The determinants of the demand for private health insurance under Medicare

Since the introduction of Medicare in 1984, the proportion of the Australian population with private health insurance has declined considerably. Insurance for health care consumption is compulsory for the public health sector but optional for the private health sector. In this paper, we explore a number of important issues in the demand for private health insurance in Australia. The socio-economic variables which influence demand are examined using a binary logit model. A number of simulations are performed to highlight the influence and relative importance of various characteristics such as age, income, health status and geographical location on demand. A number of important policy issues in the private health insurance market are highlighted. First, evidence is provided of adverse selection in the private health insurance pool, second, the notion of the wealthy uninsured is refuted, and finally it is confirmed that there are significant interstate differences in the demand for private health insurance.     

Community rating and the market for private non-group health insurance

Prior research on adverse selection in health insurance markets has found only mixed evidence for adverse selection in group settings. We examine the impact of state community rating regulations enacted in the 1990s, which greatly limited insurers' ability to risk rate premiums, to determine if adverse selection is more evident in non-group insurance markets. Using data from large, national surveys we find evidence of a shift to a less healthy pool of non-group enrollees as a consequence of community rating. Community rating made healthy people 20 to 60% less likely to be insured by non-group health insurance; in addition, we found evidence that young and healthy people were 20 to 30% more likely to be uninsured as a result of community rating. We also find evidence that individuals in poor health were 35 to 50% more likely to be insured in the non-group market, but only limited evidence suggesting that persons in poor health were less likely to be uninsured. Our results are further supported by findings suggesting that non-group enrollees were sicker as a result of the community rating laws. Lastly, we find evidence suggesting that HMO penetration in the non-group market increased disproportionately in states that implemented community rating relative to states that did not.     

社会医疗保障改革的福利效应:以中国城镇为例

This paper evaluates Chinese public health insurance reform enforced since 1998 in terms of its welfare effects. We evaluate China health insurance reform since 1998 using the China Health and Nutrition Surveys (CHNS) data with relevant econometric models. The results of empirical studies show that the public health insurance status has significant impact on medical service utilization and expenditure. The reform reduces the positive effect of public health insurance on medical service utilization, meaning the utilization gap is narrowed after the reform. However, the empirical studies find that the medical expenditure growth of the sample individuals in urban China has not been controlled after the Basic Medical Insurance (BMI) program even if a new co-payment is enforced. Two main reasons for this failure might be the rising cost of medical service and physician’s severe moral hazard, while both of them come from no managed care mechanism for medical service providers in China.      

Premium subsidies and demand for private health insurance: results from a regression discontinuity design

This article investigates the impact of a private health insurance (PHI) subsidy on the demand for PHI in the context of the Australian health care system. In particular, we focus on the subpopulation of elderly Australians and exploit discontinuous increases to the universal ‘PHI rebate’ that occur when people turn 65 and 70 years. Using a regression discontinuity design, we find the policy has little effect on take-up of PHI and is best interpreted as a wealth transfer to elderly Australians who already have insurance.     

Long-term care insurance: a private sector challenge

Powerful demographic and economic forces are fueling the looming crisis related to providing medical and social services for the elderly. However, the American public remains largely oblivious to the devastating implications of the need for institutional or home-based care among senior citizens. Employers have a key role to play in resolving the situation by evaluating competing long-term care policies, endorsing the program of a strong carrier, assisting in offering the policies through payroll deduction and educating employees on the importance of selecting policy riders that best meet their evolving needs.     

保险资金运用的新途径：私募股权基金

中国保险业发展迅速,积累了大量的富余资金.但是,这部分规模庞大的资金的运用却不尽合理,存在着较为严重的"资金浪费".本文从我国保险资金运用的现状出发,论述了保险资金投资于私募股权基金的合理性,并结合当前我国实际情况,阐述了发展私募股权基金的有利条件以及限制性因素,最后提出发展私募股权基金的建议.     

The micro-firm health insurance hypothesis

The objective of this study is to investigate the ‘micro-firm health insurance hypothesis’, a hypothesis that the greater the percentage of domestic firms that are ‘very small’, i.e. have four or fewer employees, the greater the percentage of the US population that will be without health insurance. The focus of this study is based on the premise that very small firms (as defined), ‘micro-firms’, which constitute 58.6% of all private sector firms in the US, face bargaining-power, financial, and competitive constraints that tend to limit their ability to provide group health insurance benefits to their employees, with the result being that employees at very small firms are relatively more likely than employees at larger firms to be without a health insurance fringe benefit. Weighted Least Squares (WLS) estimates provide strong empirical support for the hypothesis.     

Solvency regulation in the property-liability insurance industry

This paper evaluates guaranty funds and solvency regulations. One main question addressed is how solvency regulations will benefit consumers. Many previous studies have found that most forms of solvency regulations do not have significant deterrent effects on insolvency. Even when solvency regulations are effective, they might still adversely affect consumers. This could happen because increasing the probability of solvency usually requires raising premiums. Therefore, it is interesting to see how regulators should design insurance regulations that benefit consumers. Insolvency of insurance firms provides a unique environment under which one is able to analyze the effects of solvency regulations and guaranty funds on the quality of insurance products and on consumers. This paper shows that guaranty funds are always desirable, but solvency regulations are of certain value only when they have the effect of protecting guaranty funds and alleviating the disincentives which they create.     

The impact of private hospital insurance on the utilization of hospital care in Australia

We use the Australian National Health Survey to estimate the impact of private hospital insurance on the propensity for hospitalization as a private patient. We account for the potential endogeneity of supplementary private hospital insurance purchases and calculate moral hazard based on a difference-of-means estimator. We decompose the moral hazard estimate into a diversion component that is due to an insurance-induced substitution away from public patient care towards private patient care, and an expansion component that measures a pure insurance-induced increase in the propensity to seek private patient care. Our results suggest that on average, private hospital insurance causes a sizable and significant increase in the likelihood of hospital admission as a private patient. However, there is little evidence of an expansion effect; the treatment effect of private hospital insurance on private patient care is driven almost entirely by the substitution away from public patient care towards private patient care. We discuss the implications for policies that aim to expand supplementary private insurance coverage for the purpose of reducing excess demand on the public healthcare system.     

Willingness‐to‐pay for parallel private health insurance: evidence from a laboratory experiment

Abstract Debate over the effects of public versus private health care finance persists in both academic and policy circles. This paper presents the results of a revealed preference laboratory experiment that tests how characteristics of the public health system affect a subject's willingness‐to‐pay (WTP) for parallel private health insurance. Consistent with the theoretical predictions of Cuff et al. (2010), subjects’ average WTP is lower and the size of the private insurance sector smaller when the public system allocates health care based on need rather than randomly and when the probability of receiving health care from the public system is high.     

老龄化社会和谐与保险行业创新

在建设和谐社会的过程中，必须面对我国人口老龄化的现实，从这层意义上说，建设我国和谐社会，也就是建设一个老龄化的和谐社会。因此，必须加快保险行业制度创新与产品创新步伐，主动适应社会发展要求，以保险业自身的创新及和谐进步来保障老龄化社会和谐建设。     

Scenario development for an evolving health insurance industry in rural India: INPUT for business model innovation

The article discusses the use of Delphi-based scenarios for the development of business model innovations in emerging markets. Motivated by insights from information processing and institutional theory we present a scenario development process combining a PEST (political, economic, socio-cultural, and technological) and a stakeholder approach. We exemplify its use for the evolving health insurance market in rural India and present how our approach can be used to study possible future developments relevant for business model innovations. Key insights are that NGOs might play a crucial role along with the regulatory support of the Government of India and significant advances in mobile payment technologies.     

Fiscal policy and private consumption behaviour: The Spanish case

In this article we analyse whether the Ricardian equivalence hypothesis is a valid approximation for Spains economic reality or whether there exist deviations from that situation which would be more in line with the conventional Keynesian perspective of the effects of debt on private consumption-savings decisions.Our aim is to contribute to the rather sparse empirical literature on the subject for the Spanish case. The analysis is based on annual aggregate data for Spain covering the years 1955 to 2000, and uses both the structural and the Euler equation approaches to test the neutrality proposition, and is thus to be considered as a generalization of foregoing work on the Spanish economy.The findings indicate that support for Ricardian equivalence is mixed, while we also find very little support for the Keynesian specification of consumption and fiscal policy.First revision received: March 2003 / Final version received: October 2003The authors wish to thank M. Ferré, J.M. González-Páramo, A. Marchante, P. Meguire, F. Pedraja, J.L. Raymond, J. Salinas and two anonymous referees for their helpful comments and suggestions on this paper. We also thank the participants in the V Encuentro de Economía Aplicada (Oviedo, Spain, June 2002) and the XVII Simposio de Análisis Económico (Salamanca, Spain, December 2002) for their comments. Any remaining defects are our responsibility. We also are grateful to the Institute for Fiscal Studies of Spain (Ministerio de Hacienda, Secretaría de Estado de Hacienda) for its financial support.     

Productivity dispersion: A case study

This paper studies productivity dispersion in a retail chain. We find that productivity is highly dispersed between the branches. Furthermore, productivity rankings are quite persistent. Accounting for employee skills and human resource management decreases the productivity dispersion only slightly. The results suggest that productivity dispersion is “real”.     

Floor-level premiums in private housing: the case of condominiums in Singapore

Using a sample consists of 3367 actual condominium sales transacted in resale market from May 2012 to April 2015 from the Singapore Urban and Redevelopment Authority, a hedonic pricing model is used to investigate for the presence of floor-level premiums in the private housing market, condominium, in District 23 of Singapore. Unit size, types of land tenure and the distance to the nearest mass rapid transit (MRT) station are also used as other independent variables. The estimated coefficient of each of these independent variables is statistically significant. Each of these independent variables also has positive estimated coefficient, suggesting that they have positive effects on condominium resale prices. Main findings are (a) there is a presence of floor-level premium; (b) the condominiums with a distance more than 400 m to the MRT station get higher resale prices; and (c) there is an increasing effect of floor level on condominium price.     

Cyclical industrial dynamics: The case of the global semiconductor industry

In this paper, we focus on firms' cyclical behavior in the global semiconductor industry. We demonstrate that these cyclical dynamics at the industry level differ from both the business cycles at the macro-economic level and the lengthy industrial technology life cycle. We discuss a range of possible causes of those cyclical industrial dynamics, including the general business cycles as well as industry-specific factors. Our study reports three stylized facts in relation to the cyclical industrial dynamics in the global semiconductor industry: first, the industry is more concentrated during the industry cycle downturns; second, the capital investment of the industry as a whole follows a ‘pro-cyclical’ pattern; and third, firms that pursued a ‘counter-cyclical’ capital investment strategy during the industry cycle downturn have reaped rewards during the subsequent cycle period. These facts suggest that cyclical industrial dynamics, especially the industry cycle downturns, play an important role in firm rivalry, strategic positioning and industrial growth.     

Price dispersion across US districts of entry

Price dispersion of US imports are investigated across US districts of entry. Markups explain about 31% of price dispersion, while marginal costs of production explain about 69%; effects of trade costs, for which we have actual data, are almost none.     

Price discrimination and price dispersion in a duopoly

This paper analyses the problem of price discrimination in a market where consumers have heterogeneous preferences both over a horizontal parameter (brand) and a vertical one (quality). Discriminatory contracts are characterized for different market structures. It is shown that price dispersion, i.e. the observed range of prices for each class of customers, increases almost everywhere as competition is introduced in the market.