Information Asymmetries and Risk Management in Healthcare Markets: The U.S. Affordable Care Act in Retrospect

This article critically examines the pertinent issues in ex ante and ex post moral hazard in healthcare markets, with the U.S. Affordable Care Act (ACA) as its focal point of inquiry. First, it compares the various types of information asymmetries resulting from the production, allocation, and utilization of health insurance. Second, it reviews the literature on adverse selection, moral hazard, and risk mitigation against which salient ACA reforms are analyzed. In contrasting conventional moral hazard from an alternative theory of welfare maximization, it suggests that healthcare (over)utilization cannot necessarily be considered wasteful, even if it ends up costing insurers more on a short-term basis. Costs and savings attributable to healthcare spending under the ACA will vary between the consumer, insurer, and regulator-subsidizer. Despite the ambiguities surrounding definitions of “health,” the challenge of containing inefficient moral hazard, and encouraging its desirable counterpart, lies in the tradeoffs that arise between consumer access to affordable and quality healthcare and the market competitiveness of health insurers. The new Trump administration will have to address these tradeoffs in repealing and replacing the ACA, particularly in light of escalating insurance premiums and deductibles, narrower provider networks, and technical implementation issues.     

UNEMPLOYMENT POLICIES IN AN ECONOMY WITH ADVERSE SELECTION

This paper studies the effects of unemployment policies in a simple static general equilibrium model with adverse selection in the labour market. Firms offer a contract that induces the self‐selection of workers. In equilibrium, all unskilled workers are screened out and some skilled workers are rationed out. It is shown that the provision of unemployment insurance raises involuntary unemployment by encouraging adverse selection, while unemployment assistance – or subsidy to unemployment – reduces involuntary unemployment. A simple efficiency wage model is also presented to show that either of the two policies reduces employment by taxing effort and subsidizing shirking. The key is whether the social role of unemployment is a sorting device or a worker discipline device.     

城镇低保户医疗服务利用和医疗保障制度设计对就医行为的影响——基于兰州、西宁和白银城镇家庭调查数据的分析

解决低保户看病难问题事关社会底线公平。文章基于2005年三个西北城市的17 690个样本对低保户就医问题展开实证研究,分析结果表明,由于中国医疗机构扭曲的激励机制和偏重住院报销的给付结构,低保户和非低保户两个群体都倾向于自己购药处理日常病患,而减少了门诊利用,经常面临生存危机的低保户由此拖延病情直至病情严重;个人账户既不能横向分散不同人群的疾病风险,也不能纵向分散个人在生命周期不同阶段的疾病风险;职工基本医疗保险能够显著增加中青年低保户对住院服务的利用,但对老龄低保户没有效果。     

Does health insurance reduce illness-related worker absenteeism?

The objective of this article is to examine whether having health insurance reduces illness-related absenteeism among older workers. A nationally representative sample of 1780 workers in the United States, aged 52–64, are drawn from the 2004–2006 Health and Retirement Study (HRS). Binary logistic regressions and censored Tobit models are estimated for workers’ likelihood of missing work days due to illness and the number of illness-related work days missed, respectively, while explicitly addressing the possibility of insurance-selection effects. The findings suggest that over a 12-month period, older workers without health insurance are as likely as insured workers to miss work days due to illness and there are no differences in the number of days missed between insured and uninsured workers. However, there is strong evidence that poor baseline health, onset of new diseases and longer hospitalization significantly increase an older worker's absenteeism at work. These results suggest that having health insurance does not affect illness-related absenteeism among older workers in the US. Future research examining other aspects of worker productivity, such as ‘presenteeism’, and the longer term effects of insurance on productivity can extend our understanding of the role of health insurance in the workplace.     

中国社会医疗保险道德风险刍议

中国社会医疗保险是由国家立法实行的一种非盈利性社会事业,关系到人们的生活健康、人力资源的保护增值与社会经济的有序发展,其要义不言而喻。然而,由于现行的医疗保险体制运行中的种种缺陷而引致的医保欺诈现象愈演愈烈,不仅给国家财政带来巨大负担,还给整个社会带来严重的信用危机。因此,医保道德风险的防范与控制已经刻不容缓。     

MIDDLEMEN AND THE ADVERSE SELECTION PROBLEM

We demonstrate that the coexistence of an uncoordinated search market and a middleman market may alleviate adverse selection in the trade of goods of different quality. Inability to conduct trade penalizes sellers of low‐quality goods disproportionately, encouraging them to trade via middlemen. A semi‐separating equilibrium exists when a sufficient number of sellers of low‐quality goods choose the middleman market to allow high‐quality goods to be successfully traded in the search market. The result may explain why a search market can survive alongside a coordinated market, a phenomenon characteristic, for example, of markets for used cars, housing and labour.     

A Simple Test of a Screening Procedure for Economics Faculty: A Note

This article discusses a graphical framework for classroom presentation of interactions between balance-of-payments flows and foreign exchange market equilibrium.     

Using a Simple Contest to Illustrate Mechanism Design

This article describes a simple classroom activity that illustrates how economic theory can be used for mechanism design. The rules for a set of contests are presented; the results typically obtained from these contests illustrate how the prize structure can be manipulated in order to produce a particular outcome. Specifically, this activity is designed to show how changing the prize structure can impact both the contestants’ average efforts and the effort level of the hardest-working contestant. The activity can be run in a 50-minute class, has instructions that fit on a single piece of paper, and, although it can be run in large classes, requires only six students.     

长期护理保险在山西的市场调查与发展对策研究

因家庭养老功能的弱化、护理费用的高涨及现有社会保障制度的不完善,使得长期护理保险自面世以来倍受人们的关注.这一保险产品目前在山西存在巨大的有效需求,而市场供给却为空白,巨大的供需缺口孕育着巨大的市场潜力.为此保险公司应结合山西地区发展实际,有针对性地改造现有产品,开发新产品,政府也应给予适当的财税优惠政策,并最终应将长期护理保险纳入社会保险范畴.     

Price Indexes for US Medical Care Spending, 1980–2006

We construct price indexes for medical care spending in the US economy for the period 1980–2006. Our indexes show slower price growth than the official deflator from 1987–2001, consistent with the fact that indexes that improve on the official statistics typically find slower price growth than the official indexes. However, the result is reversed for the 2001–2006 time period. We develop a decomposition that parses out the numerical differences in these indexes into three factors that are held constant in the official price indexes but are not in our indexes: changes in the type of provider supplying care, changes in the type of insurance plan used by the patients, and changes in the bundle of procedures used to treat patients. Our results suggest that using the official price measures may provide misleading conclusions about spending trends and productivity growth in this important sector over this time period.     

Adverse Selection in the Annuities Market and the Impact of Privatizing Social Security

The observation that few Americans purchase life annuities has often been attributed to adverse selection. A still unanswered question is whether observable price increases caused by adverse selection can be generated endogenously in a life cycle model. This paper calibrates a pure life cycle model for a characteristic US cohort and reproduces three stylized facts. Adverse selection increases annuity prices by 7–10 percent; the cost of adverse selection rises with the age of the annuitant; and the cost is smaller for females than for males. Social security privatization could reduce annuity prices by between 2 and 3 percent.     

IS THERE A ‘SECESSION OF THE WEALTHY’? PRIVATE HEALTH INSURANCE UPTAKE AND NATIONAL HEALTH SYSTEM SUPPORT

The purchase of private health insurance (PHI) as a means to partially supplement the National Health System (NHS) coverage is often regarded as a potential signal for a declining support for the NHS. Exploiting the fact that PHI is typically purchased by the most affluent, in this paper we test the so called ‘secession of the wealthy’ hypothesis whereby the likelihood of expressing ‘lack of support for the NHS’ increases with having supplementary PHI. Using empirical data from Catalonia, we draw upon an empirical strategy that circumvents an obvious simultaneity problem by estimating both a recursive bivariate probit as well as an IV probit. After controlling for insurance premium, household income and other socio‐demographic determinants, we find that the purchase of PHI reduces the propensity of individuals to support the NHS. We also find evidence that PHI is a luxury good and sensitive to fiscal incentives.     

Adverse Selection and Pigou Taxes

It id assumed that firms have different technologies, and that an environment protection agency knows which technologies exist, but not which is used by which firms. Neither the emissions of individual firms nor their total emissions are observable. The output of each individual firm, however, can be monitored without cost. Based on this information tax schemes are constructed which induce firms to produce the socially efficient output quantities. Conditions about cost functions are derived which ensure the existence of tax schemes which yield first best solutions.     

A Rent-Seeking Experiment for the Classroom

Abstract: Recent research has demonstrated that active learning techniques improve student comprehension and retention of abstract economic ideas such as rent seeking. Instructors can reinforce the concept of rent seeking with a classroom game, particularly one involving real money. The authors improve upon a game first introduced by Goeree and Holt (1999) and later expanded upon by Bischoff and Hofmann (2002). The authors present a version of the game in which students participate in an all-pay auction, risking their own money, and discover first hand the potential inefficiencies of rent seeking. The authors suggest extensions of the rent-seeking game, including discussions of social welfare effects, equity, campaign finance reform, tax simplification, and congressional reforms designed to limit the influence of rent seeking in the economy.