The medical expense deduction and income levels: Progressive or regressive?

The medical expense deduction (MED) allows taxpayers to deduct from taxable income a proportion of their out-of-pocket medical insurance and health care expenses. Because the rate of subsidy is equal to the marginal tax rate previous studies have found MED to be a regressive tax mechanism biased toward benefiting higher-income taxpayers. The authors demonstrate, using GINI coefficients, that MED makes the tax structure more progressive than it would otherwise be and increases equality of after-tax incomes.     

Elderly Consumers' Knowledge Related to Medigap Protection Needs

Elderly consumers’ knowledge of Medicare coverage and the major factors they considered in purchasing supplementary health insurance were examined. Perceptions of the financial consequences of being hospitalized also were investigated. The findings based on a sample of Florida residents indicated that many older people may be ill-prepared to correctly assess their medigap protection needs and to choose wisely among alternative insurance policies if they decide to purchase supplementary coverage. Inadequate knowledge may result in unfulfilled expectations about protection when medical expenses are incurred, vulnerability to questionable insurance sales appeals and methods, and purchase of uneconomic duplicate coverage.     

Improving Incentives in Health Care Spending

Although U.S. economic growth is likely to continue to be robust, the growth of private and public spending on health care presents long-run public policy challenges. To meet these challenges health care resources must be used more efficiently. Currently, there are few incentives to put health care dollars to the highest value use. This is true in both public and private spending. An important element of the problem lies in the tax-preferred treatment given to employer-provided insurance but not to out-of-pocket spending. The resulting bias towards first-dollar insurance coverage means that consumers are insulated from the real costs of the health care that they consume and have little reason to evaluate whether the benefits are greater than those costs. Moreover, they seldom have sufficient price and quality information to make informed decisions. Health Savings Accounts (HSAs) are a promising way to remove the tax-penalty for enrolling in catastrophic insurance and paying for routine care out of pocket. Given the information that they need, consumers would then have more choices and more control, strengthening their role in reducing waste, improving efficiency, and promoting competition. Coupled with other policies, HSAs can be a critical component in moving toward an efficient and equitable health care system. JEL Classification I11     

Evaluation of Social Marketing Efforts Designed to Increase Enrollment in the Children's Health Insurance Program (CHIP)

ABSTRACT

Expanded eligibility criteria for children in the federally funded Child Health Insurance Program (CHIP) has created unique social marketing challenges because of the need to engage families that historically have not received public support. The purpose of this article is to evaluate statewide outreach strategies to increase CHIP enrollment. Quantitative research identified the outreach strategies used by Ohio counties and determined the counties that demonstrated the greatest increases in child health insurance enrollment. Qualitative research explored consumer and outreach staff perceptions of which marketing strategies led to success. Findings, implications, and application to social marketing theory are discussed.     

社会保障支出是否缩小了老年收入差距?

社会保障具有综合收入分配调节功能.老年人口作为养老金和医疗保险等主要待遇享受主体,社会保障支出发挥着对老年时期经济收入应有的重要调节作用.文章基于中国居民收入调查数据库,利用构造家庭基尼系数以及再分配系数,对社会保障的老年收入再分配效应进行了宏观整体测算以及微观个体计量分析.研究表明,养老金待遇、医疗保障、社会救助水平对城乡老年人口的收入再分配效应发挥重要作用,养老金的收入再分配效应要更高;养老金转入收入对偏低收入户老人的收入再分配效应最大,医疗保险待遇对高收入户家庭的再分配效应最高,社会救助对低收入和高收入家庭有较大的再分配效应.从总体上看,社会保障对老年收入再分配效应是正向的,但依然存在较多问题,社会保障支出重点应向弱势群体倾斜并改善社会保障目标瞄准机制等,逐步缩小老年人口收入差距.     

The influence of hospitable design and service on patient responses

ABSTRACT

A study of 216 respondents examined a medical center environment’s influence on patient responses. A stimulus–organism–response (S-O-R) model was adapted to the theory that more hospitable healthcare servicescape elements will affect patients’ overall satisfaction with healthcare experience, loyalty intentions, and willingness to pay out-of-pocket expenses for healthcare services. Servicescape elements included atmospherics of the healthcare environment, service delivery by healthcare staff, physical design of the healthcare environment, and wayfinding. Results of structural equation modeling confirmed that the four servicescape elements – had a significant impact on patients’ overall satisfaction with the healthcare experience. Furthermore, overall satisfaction with the healthcare experience predicted patients’ loyalty intentions and willingness to pay out-of-pocket expenses for healthcare services. The study makes a significant contribution to the empirical modeling of patients’ behavioral responses to hospitable healthcare environments.     

基本公共服务均等化如何促进了个人创业--来自医保改革的证据

在高质量发展目标下,推行基本公共服务均等化、促进大众创业是中国经济新常态下的工作重点。基于中国城镇职工基本医疗保险在创业者和非创业者之间可得性的外生差异,本文使用中国健康与营养调查(CHNS)的微观数据,研究社会保险这一基本公共服务在创业者和非创业者之间的相对可得性如何影响个人的创业决策。我们发现,如果城镇职工基本医疗保险对于非创业者更可得,将成为“创业枷锁”,降低个人选择创业的可能性;如果城镇职工基本医疗保险对于创业者更可得,将成为“创业催化剂”,提高个人选择创业的可能性。此外,我们发现,城镇职工基本医疗保险的“创业催化剂”作用对于来自中等收入家庭和小家庭的个人更为显著,而“创业枷锁”效应则更多地影响城镇职工基本医疗保险在薪酬体系中重要性更高的个体。本文认为中国的社会保险对于大众创业具有积极正面的影响。这对于我国社会保险制度的设计和促进经济高质量发展具有重要意义。     

论入世对中国社会保险立法的影响——兼论我国社保法之进一步完善

社保法出台前我国社会保险立法存在着层次低,碎片化;内容旧,不适时;重城镇,轻农村的特点。入世对我国社保法出台的影响主要体现在3方面:国际贸易形势变化推动立法;其他相关领域法律制度的变化影响社会保险立法;WTO规则影响我国社会保险行政管理体制方面立法。以养老保险为例,入世对我国社保法具体险种的影响主要体现在:促使国家立法扩大了养老保险范围;有利于推动建立多层次的养老保险体系;一定程度上推动了养老保险关系跨区域转移。社保法出台后,仍有需完善之处:法制化有待进一步深入;公平性有待进一步提高;民族性有待进一步发掘和确立。     

A gender perspective on the use of supplemental healthcare plans

Because employer‐provided health coverage represents the main source of health insurance for Americans and its costs for employees are rising, accurate knowledge about health coverage would seem to be crucial for making sound decisions on choosing the plans that best meet the specific needs of a family. However, previous research suggests that most employees have little understanding of the scope and monetary value, or even the existence of many components of their health benefit package. This paper re‐examines employees’ general financial learning efforts and knowledge level, and how they relate to participation in and importance attached to supplemental healthcare plans. We find that, while self‐directed financial learning and general financial knowledge significantly predicted plan participation and the importance attached to them, demographic factors, such as gender, age and job classification, dominated the supplemental healthcare decisions.     

Another look at the relationship between socioeconomic factors and the black-white health benefit inequality

This paper illustrates the black-white disparity in health benefit coverage and the socioeconomic variables-unemployment, income, and education. The health benefit disparity is strongly related to the disparity in underlying socioeconomic variables. Moreover, the time-series examination reveals that the change in white workers' health insurance coverage is largely determined by its year-to-year persistence and the labor market tightness (or the business cycle), while that of black workers is largely determined by the change in their earnings with a slight persistence. The effect of the change in annual earnings seems to dominate the effect of the labor market condition (unemployment rate) and other variables. Finally, although marginally significant, an increase in the attainment of higher education (college) has a positive effect on the black-white health benefit disparity.     

残疾人医疗保险政策比较分析——基于全国23省《关于促进残疾人事业发的展实施意见》比较

残疾人医疗保障是残疾人社会保障体系的重要组成部分,在保障残疾人医疗服务需求方面发挥着积极的作用。本文以残疾人医疗保险为主要研究对象,从残疾人医疗保险的覆盖面、保障范围、资金补贴、待遇给付四个方面比较分析了全国23个省、市、自治区《关于促进残疾人事业发展的实施意见》的有关政策,并从推动城乡均衡发展、全面提高保障水平、明确界定政府责任、合理划分各级财政责任等方面提出了完善我国残疾人医疗保险制度的政策建议。     

现代健康观对我国医改的启示

现代人的健康观是整体健康,医学重点已从诊断治疗转变为预防保健;健康是一种人力资本,用于医疗方面的开支属于＂劳动能力的修理费用＂;＂健康＂已被提到公民福利和国家义务的层面,对国民健康的保障能力要用＂可及性＂和＂可得性＂这两个指标作为标准。现代健康观启示我们：对医改应预防与治疗相结合、遏制医疗费用＂黑洞＂、统筹城乡医疗资源的均衡配置等。     

Health insurance provision and labor contracts for small firms

Healthcare reform in the USA requires all Americans to buy health insurance and businesses above a certain size to offer healthcare coverage to their employees by 2014. Understanding why some entrepreneurs do not provide employer-based health insurance is important and might help to solve future health insurance problems. Using two unique features which have not yet been discussed in the literature, namely, efficiency–wage theory and a compensation package of monetary wage and health insurance coverage, we provide here a theoretical foundation to why small firms are less likely to offer health insurance and are more likely to have employees with only a weak preference for acquiring health insurance. To reach the goal of health insurance coverage for all, one feasible solution is to allow small firms or individuals to pool together and pay a lower insurance premium.     

Focusing the catastrophic illness debate.

Unlike other aspects of the American health experience, there is a current void of information on expensive illness experiences. This paper is designed to fill this void and prrsents an analysis of the incidence and cost of catastrophic illness in the United States. Catastrophic illness is defined as an illness episode for which a person incurs $5,000 or more of medical expenses in a calendar year. This information is used to provide a framework for focusing the debate about catastrophic and national health insurance.     

电子商务平台下保险保障基金的研究

《保险保障基金管理办法》要求保险公司按照自留保费的某一固定比率缴纳基金费,这会激励保险公司从事高风险高收益的业务。本文通过保险公司和保障基金之间的博弈,展示在电子商务平台下保险保障基金的方式,并提出我国保险保障基金的缴费方式应当逐步采用电子商务平台。     

Health insurance coverage during the COVID-19 pandemic: The role of Medicaid expansion

Using data from the US Census Bureau's Household Pulse Survey, we analyzed the likelihood of loss of health insurance and enrollment into new health coverage during the early months of the COVID-19 pandemic. Loss of employment was associated with a significant increase in the likelihood of loss of health insurance and, specifically, an increase in the likelihood of employer-sponsored health insurance. However, individuals in Medicaid expansion states experienced a lower likelihood of loss of health insurance compared with individuals in nonexpansion states. At the same time, there was a statistically significant increase in Medicaid enrollment in expansion states, by 3.2 percentage points. Reemployment or acquiring employment was associated with a gain in health insurance coverage. During an economic downturn, eligibility, and coverage gaps leave many without affordable coverage options, and the pandemic will likely bring renewed attention to gaps in Medicaid coverage in nonexpansion states.     

Digital force majeure: The Mondelez case,insurance, and the (un)certainty of attribution in cyberattacks

Insurance companies typically secure themselves under force majeure exclusions against the unpredictability brought about by acts of war. If a company were to be attacked by a nation-state in physical space—hit with a missile or by aerial bombing—there would be fairly clear carve-outs so their insurance company could exclude such an incident from coverage. But the same is not always true in cyberspace. This article examines an extreme outlier case in the world of cyberattacks and insurance—that is, the losses suffered by the U.S.-based food and beverage company Mondelez as a result of the NotPetya cyberattack—and scrutinizes just how far force majeure exclusions can be applied in cyberspace. The article attempts to reveal the significance of the legal qualification of a cyberattack and its attribution to a state for insurance coverage in both general insurance policies, like the one the Mondelez case stemmed from, as well as in insurance policies targeted to cover cyber risk.     

Institutional Implications for Stakeholder Modelling: Looking at Institutions in a Centralised Economy

The United States has a population of three hundred million, according to latest Census Bureau estimates. Forty-seven million, including many non-citizens, are uninsured. That is, 16% of the total United States population has no health insurance. Millions more have inadequate coverage and are in danger of losing that. Private, corporatized medical coverage, structured by the insurance industry, is the basis for the current system. This article is an attempt to lay out the principal health care issues, to look at the alternatives and the cost of those alternatives, and to try to determine whether there is a particular regime that, despite its imperfections, is the best available to us now.     

Factors influencing financial strain on elderly people who live alone in the U.S.A.

The purpose of this study is to investigate factors influencing financial strain experienced by elderly persons living alone. Data for this study were drawn from a national survey conducted by Louis Harris and Associates, Inc. in 1986 at the request of The Commonwealth Fund Commission on Elderly People Living Alone to obtain a picture of the resources, problems, needs and preferences of elderly Americans who live alone. For this study, a path model was tested by using multiple regressions. Demographic factors (gender, age and race) were statistically significant factors indirectly influencing financial strain through one economic factor (income) and one health-related factor (physical limitations). Economic factors (income and health insurance coverage) and one health-related factor (physical limitations) were statistically significant factors directly influencing financial strain.