Supplementary private health insurance and health care utilization of people aged 50+

Does supplementary private health insurance (PHI) coverage influence health care utilization in countries where the coverage ratio with public health insurance is high? I estimate this effect using the Survey of Health, Ageing and Retirement in Europe. Handling the potential endogeneity of supplementary insurance coverage and the large fraction of zero observations in the utilization models influences the empirical results. I show that the effect of PHI coverage on inpatient and outpatient care utilization is not trivial even in countries with generous public health funding. The main finding is that supplementary PHI coverage increases dental care utilization, but decreases the visits to general practitioners. Private insurance is estimated to have little and insignificant influence on the utilization of inpatient care and outpatient specialist care. The magnitude of the effect of supplementary PHI on health care utilization varies with the characteristics of the health care systems.     

Fiscal position and the financing of productive government expenditures: an application to Latin America

Government spending on public infrastructure, education, and health care can increase economic growth. However, the appropriate financing depends on a country’s fiscal position. We develop a two-sector endogenous growth model to explore how variations in the composition and financing of government expenditures affect economic growth. We find that, when tax rates are moderate, funding public investment by raising taxes may increase long-run growth. If existing tax rates are high, public investment is only growth enhancing if funded by restructuring the composition of overall public spending. Additionally, public investment that is debt financed can have adverse effects on long-run growth due to the resulting increases in interest rates and debt-servicing costs.     

Government response to increased demand for public services: The cyclicality of government health expenditures in the OECD

The more that health care expenditures are financed by general taxation, the greater the discretion governments are likely to exercise when timing increases in health care expenditures. Vote-maximising governments time increases in health care expenditures to occur in economic upturns, when voters are not as aware of the required increase in taxation. In recessions, they have an incentive to sustain expenditures on health care by diverting expenditures from other public expenditure programmes that voters perceive as low priority. In this way, government pursuit of a political agenda is likely to exert a systematic influence on the cyclicality of government expenditure. Predictions are tested with reference to the cyclicality of government health expenditures, for a sample of OECD countries from 2000 to 2012.     

The U.S. health care expenditure: evidence from 2001 to 2009

This study utilizes state-level data from 2001 to 2009 to estimate the impact of the 2007 financial crisis upon health care expenditures. Higher death rates are consistently found to have a positive and statistically significant impact on health expenditures. While mental health and COPD are not generally found to impact expenditures, increases in the percentage of the population diagnosed with cholesterol and obesity tend to increase health expenditures. Increases in health expenditures slowed considerably after the financial crisis. Even though recessions (high unemployment rates) are generally found to have a positive impact on health expenditures, the post-financial crisis time period is estimated to have much lower health expenditures than in other time periods. Our results can be used to give insight into the conditions under which the slower rate of increase in health expenditures can be expected to increase. More research will be needed to be able to more completely explore not only the reasons for these changes in health expenditures but also whether they are likely to continue into the future.     

Public provision of health insurance and aggregate saving in an overlapping generations model with endogenous health risk: The South Korean case

This paper examines the effect of expanding public health insurance in South Korea on medical expenditures and aggregate saving using an overlapping generations model with endogenous health risk. South Korea had a substantial underinsured population, which is aging rapidly. Higher public health insurance benefits reduce individual medical expenditure and health risks but lead to a modest decline in individual and aggregate saving. Even after the expansion, the medical care coverage remains incomplete, and the elderly face a substantial risk of out-of-pocket medical expenditures.     

INEQUALITY IN MORTALITY OVER THE LIFE COURSE: WHY THINGS ARE NOT AS BAD AS YOU THINK

Recent research shows increasing inequality in mortality among middle‐aged and older adults. But this is only part of the story. Inequality in mortality among young people has fallen dramatically in the United States converging to almost Canadian rates. Increases in public health insurance for U.S. children, beginning in the late 1980s, are likely to have contributed. (JEL D63, I18, I38, J1, J3, J18)     

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.     

Infant mortality,relative income and public policy

Do health outcomes depend on relative income as well as on an individual's absolute level of income? We use infant mortality as a health status indicator and find a significant and positive link between infant mortality and income inequality using cross-national data for 93 countries. Holding constant the income of each of the three poorest quintiles of a country's population, we find that an increase in the income of the upper 20% of the income distribution is associated with higher, not the lower infant mortality. Our results are robust and not just caused by the concave relationship between income and health. The estimates imply a decrease in infant mortality by 1.5% for a one percentage point decrease in the income share of the richest quintile. The overall results are sensitive to public policy: public health care expenditure, educational outcomes, and access to basic sanitation and safe water can explain the inequality–health relationship. Thus, our findings support the hypothesis of public disinvestment in human capital in countries with high income inequality. However, we are not able to determine whether public policy is a confounder or mediator of the relationship between income distribution and health. Relative deprivation caused by the income distance between an individual and the individual's reference group is another possible explanation for a direct effect from income inequality to health.     

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.      

RISK ATTITUDES AND THE DEMAND FOR PRIVATE HEALTH INSURANCE: THE IMPORTANCE OF 'CAPTIVE PREFERENCES'

ABSTRACT ** :  Captivity to a mainstream public insurer, is hypothesized to constrain the choice of purchasing private health insurance, by influencing risk attitudes. Namely, risk averse individuals are more likely to stay captive to the National Health System (NHS). To empirically test this hypothesis we use a small scale database from Catalonia to explore the determinants of private health insurance (PHI) purchase under different forms of captivity along with a measure of risk attitudes. Our results confirm that the captivity corrections are significant and can potentially bias the estimates of the demand for PHI. Risk aversion increases the probability of an individual being captive to the NHS. The latter suggests a potential behavioural (or cultural) mechanism to isolate the influence of risk attitudes on the demand for PHI in publicly financed health systems.     

Policy induced increases in private healthcare financing provide short-term relief of total healthcare expenditure growth: Evidence from OECD countries

Healthcare reforms have long been advocated as a cure to the increasing healthcare expenditures in advanced economies. Nevertheless, it has not been established whether a market solution via private financing, rather than public financing, curb aggregate healthcare expenditures. To our knowledge, this paper is the first that quantifies the impact of reforms that significantly increases (decreases) the private (public) share of healthcare financing on total healthcare expenditures relative to income in 20 OECD countries. Our reform measure is based on structural break testing of the private share of total expenditures, and verification using evidence of policy reforms. To quantify the effect of these reforms we apply Propensity Score Matching and Inverse Probability Weighted regression analysis. Over a 5-year evaluation period the reforms lead to an accumulated cost saving 0.45 percentage points of GDP. The yearly effects of the reforms are largest in the first years in the post-reform period and decreases in size as a function of time since the reform. Our findings suggest that the investigated healthcare reforms have a relatively short-lived effect on aggregate health spending relative to GDP. The findings are robust to various sensitivity tests.     

Nonlinear relationship between health care expenditure and its determinants: a panel smooth transition regression model

This paper employs a panel of 16 OECD countries over the period 1975–2009 to reexamine the health care expenditure (HCE)-income relationship by considering a lagged ratio of public expenditures on health as the transition variable in panel smooth transition regression (PSTR) models. PSTR models can capture the heterogeneity of any individual country, provide more detailed information for policy makers of an individual government, and resolve the insufficient observations problem that frequently appears in annual country-level data. Our empirical results indicate that the relationship between HCE and its determinants, including income, time (trend), and age structure variables, is nonlinear and varies with time and across countries. The time (trend) variable—a proxy for technical progress in health care—has a non-linear impact on HCE. Ignoring the variables—technological change of health care and age structure of population—will result in over-estimates of the income elasticities of HCE. Moreover, HCE behaves as a necessity good, and the income elasticity increases when the five-period lagged ratio of public expenditures on health increases. Clearly, the ratio of government financing on health plays an important role in influencing HCE.     

Social security, public education and the growth-inequality relationship

We study how the relationship between economic growth and inequality depends upon the levels of funding of two of the largest government programs, public education and social security. We do this in the context of an overlapping generations economy with heterogeneous agents where the government collects a tax on labor income to finance these programs. We show that in our model an increase in government spending on social security reduces income inequality and can have a non-monotonic effect on growth. When the initial level of social security funding is low, as is the case in most poor economies, then its increase will enhance growth. When its funding level is high as is typical for developed countries, we show that its further increase can slow down growth while reducing income inequality. These results obtain regardless of whether the increase in social security funding is financed by a tax increase or by cutting the public education budget. We also find that the effects of increasing the level of public education expenditures or the overall size of the government budget (holding the budget composition fixed) are characterized by similar non-monotonic growth-inequality relationships.     

Tropical cyclones and post-disaster reconstruction of public infrastructure in developing countries

When natural disasters destroy public capital, these direct losses are exacerbated by indirect losses arising from reduced private output during reconstruction. These may be large in developing countries that lack access to external finance. We develop a general equilibrium model of a small open economy that highlights the relation between public infrastructure and private capital, to examine the effects of natural disasters and alternative reconstruction paths. Calibrating the model to data from the Caribbean Catastrophic Risk Insurance Facility (CCRIF), we examine alternative post-disaster financing mechanisms including reserve depletion, budget reallocation, sovereign disaster insurance, debt and taxation. Disaster insurance is shown to play a limited role in financing reconstruction, while budget re-allocations are potentially damaging especially if they cannibalize operations and maintenance expenditures. Absent donor grants or concessional borrowing, tax financing – where feasible – remains the least damaging financing instrument, particularly if the country risk premium on external debt is high.     

Is smoking a fiscal good?

Even though smokers incur higher health expenditures than nonsmokers of the same age, smokers have significantly higher mortality rates, so the expected lifetime health expenditure for a smoker is actually lower than for a nonsmoker. Because of this fact, some politicians and policy-makers have argued that society might actually be better off promoting smoking rather than discouraging it. We consider this argument in a general-equilibrium model where health expenditures are paid for by a single-payer health-care system financed by taxes. Because the percentage increase in the tax base is larger than the percentage increase in health-care expenditures, the elimination of smoking actually decreases the budget-balancing health-care tax rate.     

Environmental Funds,Public Abatement,and Welfare

This paper addresses some features of environmental funds that the government uses to finance public abatement with pollution tax revenue or tariff revenue. I find that when the pollution tax rate and the tariff rate are jointly chosen optimally, then the optimal pollution tax rate is higher than the Pigouvian tax rate under public abatement financed by tariff revenue, and lower when public abatement is financed by pollution tax revenue. Furthermore, I show that the optimal tariff rate is positive regardless of which tax revenue is used to finance public abatement. These results are relevant for countries where the government seeks revenues earmarked for the financing of environmental funds.     

Income, income inequality, and health: Evidence from China

This paper tests using survey data from China whether individual health is associated with income and community-level income inequality. Although poor health and high inequality are key features of many developing countries, most of the earlier literature has drawn on data from developed countries in studying the association between the two. We find that self-reported health status increases with per capita income, but at a decreasing rate. Controlling for per capita income, we find an inverted-U association between self-reported health status and income inequality, which suggests that high inequality in a community poses threats to health. We also find that high inequality increases the probability of health-compromising behavior such as smoking and alcohol consumption. Most of our findings are robust to different measures of health status and income inequality. Journal of Comparative Economics 34 (4) (2006) 668–693.     

Does High‐skilled Migration Affect Publicly Financed Investments?

This paper analyzes the interaction between migration of high‐skilled labor and publicly financed investment. We develop a theoretical model with multiple, ex ante identical jurisdictions where individuals decide on education and subsequent emigration. Migration decisions are based on differences in net income across jurisdictions which may occur endogenously. The interaction between income differences and migration flows gives rise to the potential of multiple equilibria: a symmetric equilibrium without migration and an asymmetric equilibrium in which net income levels differ among jurisdictions and trigger migration flows. In the former equilibrium, all jurisdictions have the same public investment level. In the latter one, public investment is high in host economies of skilled expatriates and low in source economies. We empirically test the hypothesis that emigration rates are negatively associated with publicly financed investment levels for OECD countries.     

State Variations in Hospital Expenditures: An Ecological Approach

Hospital expenditures vary across states both in terms of the levels and growth rates. Economic status, insurance coverage (or lack thereof), health risk factors, and demographic factors are used to explain these differences. Interestingly, the prevalence of poverty rates across states does not seem to be a good predictor of differences in hospital expenditures but the percent without health insurance does relate to higher hospital expenditures, when the factors listed above are all considered. Policy discussions about universal health insurance may be missing a point if better health care coverage resulted in lower hospital costs.

Does the ban on trans-fats improve public health? In search of the optimal policy response

This paper examines the contribution of the regulatory ban on trans-fats and voluntary trans-fat regulation to public health outcomes for a sample of 39 countries in the period 1990–2015. To this end, we exploit within-country variation in trans-fat legislation to estimate the impact of the trans fat ban on cardiovascular mortality and obesity rates. Our difference-in-difference estimates indicate modest and beneficial effects of the trans-fats ban in reducing cardiovascular mortality and obesity rate. We find that the ban on trans fats tends to decrease the mortality rate attributed to cardiovascular diseases while the effects on the obesity rates are significant, especially among children and adolescent age group. By contrast, voluntary regulation of trans fats and demand-driven regulatory strategies are generally not associated with a marked drop in the obesity rate. By controlling for country-specific time trends, we show that the estimated mortality- and obesity-related impact of the ban is not driven by pre-existing trends, and does not affect non-cardiovascular mortality rate.