TAXES,HEALTH INSURANCE,AND WOMEN'S SELF‐EMPLOYMENT

I examine whether the availability of health coverage through the spouse's health plan influences a married woman's decision to become self‐employed. The Tax Reform Act of 1986 (TRA86) introduced a tax subsidy for the self‐employed to purchase their own health insurance. I test whether this “natural” experiment induced more women without spousal health insurance coverage to select into self‐employment. The most conservative difference‐in‐difference estimates based on an analysis of employed women indicate that the incidence of self‐employment among single women rose by 10% in the post‐TRA86 period, while a multinomial specification based on a sample of both employed and nonemployed women suggests that the increase was about 13%. (JEL J0, J3, I1)     

Why Subsidise Private Health Insurance?

What are the economic rationales for the public subsidy of private health insurance? Inducing more people to purchase private cover has the potential to create a positive fiscal externality, as it frees up the limited public beds and other public resources for people who cannot afford private health insurance. Investigating this quantitatively, based on short‐run demand estimates, we find that the subsidy cannot be justified on the basis of this externality effect alone. We estimate that the optimal subsidy is actually negative, that is, a tax on private health insurance premiums. On the other hand, the externality does finance some of the costs. We then consider a long‐run dynamic version, consistent with the government's stated rationales for the reforms. In this context, the subsidy might be justified, or at least largely offset, by the fiscal externality. We then discuss other rationales for a subsidy and implementation issues.     

中国城镇医疗体制改革前后的医疗融资比较

The health financing schemes is the foundation for the nation’s health care system, and the health insurance is a main one of some options for financing health care. This article compares two health care financing schemes in urban areas before and after the health reform, and targets at the impacts facing coverage groups, the financing methods, decision-making power or financial management (i.e. the distribution of responsibility and rights between the central government and local governments), payment arrangement and cost containment of health care financing mechanisms. Prior to reform, the equal access and universal coverage of health care services were implemented through the employment-based health insurance in a state-controlled economy with guaranteed full employment and central control in general. The decentralization reforms of fiscal system and tax sharing reforms disrupts the past economic foundation, the rebuilding health insurance system which still benefits the employed bring the limited coverage. The next trend is to make transition from health insurance covering only part of the employed population to what are in effect national health services covering the whole population in urban areas.      

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.     

Employee cost-sharing and the welfare effects of flexible spending accounts

Flexible Spending Accounts (FSAs) subsidize out-of-pocket health expenses not covered by employer-provided health insurance, making health care cheaper ex post, but also reducing the incentive to insure. We use a cross section of firm-level data to show that FSAs are indeed associated with reduced insurance coverage, and to evaluate the welfare consequences of this shift. Correcting for selection effects we find that FSAs are associated with insurance contracts that have coinsurance rates about 7 percentage points higher, relative to a sample average coinsurance rate of 17%. Meanwhile, coinsurance rates net of the subsidy are approximately unchanged, providing evidence that FSAs are only welfare neutral if we ignore distributional considerations and the deadweight loss of the taxes necessary to finance the subsidy. These results also suggest that FSAs may explain a significant fraction of the shift in health care costs to employees that has occurred in recent years.     

Tax incentives and the decision to purchase long-term care insurance

This paper studies the impact of the tax incentive prescribed in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on individuals' long-term care insurance purchasing behavior. Using data from the Health and Retirement Study, we find that the tax incentive in HIPAA increased the take-up rate of private LTC insurance by 3.3 percentage points, or 25%, for those eligible. Despite this seemingly strong response, our results imply that even an above-the-line tax deduction would not increase the coverage rate of seniors beyond 13%, indicating that tax incentives alone are unlikely to expand the market substantially. We also present, to our knowledge, the first estimate of the price elasticity of demand for LTC insurance of around ? 3.9, suggesting that demand is highly elastic at the current low ownership rate. Finally, we evaluate the net fiscal impact of the tax incentive and find that the tax deductibility of LTC insurance premiums leads to a net revenue loss for the government, as the reduced tax revenue from granting the tax incentive exceeds the savings in Medicaid's LTC expenditures.     

TAXING HEALTH INSURANCE: HOW MUCH IS ENOUGH?

The Reagan administration has again proposed in 1984 to limit the tax exemption on health-insurance premiums. Objectives of the proposal are to curtail rising health costs by reducing insurance coverage—and hence medical-care use—and to raise revenues to offset the large federal deficit. The change would have little effect on either dimension. Most likely, consumer response would reduce dental, drug, and eyeglass insurance, but would leave coverage for hospital and doctor care—the most bothersome health-cost sectors—essentially unaffected. Larger tax changes which are structured differently possibly could reduce health costs dramatically and raise up to $27 billion a year in new tax revenues.     

Efficiency of health care delivery systems: effects of health insurance coverage

Health insurance expansions may increase the demand for care-creating incentives for health systems to increase input consumption. The possibility remains that added capacity and personnel will have little effect on health outcomes, decreasing the technical efficiency of health care delivery systems. We estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1.3 percentage points, translating into approximately 50 billion dollars in additional health expenditures. This finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur.     

URBANIZATION AND HEALTH CARE IN RURAL CHINA

Strong economic growth has led to remarkable urbanization in China. Using the China Health and Nutrition Survey, this study provides the first empirical evidence documenting the impact of urbanization on rural health care and insurance. The primary finding is that urbanization leads to a significant and equitable increase in insurance coverage, which in turn plays a critical role in access to care. In addition, adverse selection exists in the demand for insurance. Income is also a significant determinant of insurance coverage. This study concludes that urbanization can help make substantial changes in rural health care and insurance status.     

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.     

The demand for preventive medical care

The idea that people invest in health capital is an essential part of models of the demand for health, but the investment motives behind health decision are often obscured by other factors. This empirical paper investigates the demand for adult preventive medical care, where the investment motives are relatively clear cut. Several important results demonstrate the usefulness of the approach. First, the analysis finds that annual use of two preventive services decreases with age. Although not the only plausible explanation, the results are consistent with individuals shortens over the lifecycle. Second, schooling is found to be an important determinant of demand, with the more educated much more likely to use the services. Neither lifecycle nor schooling effects are consistently found in studies of the demand for culture care. Finally, the empirical analysis also provides additional evidence on the responsiveness of the demand for preventive care to change in insurance coverage, an important issue for health policy.     

GROWTH OF U.S. HEALTH CARE SPENDING

The share of output allocated to health care has more than doubled since 1960. This paper models the growth in this ratio and finds that the increase in the elderly population whose medical spending is heavily subsidized is a key factor behind this growth. Technological change is a symptom of the medical market structure rather than a cause of medical spending growth. The econometric model in the analysis here is based on a micro model composed of two groups. The first group is a healthier group that makes income transfers in order to finance the sicker group's health insurance premiums. In this model, a technical constraint places an upper bound on the healing ability of the medical good. This upper bound changes through an unobservable endogenous process. Estimating the health care model involves using estimation techniques that bypass the need to make any a priori assumptions about the functional form of the regressions or about the distribution of the residuals. The results suggest that technical change cannot indefinitely induce health care spending growth if no subsidies exist that provide full health care coverage with premiums fully paid by the subsidy. If subsidies provide full coverage and pay the entire premium, then new technical discoveries can induce constantly expanding medical expenditures.     

The Macroeconomic Consequences of Financing Health Insurance

Employer-financed health insurance systems like those used in the United States distort firms’ labor demand and adversely affect the economy. Since such costs vary with employment rather than hours worked, firms have an incentive to increase output by increasing worker hours rather than employment. Given that the returns to employment exceed the returns to hours worked, this results in lower levels of employment and output. In this paper, we construct a heterogeneous agent general equilibrium model where individuals differ with respect to their productivity and employment opportunities. Calibrating the model to the U.S. economy, we generate steady state results for several alternative models for financing health insurance: one in which health insurance is financed primarily through employer contributions that vary with employment, a second where insurance is funded through a non-distortionary, lump-sum tax, and a third where insurance is funded by a payroll tax. We measure the effects of each of the alternatives on output, employment, hours worked, and wages.     

Tax effects on job search,training, and work effort

The conventional economic model of labour supply is extended to include job-search activity or off-the-job training. For most tax and transfer policies, the slope of the labour-supply schedule affects the direction of search incentives relative to laissez faire. Only the income subsidy exerts unambiguously negative effects on search activity. A proportional income tax offers greater search incentives than an equal-revenue progressive income tax. The positive marginal subsidy range of an earnings subsidy evokes more search than an equal-transfer wage or income subsidy, but ranking of the latter two programs is ambiguous. Work and search effects are combined in an analysis of the impact of each policy on workers' gross market earnings.     

Private insurance subsidies and public health care markets: evidence from Canada

In this study I examine the effects of government subsidies to employer-provided health insurance on the decision to purchase insurance, and on utilization of publicly funded health services. Using unique variation in tax subsidies across Canadian provinces as an instrument, I estimate the effects of these subsidies on the demand for supplemental health insurance and their extended effects on the decision to use publicly-funded health services. My results show that government subsidies through tax exemptions have significant effects on the decision to purchase insurance. Furthermore, additional insurance policies lead to moral hazard in the use of publicly funded health services. JEL Classification: H2,H4, I1     

中国老人医疗保障与医疗服务需求的实证分析

本文采用2005年中国老年健康长寿调查数据库(CLHLS)22省调查数据,建立了中国65岁以上老年人群的医疗服务需求模型,实证分析了医疗保障对老人医疗服务需求的影响。本文的主要结果如下:第一,医保制度对老人医疗服务的影响主要表现在提高就医程度,而非就医选择行为的改变,同时医保制度又明显地促进了老人及时就医率。第二,医保制度对减轻老人家庭医疗负担具有显著作用。第三,城镇医保和公费医疗所发挥的作用明显高于其他保险形式。本文的基本判断是,国家医保政策在改善中国老人医疗服务利用和减轻老人家庭医疗负担方面确实发挥了良好的积极作用,并且更多惠及了就医必要性更大的老年人群,从资源配置角度看是提高效率的。因此,进一步推进全民基本医疗保障制度的建设不仅是国家惠及全民的医改重任,也是中国医疗卫生应对老龄化挑战的有效选择。     

A Critique of the Private Health Insurance Regulations

The private health insurance sector is one of the most regulated sectors in Australia. The Private Health Insurance Incentives Scheme, along with community rating, is intended to make private insurance equitable, profitable and popular. We argue that the subsidy to health insurance ought to be a very effective tool for increasing insurance–but it was ineffective because community rating was ineffective. Using data from the Household Expenditure Survey we find that despite community rating rules which prohibit age‐adjusted premiums, young adults paid considerably less for their insurance than older adults. We conclude that insurers circumvented community rating through plan design, screening older consumers into more expensive plans. We also find that the penalty of 2 per cent per year for delaying insurance, introduced as part of the lifetime cover plan, is too low to be effective. We reflect on the New Zealand experience, where a completely deregulated insurance industry continues to be profitable and enjoys similar rates of coverage to those of Australia, and we ask whether Australia too could not benefit from complete deregulation.     

Health subsidies,prevention and welfare

People value healthy ageing but may underinvest in health-improving preventive care. This arises when they ignore the beneficial effects of healthy ageing on public health expenditures and hence on the tax burden of future generations. This health externality justifies public intervention. We build an overlapping generations model with a government subsidizing investment in health by the young generation and paying the health care costs of the old generation. We find that the welfare-maximizing subsidy rate depends positively on the health externality and the size of health care costs, and negatively on the discount factor. The subsidy rate should therefore be high when prevention is cost-effective and when the population is careless about the future. Moreover, the welfare-maximizing subsidy rate is lower than the health-maximizing rate but higher than the capital-maximizing rate. This underlines the trade-off for a policy maker between health and economy.     

碳税再循环分配效应演化博弈研究

促进企业低碳生产和消费者绿色消费,是在社会经济高质量发展条件下实现碳达峰、碳中和目标的充分保障。构建由地方政府、企业和居民多主体构成的碳税再循环系统,结合当前中国国民收入水平和低碳经济发展状况,利用三方演化博弈理论研究多主体策略选择的演化过程,并应用Python程序设计语言对整个演化过程进行数值仿真,探究地方政府不同的补贴策略、产品的收入需求弹性和需求价格弹性等变量对碳税再循环分配效应的影响。研究结果表明：在低碳补贴和收入补贴策略之间,地方政府实施前者更能够促进居民绿色消费和企业低碳生产,但实施后者有利于改善收入不平等问题,同时产品的收入需求弹性和需求价格弹性差异也会影响地方政府碳税返还政策的效果。