Anti-insurance: Analysing the Health Insurance System in Australia

This paper develops a model to analyse the Australian health insurance system when individuals differ in their health risk and this risk is private information. In Australia private insurance both duplicates and supplements public insurance. We show that, absent any other interventions, this results in implicit transfers of wealth from those most at risk of adverse health to those least at risk. At the social level, these transfers represent a mean preserving spread of income, creating social risk and lowering welfare – what we call anti-insurance. The recently introduced rebate on private health insurance can improve welfare by alleviating anti-insurance.     

Health and Welfare Measurement

The strengths of the welfarist framework are a reliance on empirical analysis and an explicit social evaluation framework. The focus of economists should be on applying developments in welfare measurement to the health sector.     

Do Consumers Purchase Too Much Health Insurance? The Role of Market Power in Health‐Care Markets

Several authors have suggested that consumers purchase too much health insurance in private markets. We readdress this issue within a model that combines excess health‐care demand due to health insurance with market power due to monopolistic production of health‐care services. We evaluate the market equilibrium in terms of consumer welfare and social welfare. The consumer welfare criterion suggests that in the market equilibrium consumers in fact purchase too much health insurance coverage. The social welfare criterion, in contrast, suggests that because profits of the health‐care industry are properly accounted for, consumers should purchase more insurance coverage than they choose to do in the market equilibrium.     

Ex Post Welfare under Alternative Health Care Systems

The implications of a societal aversion to inequality for the optimal structure of the health care system are studied. The agents are assumed to be ex ante identical, but to differ ex post in the state of their health. Inequality aversion is introduced by postulating a strictly concave ex post social welfare function. It is shown that the optimal public health care system allocates health care differently than would private health insurance; specifically, people who are relatively unhealthy with and without treatment receive more health care, and people who are relatively healthy with and without treatment receive less health care. The aggregate quantity of health care under the optimal public health care system can be either greater or smaller than under private health care insurance. If the public health care system is optimally designed, allowing agents to purchase supplementary private health care insurance cannot raise social welfare and is likely to decrease it.     

Health investment, saving, and public policy

Abstract.  This paper develops an overlapping‐generations model in which agents invest in health to prolong life in both working and retirement periods. It explores how unfunded social security with or without health subsidies affects life expectancy, economic growth, and welfare. In particular, by extending life at a possible cost of capital accumulation, health subsidies and a pay‐as‐you‐go pension can improve welfare, especially in the short run. JEL classification: I12, J14, J18, O11     

A Macroeconomic Analysis of Publicly Funded Health Care

In a general equilibrium, overlapping generations framework this paper examines how the tax-benefit system that underlies the U.S. health care system affects the well-being of different age groups, and the lifetime well-being of different socioeconomic groups, as well as society as a whole. We find that the optimal set and generosity of publicly funded health care programs is sensitive to the social welfare function and to the prices that various agents in society pay for medical care. Social welfare under the current financing system is also compared to alternative financing mechanisms such as Medical Savings Accounts.     

养老模式对健康的影响

中国人口老龄化趋势日益明显,这给养老、医疗、社会服务带来了巨大的压力。本文从居住模式和主要经济来源两个方面来界定中国老年人的养老模式,利用经济学方法,根据2002年、2005年中国老年人口健康状况调查数据(Chinese Longitudinal Healthy Longevity Survey,CLHLS),从实证角度,讨论了中国不同养老模式如何影响老年人的健康状况,并且分析了这一关系是否存在性别差异、城乡差异和年龄段差异。研究发现,养老模式是关系到中国老年人健康的一个关键因素,经济与居住均独立的老年夫妻有最明显的健康优势和主观幸福度优势,而依靠子女供养或政府补助的个人独居养老模式是最差的。这些经验发现可以为政府改善老龄人群的健康提供可靠的政策依据。     

Informal Payments in Developing Countries' Public Health Sectors

In many developing countries, public patients offer payments to their doctors outside the official payment channels. We argue that the fundamental reason for these informal payments is that formal prices cannot fully differentiate patients' various needs. We compare patient welfare and social efficiency when informal payments are allowed with the scenario when they are banned. Patient heterogeneity plays a central role in the comparison. Contrary to conventional wisdom, allowing informal payments always improves social efficiency when patients do not face income constraints. Moreover, allowing informal payments improves patient welfare if patients' willingness to pay differs significantly.     

A Simple Model of Health Insurance Competition

This study investigates competition between health insurance companies under different financing regulations. We consider two alternatives advanced in recent German healthcare reform discussions: competition by contribution rates (health contributions) and by fees (health premia). We find that contribution rate competition yields lower company profits and higher consumer welfare than premia competition when switching between insurance companies is costly.     

Health, Wealth, and Fairness

How much health should we have and how should it be distributed? This paper studies how to define social objectives for the allocation of health and income in a setting where individuals may differ in their preferences about health and consumption, earning ability, and health disposition. It is shown, on the basis of three simple ethical principles, that a reasonable social objective is to apply the maximin criterion to “full‐health equivalent” incomes. An application to the choice of the optimal health policy illustrates how this social objective may be used.     

Flows of Air Pollution,Ill Health and Welfare

We provide a theoretical framework for measuring welfare when pollution influences economic growth by impairing health and driving up defensive medical expenditures. We demonstrate the usefulness of our framework in practice by applying it to data from Swedish valuation studies designed according to the accounting principles suggested here. We estimate that the negative health effects of nitrogen dioxide emissions amount to 0.6% of GDP in Sweden. We also show that a corrective Pigouvian tax should internalize the direct disutility, reduced labor productivity, and increased healthcare expenditures caused by pollution. According to our calculations, harmful health impacts alone (excluding ecosystem effects) justify 65% of the current Swedish tax on nitrogen dioxide.      

Altruism,fertility, and the value of children: Health policy evaluation and intergenerational welfare

This paper accounts for the value of children and future generations in the evaluation of health policies. This is achieved through the incorporation of altruism and fertility in a “value of life” type of framework. We are able to express adults' willingness to pay for changes in child mortality and also to incorporate the welfare of future generations in the evaluation of current policies. Our model clarifies a series of puzzles from the literature on the “value of life” and on intergenerational welfare comparisons. We show that, by incorporating altruism and fertility into the analysis of the recent U.S. experience, the estimated welfare gain of a young adult from reductions in mortality easily doubles.     

Taking Chances: The Effect that Growing Up on Welfare Has on the Risky Behavior of Young People*

In this paper, we analyze the effect that growing up in a family with a history of welfare receipt has on young people's engagement in a variety of social and health risks. Unique administrative data matched to survey data for 18‐year‐olds and their mothers allow us to evaluate the effect of welfare receipt over the course of a young person's childhood. Much of the apparent link between family welfare history and risk taking disappears once we control for the effects of family structure, mothers’ own risk taking, and mothers’ investments in their children. We find no evidence that growing up on welfare causes young people to engage in risky behavior.     

城乡公共福利差距的影响因素研究

长期以来,我国财政投入明显偏向城市的政策使城乡基本公共福利存在着巨大差距。随着我国国民经济的快速发展,国家经济实力的增强,农村公共福利供给有所改善,但城乡在教育、卫生医疗、社会保障、基础公共设施和就业服务等方面存在很大差距。目前,在我国公共福利分配主要由地方财政承担的前提下,区域经济发展不平衡、各地区财力大小的不同等因素是导致我国城乡公共福利差异的主要原因。     

河北省建立农村社会保障制度成本效益分析

在现代化进程中，农村社会保障始终处于整个社会保障体系的边缘，农民长期游离于社会保障网络之外。改革的实践和理论都未能突破城市和农村两个独立的圈子，这造成了农村社会保障制度建设严重滞后的状况。建立农村社会保障制度必然要付出巨大的成本，包括推行成本和社会保障费用支出成本。但建立农村社会保障制度带来的社会效益也是非常明显，是难以用数据来衡量的。     

Pollution,Private Investment in Healthcare,and Environmental Policy*

In this paper, we demonstrate that, in a two‐period overlapping‐generations model, the relationship between environmental taxation and economic activity (output level and growth) has an inverted‐U shape when we take into account the detrimental impact of pollution on health and the individual decision of each working‐age agent to improve her health. We also demonstrate that the link between environmental tax and lifetime welfare also has an inverted‐U shape, and that a tighter environmental policy might enhance economic activity while reducing steady‐state lifetime welfare. Finally, we investigate the social optimum and the determinants of the optimal environmental tax.     

西方社会福利的三种分析框架

阐述了三种用于分析西方社会福利的架构,并结合实例进行了分析。在现代社会福利发展日趋复杂的情况下,可灵活使用此三种分析框架,有助于较深入了解各国社会福利的本质,使得各类福利服务之间的区别更加明晰。     

Public health insurance and optimal income taxation

If individuals differ not only in their inherent capacity to earn income, but also in the probability that they will fall ill, can subsidized public health insurance be justified on the grounds that it serves as an efficient tool to redistribute welfare? This question is analyzed in a model where the social welfare function is a weighted average of individual expected utilities, and where taxation is by a linear income tax. The answer is ‘yes’, except in certain special cases.     

增长失衡与政府责任:基于社会性支出角度的分析

There exists a kind of growth imbalance in China’s current development process, which is essentially characterized by the imbalance between the nation’s wealth and the people’s welfare. This paper points out that growth imbalance results mostly from insufficient government social spending on people’s welfare. Consequently, the government should shoulder the basic responsibility for the provision of education, health and social security, quicken the transformation of government expenditure structure and increase the share of social spending, in order to improve the people’s welfare and achieve the rebalancing of growth. The increase in social spending can also promote the accumulation of human capital, which will help the conversion of economic growth pattern and the realization of sustainable and healthy economic development. Translated from Jingji Yanjiu 经济研究 (Economic Research Journal), 2006, (10): 4–17