The effect of non-employment-based health insurance program on firm's offering of health insurance: Evidence from the social health insurance system in China

To achieve universal health insurance coverage, many developing countries have established a segmented health insurance system, which contains separate programs for workers with formal employment and residents without formal employment. A potential concern with such a segmented system is that the establishment of a non-employment-based insurance program may generate a disincentive for firms to provide health insurance benefits to workers. In this study, we empirically examine this crowd-out effect of a non-employment-based insurance program, the Urban Residents Basic Medical Insurance (URBMI), in China. Exploiting city-by-year variations in the roll-out process of the program and utilizing a unique administrative dataset on Chinese firms, we find that the enactment of URBMI reduced a firm's offering of an employment-based health insurance program by a statistically significant 0.94-1.29 percentage point. This crowd-out effect was stronger among domestic private firms, new firms, and firms that are individual-owned.     

The relationship between the markets for health insurance and medical malpractice insurance

This article evaluates the interdependence of medical malpractice insurance markets and health insurance markets. Prior research has addressed the performance of these markets, individually, without specifically quantifying the extent to which they are linked. Increasing levels of health insurance losses could increase the scale of potential malpractice claims, boosting medical malpractice losses, or could embody an improvement in medical care quality, which will reduce malpractice losses. Our results for a state panel data set from 2002 to 2009 demonstrate that health insurance losses are negatively related to medical malpractice insurance losses. An additional dollar of health insurance losses is associated with a $0.01–$0.05 reduction in medical malpractice losses. These findings have potentially important implications for assessments of the net cost of health insurance policies.     

The effect of self-employed health insurance subsidies on self-employment

This paper estimates the effect of an increase in the deductibility of health insurance premiums for self-employed individuals on the probability of being self-employed. Using a panel of tax returns from 1999 to 2004, we estimate fixed effects instrumental variable regressions for the probability of being self-employed, entering into self-employment, and exiting from self-employment. Our results suggest that this policy increased the probability of being self-employed by 1.5 percentage points, and increased the probability that a taxpayer would be primarily or exclusively self-employed by 1.1 and 0.35 percentage points respectively. These effects explain about a third to a half of the total increase in self-employment by these definitions over the sample period. We also find that the probability of entering self-employment increased by 0.8 percentage points and find suggestive evidence that the probability of exit decreased by 2.8 percentage points.     

Adverse selection in health insurance markets? Evidence from state small-group health insurance reforms

The past decade witnessed major changes in state laws governing the sale of health insurance to small employers. States took measures to restrict insurers' ability to distinguish between high and low-risk customers because of concern about the low rate of coverage among workers in small firms, the high prices in the small-group market and the absence of federal health reform. Using both individual-level and employer-level data, I test predictions about the effect of reforms on the employer-provided health insurance market. I estimate these effects for small firms and their workers using large firms and their workers in the same states, as well as large and small firms and their workers in non-reform states, as comparison groups. I find the reforms decreased the rate of employer coverage on average for workers in small firms by less than two percentage points. Within small firms, low-expenditure individuals experienced a larger decline in the rate of coverage through their employer, while the coverage rate of high-expenditure individuals rose slightly in some specifications. There is also evidence that comprehensive reforms increased premiums slightly for small employers, and that most of this increase was passed on to workers through higher employee contributions.     

Public sector health insurance trusts

Public sector associations have successfully developed and run employee health insurance pools for almost 30 years, providing members with savings and flexibility not available from commercial health insurance carriers. This article looks at the models, technical tools and governance philosophy that have contributed to their success in a very challenging business environment.     

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.     

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.     

The political sustainability of a basic income scheme and social health insurance

This paper studies within a two‐stage framework the political economy of a basic income (BI) and social health insurance (SHI) scheme. At the constitutional stage, individuals decide whether these schemes are implemented behind a veil of ignorance about their future income and risk type. This decision is made in anticipation of the outcome at the second stage in which individuals vote on the payroll tax to finance a BI and the contribution rate of a SHI scheme provided these schemes have been implemented. Depending on the amount of healthcare expenditure and the inequalities in income and risk, only a social health insurance scheme is implemented at the constitutional stage.     

The implications of job matching for retirement health insurance and leave benefits

This paper focuses on potential reasons for variations in benefit packages, in particular variations in the availability of retirement health insurance and leave. An important feature of our analysis is that we do not start with heterogeneity in workforces to explain fringe benefit differences across employers. It would be straightforward to say that differences across employers in fringe benefit packages simply represent differences in the preferences of their workforces. Rather, we focus on heterogeneity across employers as an important source of differences in fringe benefit packages. Preliminary evidence is found supportive of the predicted differences in the likelihood of such fringe benefits as retirement health insurance and leave based upon two variables–the extent of on-the-job training offered by the employer and the size of the employers. We also examine the implied links between these fringe benefits and such variables as average tenture and the proportion of the workforce that is female.