Estimating willingness to pay for medicare using a dynamic life-cycle model of demand for health insurance

Medicare is the largest health insurance program in the US. This paper uses a dynamic random utility model of demand for health insurance in a life-cycle human capital framework with endogenous production of health to calculate the individual willingness to pay (WTP) for Medicare. The model accounts for the feature that the demand for health insurance is derived through the demand for health, which is jointly determined with the production of health over the life-cycle. The WTP measure incorporates the effects of Medicare insurance on aggregate consumption through effects on medical expenditures and mortality, and consumption utility of health. The model is estimated using panel data from the Health and Retirement Study. The average WTP or change in lifetime expected utility resulting from delaying the age of eligibility to 67 is found to be $ 24,947 in 1991 dollars ($ 39,435 in 2008 dollars). However, there is considerable variation in the WTP, e.g., in 1991 dollars the WTP of individuals who have less than a high school education and are white is $ 28,347 ($ 44,810 in 2008 dollars), while the WTP of those with at least a college degree and who are neither white nor black is $ 15,584 ($ 24,635 in 2008 dollars). More generally, the less educated have a higher WTP to avoid a policy change that delays availability of Medicare benefits. Additional model simulations imply that the primary benefits of Medicare are insurance against medical expenditures with relatively smaller benefits in terms of improved health status and longevity. Medicare also leads to large increases in medical utilization due to deferring of medical care prior to eligibility.     

决策树算法在基本医疗保险中的应用研究

随着计算机技术以及学科交叉的发展,数据挖掘技术被越来越多应用到保险的风险分析中。文章使用数据挖掘基本算法之一的决策树算法分析研究了某市的基本医疗保险数据样本,找出隐含的有效信息,并在此基础上提出了完善基本医疗保险的对策建议。     

具有奖励机制与再保险安排的最优保险合约设计

在保险合约中引入奖励机制可以使投保人动态参与到保险合约中,赋予了投保人在面对索赔事件时是否执行索赔的可选择权,改变了传统保险合约中投保人执行索赔的单一权利,但却增加了保险人潜在的流动性风险。保险合约中再保险的安排则可以对冲由于奖励机制产生的潜在流动性风险,进一步分散保险人的风险,有助于保险人稳健经营。基于此,通过建立具有红利奖励机制与再保险安排的最优保险合约设计模型,最终求解得到最优保险合约是具有最优免赔额形式的保险合约。利用算例研究方法进行建模,研究结果显示,最优保险合约中的最优免赔额与奖励机制中的红利奖励之间具有正向关系,保费、自留额与最优免赔额之间则存在着显著的负向关系。     

统筹城乡医疗保障制度的福利分配效应——来自江苏省的实地调查数据

基于江苏省2073个实地调研数据,利用样本选择模型及分位数分解方法,实证研究统筹城乡医疗保障制度的福利分配效应.实证结果表明,统筹城乡医保制度更多地将医保补偿福利分配给高风险人群、高收入阶层和农村居民.针对不同收入阶层的福利差异,分位数分解结果进一步证实:允许参保自选的统筹模式在缩小贫富人群、城乡人群的医保补偿差异上也更具优越性,并且这种优越性多来自于统筹模式本身,而非地区禀赋差异.     

Employee health insurance decisions in a flexible benefits environment

This study investigates the factors which influence employees' choices among different health insurance options under a flexible benefits plan. Employee-specific selection and demographic data provided by the former National Cash Register (NCR), were used to analyze the effects of employee and plan characteristics on choice of health care plan. Results suggest that employees' health plan choices are influenced by premium, deductible, and coinsurance amounts, and by employees' age, gender, salary, and marital status. The results are considered within an expected utility maximization model. Implications for the design of flex plans as well as future research and theory are discussed. © 1996 by John Wiley & Sons, Inc.     

促进医药卫生改革的税收政策研究

我国医药卫生领域现行税收政策与新一轮医药卫生体制改革目标存在一定冲突。现行税收政策不利于医疗行业公益性目标的实现,不利于吸引民营资本进入,不利于营利性民营医疗机构的发展,不利于鼓励商业健康保险的发展。我国应建立和完善能够与医药卫生体制改革目标相适应的税收政策体系,包括医疗服务营业税及税收优惠制度、医疗机构所得税税收优惠制度、药品增值税及税收优惠制度、商业健康保险税收优惠制度等。     

Optimal insurance contract under VaR and CVaR constraints

This study endogenously develops an optimal insurance contractual form for maximizing insured expected utility under VaR and CVaR constraints. We find that CVaR constraint does not affect the contractual form, but may increase minimum insurance premium requirement. Additionally, when the VaR constraint is binding, the optimal contract is a double deductible insurance. However, if the contract is restricted to a regular form (both indemnity schedule and retained loss schedule are continuously nondecreasing) for avoiding moral hazard problem, the optimal contract is a piecewise linear deductible insurance. Finally, we provide intuitive comparison between this study result and relevant studies.     

Correlated income shocks and excess smoothness of consumption

In the literature, econometricians typically assume that household income is the sum of a random walk permanent component and a transitory component, with uncorrelated permanent and transitory shocks. Using data on realized individual incomes and individual expectations of future incomes from the Survey of Italian Households׳ Income and Wealth, I find that permanent and transitory shocks are negatively correlated. Relaxing the assumption of no correlation between the shocks, I explore the effects of correlated income shocks on the estimated consumption insurance against permanent and transitory shocks, and consumption smoothness using a life-cycle model with self-insurance calibrated to U.S. data. Negatively correlated income shocks result in smoother consumption, and upward-biased estimates of the insurance against transitory (and permanent when borrowing constraints are not tight) income shocks. While the life-cycle model with negatively correlated shocks fits well the sensitivity of consumption to current income shocks observed in U.S. data, it falls short of explaining the sensitivity of consumption to income shocks cumulated over a longer horizon.     

Are generalized call-spreads efficient?

In order to explain coexistence of a deductible for low values of the loss and an upper limit for high values of the loss in insurance contracts, we consider the exchange of risk between two rank dependent expected utility maximizers. It is shown that if the insurer (insured) takes more into account the lowest outcomes – hence maximal losses – than the insured (insurer), then the optimal contract has an upper limit (includes a deductible for high values of the loss). If furthermore, the insured (insurer) neglects the highest outcomes while the insurer (insured) does not, the optimal contract includes a deductible (full insurance) for low values of the loss.     

Who is more important,parents or children? Economic and environmental factors and health insurance purchase

The existing research indicates that insurance demand is affected by the policyholder’s occupation, family economy, urbanization level, and insurance coverage. Using micro data of insurance purchase at the individual level, this study investigates the influence of economic and environmental factors on the priorities of health insurance purchase decision. The results reveal that the more developed the economy and the more financial knowledge people possess, the more the latter tend to prioritize health insurance for their children. Furthermore, the study investigates the influence of air pollution on the decision to purchase health insurance. If the air pollution level is high, policyholders prioritize obtaining insurance for their children. Our research on the order of insurance purchase indicates that Chinese families have a lack of support from their children, and the function of family pension is gradually weakening. Our research also reveals that families are willing to spend money on the insurance of their children. Therefore, to solve the problem of health and old-age security for the elderly, it is more effective to promote health insurance by considering families as a unit     

Health insurance and savings over the life cycle—a semiparametric smooth coefficient estimation

Individuals save for future uncertain health care expenses. This is less efficient than pooling health risk through insurance. The provision of comprehensive health insurance may raise welfare by providing the missing market to smooth out consumption through the life cycle. We employ a semiparametric smooth coefficient model to examine the effects of the introduction of the National Health Insurance in Taiwan in 1995 on savings and consumption over the life cycle. The idea is to estimate the coefficients of health insurance which vary with age. Our results suggest that younger households are more sensitive to the risk reductions, and that they demonstrate a greater response in the reduction of their precautionary saving. Copyright © 2004 John Wiley & Sons, Ltd.     

“新农合”对农村居民耐用品消费的影响

本文利用中国营养健康调查（CHNS）数据,基于改进的Probit模型检验了新型农村合作医疗保险对农村居民耐用品消费的影响。研究发现：“新农合”能有效提高农村家庭的耐用品消费水平,且农村家庭上一期参保行为对耐用品消费的刺激作用更显著。另外,“新农合”对存在中、高健康风险居民的耐用品消费刺激作用明显,且上期参保行为对健康高风险居民的耐用品消费促进作用更强。     

医院应加强外办门诊财务的规范化管理

实施"医药分开核算,分别管理"、病种限价和农合、医保病人利润微薄,以及医疗卫生体制的不断改革,医院的获利空间相对缩小。医院为了在困境中求得生存和发展,各医院在辖区内外相继开设了多个综合门诊和专科门诊,以增加医疗收入。但加强院外办门诊的规范管理尤为重要,一是开办院外门诊应首先报卫生主管部门批准:二是开办院外门诊要具备房屋、设备条件:三是制定合同要实事求是,积极可靠:四是明确管理体制,使国家各项政策、法令、经济措施的宣传、贯彻得以落实:五是会计人员应由医院指派。会计、出纳应同时配齐:六是完善分配机制:七是严格医德医风考核。只有不断加强管理,才能使其朝着健康的方向发展。使院外办门诊对医疗卫生事业起着拾遗补缺的作用。     

A micro view on home equity withdrawal and its determinants: Evidence from Dutch households

For most households, home ownership is the largest wealth component that has become more accessible through innovation and deregulation in mortgage markets. This paper studies the factors driving home equity withdrawal (HEW) at the household level using Dutch survey data. In the Netherlands, house prices were growing fast and mortgage expenses are to a large extent tax deductible. Expectations and perceptions do seem to play an important role in HEW. Withdrawers tend to be more positive about house price developments and – although having lower income – less concerned about their future economic situation. HEW can have a significant impact on both households and the economy, with most of the equity released being reinvested in the housing sector and only a small share used to finance consumption expenditure.     

The role of asset testing in public health insurance reform

Starting slowly with the 1996 Welfare Reform Act and culminating in the 2010 Affordable Care Act, means-tested public health insurance eligibility expanded to include adults in low-income families regardless of their asset holdings. This paper quantifies the effects of these eligibility expansions within the context of the 2010 Affordable Care Act. I construct a dynamic stochastic general equilibrium model with indivisible labor supply expanded to include an endogenous household choice of health insurance coverage and calibrate it to U.S. data. I establish that changes in the distribution of labor and welfare associated with removal of asset testing are driven by exit of high productivity and high wealth households from the labor market. I then expand my analysis to the 2010 Affordable Care Act to demonstrate that removal of asset testing is critical to the obtained results even when combined with other provisions of the Act. Finally, I find that a simple asset test for eligibility of health insurance transfers undoes the distortion to the household labor supply decision among high productivity types. These results are robust to the introduction of employer premium contributions, an independent health insurance market, and idiosyncratic shocks to eligibility for employment-based health insurance.     

收入差距、社会资本与居民贫困

研究目标：分析收入差距与社会资本及其交互作用对居民贫困的影响,并探讨两者的影响机制。研究方法：构建Logit等计量模型,并采用三阶段最小二乘法（3SLS）与工具变量法（IV Probit）进行稳健性检验。研究发现：在社区层面上,收入差距导致了教育与财政资源在区县间的配置不均等,阻碍了医疗保险制度的发展以及产业结构的提升,进而提高了居民的贫困发生率;在个体层面上,收入差距降低了居民对教育资源的可及性,恶化了居民的健康水平,从而导致居民进入贫困状态。社会资本能够降低居民发生贫困的概率,同时也能够缓解收入差距对居民贫困的不利影响;提升就业能力与收入水平、增加教育与医疗投资、改善社会经济地位、强化融资能力等是社会资本缓解贫困的主要渠道与机制。研究创新：采用具有代表性的中国家庭追踪调查数据,研究收入差距与社会资本对居民贫困的作用机制,指出社会资本是缓冲收入差距对居民贫困不利影响的重要保障。研究价值：为相关理论研究提供更多的经验证据和路径解释;在实践中,对减贫、防贫具有指导意义。     

Development of an integrated medical supply information system

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.     

Regional Inequalities in Consumption Patterns: A Multilevel Approach to the Case of Italy

The main aim of this paper is to evaluate the disparities in the Italian regions on the demand side. In more detail, an attempt will be made to find if the consumption behaviour of Italian households is different in the regions. With this in mind, Istat's 2000 Italian Family Budget data set was analysed. The data in question, which were collected through a two‐stage sample over Italy's 20 regions, contains information regarding the expenses of approximately 23,000 households. In this analysis, both households and regions are considered as units: households are nested in the regions so that the basic data structure is hierarchical. In order to take this hierarchical structure into account, a multilevel model was used, making it possible for parameters to vary randomly from region to region. The model in question also made it possible to consider heterogeneity across different groups (regions), such as stochastic variation. First, regional inequalities were tested using a simple model in which households constituted the first level of analysis and were grouped according to their region (the second level). As a second step, and in order to investigate the interaction between geographical context and income distribution, another model was used. This was cross‐classified by income and regions. The most relevant results showed that there is wide fragmentation of consumption behaviour and, at the same time, various differentiated types of behaviour in the regions under analysis. These territorial differentials become clear from income class and items of consumption.     

A voucher plan for financing health care delivery

There seems to be a growing consensus in this country that everyone should have guaranteed access to at least a minimum level of preventive and curative medical care. The real controversy is over the method by which such care would be assured.

I have proposed elsewhere that each individual be given a voucher; ‘good’ for either full premium payment for membership in a comprehensive prepaid health plan in a specified period, or for a predetermined amount toward one's health insurance premium if it is desired to maintain consumption of care in a fee-for-service (ffs) mode.

The purpose of the present paper will be to provide a preliminary examination of some of the operational characteristics of such a voucher which may be implemented on an ‘area’ basis, such an area containing some number of somehow identifiable ‘regions’. In each of the regions a governing board would make management decisions taking into account its peculiarities and needs. The regional board would then be responsible to some area Health Council. This, of course, parallels the kinds of decision-making bodies specified both in national proposals such as Senator Kennedy's, and statewide plans such as California Senate Bill 770 proposed by Senator Moscone (D., San Francisco).

An analytical model of the decision process of such regional boards and Health Councils is developed and the optimal selection of voucher redemption levels and capital subsidy programs is characterized.     

The utilization of diagnostic tests among the elderly: Evidence from Malaysia

Diagnostic test plays a major role in reducing the prevalence of non-communicable diseases (NCDs). The present study examines the relationships between the utilization of diagnostic tests and socioeconomic, insurance, lifestyle, and health factors among the elderly in Malaysia. Analyses based on the National Health and Morbidity Survey 2011 (NHMS 2011) suggest that high income and having private insurance are associated with a higher likelihood of utilizing diagnostic tests. However, low education levels, being employed and smoking are associated with a lower propensity to utilize. These results provide public health administrators with useful information on policy development. In particular, the proposed policies include providing the poor with nominal price of basic diagnostic tests, introducing various health education programmes to the public, creating health awareness campaigns to encourage elders who do not own private insurance to utilize diagnostic tests, as well as making basic diagnostic tests compulsory for all elders owning government insurance.