medicare supplement insurance (Medigap) market. Two firms control nearly three fourths of the Medigap market, and premiums exceed claims by over 25%. I find that a low price elasticity and consumers' brand preferences lead firms to engage in substantial marketing and price above cost. Therefore, the strategic behavior of insurers facing relatively inelastic demand is critical in explaining poor market performance. I also find that insurers do not capture all of the rents in this market; rents also accrue to actors who perform marketing functions, including agents and brokers.     

The Demand for Life Insurance in OECD Countries

This article examines the determinants of life insurance consumption in OECD countries. Consistent with previous results, we find a significant positive income elasticity of life insurance demand. Demand also increases with the number of dependents and level of education, and decreases with life expectancy and social security expenditure. The country's level of financial development and its insurance market's degree of competition appear to stimulate life insurance sales, whereas high inflation and real interest rates tend to decrease consumption. Overall, life insurance demand is better explained when the product market and socioeconomic factors are jointly considered. In addition, the use of GMM estimates helps reconcile our findings with previous puzzling results based on inconsistent OLS estimates given heteroscedasticity problems in the data.     

Price Elasticity of Demand and an Optimal Cash Discount Rate in Credit Policy

While the provision of a cash discount is equivalent to a reduction in price, the role of price elasticity of demand in determining credit terms has been neglected in the extant literature. In this paper, this role is investigated and it is shown that the optimal cash discount rate is affected by the price elasticity of demand for the firm's product. The comparative effects on the optimal cash discount rate with respect to exogenous changes in the fraction of credit sales paid after taking cash discount, the cost of short-term funds and the bad debt loss ratio are investigated. A trade-off between the time value gain and the price elasticity of demand is established. We find that firms which sell in locations having different price elasticities for their products, and/or which face various costs of short-term funds in different locations, should vary their cash discount terms accordingly.     

尿毒症透析治疗价格谈判机制研究

随着尿毒症患病率的增加,尿毒症给患者和社会带来沉重的经济负担,临床上诱导需求客观存在,给医保基金的运营也带来一定的挑战。本文就医疗保险机构建立尿毒症透析治疗价格谈判的必要性、可行性及谈判机制的构建做一些理论探讨,以期推动医疗保险机构和医疗机构尽快建立尿毒症透析治疗价格谈判机制。     

An Analysis of the Demand for Earthquake Insurance

This research examines the decision to purchase earthquake insurance by analyzing data on earthquake insurance price and penetration in the New Madrid fault zone in Missouri. Earthquake risk is of concern to consumers, the insurance industry, industry regulators, and government agencies because of the potentially catastrophic nature of losses resulting from a major earthquake. Despite the significance of the earthquake peril, the recent literature does not contain estimates of the price and income elasticity of the demand for earthquake insurance. Our analysis indicates that homeowners acquire earthquake insurance because of risk considerations, at higher levels of risk the demand for earthquake insurance is higher, and the price of earthquake coverage does not provide incremental information in explaining the demand for earthquake coverage.