The Impact of the Rhode Island Catastrophic Health Insurance Plan

Under Rhode Island's statewide Catastrophic Health Insurance Plan (CHIP) in effect since January, 1975, and similar to the Long-Ribicoff National Health Insurance Proposal, Rhode Island pays catastrophic medical expenses over and above a “personal resource payment” (out-of-pocket expenses) that varies with income and amount and type of health insurance coverage. Those with qualified plans (plans providing more services) pay less out-of-pocket. Benefits accrue mainly to some middle income households. CHIP has increased demand for and prices for health insurance with qualifying coverage, and utilization of medical care. Similar impacts on a larger scale may be expected from any national health insurance program.     

Energy,Insurance, and Health: Viewpoints of a Microeconomist

Abstract

This contribution reviews developments in the microeconomic analysis applied to three fields that are rarely considered in combination – energy, insurance, and health – focusing on four themes. First, it finds that stocks are crucial not only in energy but also motivate (in the guise of assets) demand for insurance coverage, as well as healthcare services designed to maintain one’s stock of health. Second, however, the three fields strongly diverge in terms of their industry structure. While oil and, until recently, electricity are vertically integrated, healthcare has been the leading example of a cottage industry, with private insurance in between. Third, the structure of innovation also differs. In energy and private insurance, process and organizational innovation prevail; in healthcare, it is product innovation, meaning new characteristics at higher cost, facilitated by health insurance. Finally, government regulation impinges on all three industries.     

Perceptions of the Ethicality of Consumer Insurance Claim Fraud

It was proposed that ethical evaluation of insurance claim padding behavior would be affected by characteristics of the policyholder, insurance agent, and company. These three factors were manipulated in written scenarios and the premise was tested in a factorial experimental design. No significant support was found for an effect of any of the three factors on ethical perceptions of claim padding. However, females found claims padding to be significantly less ethical than males. Given a claim scenario where the actual loss was $500 and the claimed amount was $3000, subjects awarded an average of $986.91 on the claim. Many respondents were willing to compensate victims for intangible losses as well as tangible losses.     

Understanding the Impact of Health Reform on the States: Expansion of Coverage through Medicaid and Exchanges

The Affordable Care Act (ACA) expands Medicaid coverage and creates subsidized state health insurance exchanges. The implementation of the ACA will impact the states and consequently the state residents differently. We discuss the factors contributing to the variation in uninsured rates and the Medicaid population, and we predict that these underlying economic, demographic factors and state policies will continue to affect health insurance coverage. Using data from the March 2010 Current Population Survey (CPS), we examine health care coverage at the state level prior to the ACA and forecast the percentage of state residents eligible for expanded Medicaid and the exchanges. Our results suggest the percentage of state population eligible for expanded Medicaid and subsidized exchanges will vary considerably, especially for adults. Further, we show that current state Medicaid eligibility rules, the percentage of employers offering health insurance and poverty rates will continue to shape the variation in projected health insurance coverage across the states. Finally, we discuss the potential impact of the Supreme Court decision that allowed states to opt‐out of Medicaid expansion.     

Health insurance and job creation by the self-employed

Health insurance is regulated at the state level by the use of state-mandated health benefits. These are regulations issued by the state that mandate minimum levels of certain benefits as part of policies offered, e.g., drug abuse and alcohol treatment services, treatment for mental illnesses, etc. In this paper, we evaluate the impact of state health insurance mandates on job creation by small firms using data from the Survey of Income and Program Participation (SIPP) dataset for the period 1993–1995. Results from an ordered probit regression indicate that, the larger the number of mandates in a state, the lower the probability that a self-employed person will be a significant employment generator. These results hold when we consider both the sum of mandates as well as a cost-weighted measure of the most expensive mandates.     

Health Insurance,Job Lock,and the Supply of Self‐Employment

Unlike most wage earners, self‐employed Americans have limited access to health insurance and face higher costs. Thus, social commentators and policymakers argue that many potential entrepreneurs are “locked” into their current jobs for fear of losing their health coverage even though they could be more productive in self‐employment. Using a large data set for the period 2000–2008, we find the availability of employer‐provided health insurance to be negatively correlated to the likelihood of self‐employment in the long run, but the effect to be mediated by individual and family health status. However, we find employer‐provided health insurance to have no significant effect on the probability of switching in the short run. Finally, we find differences in the magnitude of the effects between our samples of husbands and wives.     

关于大学生医疗保险体系完善的研究分析

当前,大学生医疗保险体系存在的主要问题是大学生对医疗保险常识以及各项权利和义务的理解欠缺,高校对大学生的医疗理赔行为缺乏有效的支持与帮助,大学生参保积极性不高、医保使用率较低。完善大学生医疗保险体系,应坚持以社会保险为主,商业保险为辅,构建多层次医疗保险体系,充分发挥高校在大学生医疗保险体系中的作用,各级政府应加大政策力度和经济投入,应该在政策的制定和执行方面加大力度,根据需要适当增加资金投入,积极协调高校、保险公司、定点医院及大学生之间的关系,充分降低高校在大学生医疗保障方面的压力,保证所有大学生都有能力参加社会医疗保险。     

Fine‐Tuning of Health Insurance Regulation – Unhealthy Consequences for an Individual Insurer

This paper sheds light on some unexpected consequences of health insurance regulation that may pose a big challenge to insurers' risk management. Because mandated uniform contributions to health insurance trigger risk‐selection efforts, risk adjustment (RA) schemes become necessary. A good deal of research into the optimal RA formula has been performed. A recent proposal in Switzerland has been to add ‘Hospitalization exceeding three days during the previous year’ as an indicator of high risk. Applying the new formula to an individual Swiss health insurer, its payments into the RA scheme are predicted to increase substantially, reaching up to 13% of premium income. Its mistake had been to implement Managed Care successfully, resulting in low rates of hospitalization. The expected risk management response is to extend hospital stays beyond three days, contrary to stated policy objectives.     

大病保险对中老年居民医疗利用及健康的影响——基于CHARLS数据的实证检验

运用CHARLS 2011、2013、2015年三期数据,采用双重差分模型和准自然实验框架,分析城乡居民大病保险制度对中老年居民医疗服务利用和健康的影响及其作用机制,并从城乡和收入两个角度对制度实施效应的异质性进行探究。研究表明:大病保险制度实施能够显著促进中老年居民住院医疗服务及健康,增加中老年居民住院概率1.03%,提高住院次数0.022次,提高住院总费用10.4个百分点,总体健康水平提高0.023个单位;制度实施主要促进了农村和中等收入群体的住院医疗服务利用和健康水平的改善,对低收入人群住院医疗服务影响有限,且对城镇居民和高收入群体的影响并不显著;作用机制分析显示大病保险制度实施通过提高居民医疗服务利用进而起到改善其健康水平的作用。研究表明大病保险制度对中老年居民的住院服务利用和健康起到积极作用,但对于低收入群体的效应仍有待进一步改善。     

Psychological and Demographic Characteristics as Determinants of Women's Health Insurance Coverage

The study examines the role of demographic and psychological characteristics in determining women's healthcare insurance coverage. To assess the role of these characteristics, data from the National Longitudinal Survey of Labor Market Experience (NLSLME), Young Women's Cohort, were used considering both a married and not married subsample. Overall, the results indicate that in addition to the influence of previously examined demographic characteristics, the role of psychological attributes is substantial particularly for the not married subsample. Findings suggest that in addition to policy aimed at increasing health insurance coverage by way of considering demographic characteristics policy should also consider psychological attributes.     

The Japanese Export Insurance Arrangements: Promotion or Subsidisation?

Japan has promoted its exports by reducing the risks accompanying overseas sales through short‐term facilities for exporters. Short‐term export insurance schemes operated in line with rules on minimum premia are not prohibited according to current international trade rules. The insured amount of underwriting has however grown steadily and the balance of accounts of export insurance has deteriorated over a sustained, ‘long‐term’ period. The Japanese government has supported the system by reinforcing its financial base. In the 1980s and 1990s, the amount of claims was almost three times higher than premium incomes. Although the Japanese government may have subsidised exporters through the export insurance system, such subsidisation is notionally at least in accordance with the current regulations of the global trading system. The multilateral trading system has included export insurances at premium rates inadequate for covering the long‐term operating costs and losses of the programmes in the list of export subsidies. The current Members of the WTO are obliged to abide by the Agreement on Subsidies and Countervailing Measures which comprises the illustrative list of export subsidies. However, the Agreement also stipulates that export insurances consistent with the interest rate provisions of the OECD Arrangement should not be considered as an export subsidy. Therefore, provision of export insurances not prohibited by the WTO regulations may be considered by developing countries undergoing trade deficits as a means of export promotion. Japan has done similarly for the past half century.     

When Lying Does Not Pay: How Experts Detect Insurance Fraud

A growing literature has focused on understanding how to detect and deter unethical consumer behavior. In this work, we focus on a particularly important type of unethical consumer behavior, consumer insurance fraud, and we analyze a unique dataset to understand how experts investigate suspicious claims. Two separate but related literatures inform the process of investigating suspicious insurance claims. The first literature is grounded in field research and emphasizes the importance of secondary sources. The second literature is grounded in laboratory studies that emphasize the importance of interpersonal interactions. Here we draw upon both literatures to consider the importance of claimant interviews within the context of many investigative actions and the potential for claimants to avoid interviews. In an empirical study using qualitative and quantitative data from auto insurance claim investigations, we analyze investigative chronologies conducted by skilled experts. In doing so, we find that even when investigators can access information from a variety of sources such as witnesses, databases, and physical evidence, claimant interviews are the most important step in determining whether or not claims are denied or paid. Furthermore, we identify interpersonal avoidance as an important signal of unethical claimant behavior. Our findings inform deception detection theory and practice. We identify implications for deception detection in business, particularly for consumer unethical behavior and insurance fraud investigations.     

灵活就业人员医疗保险参与及受益归属——基于逆向选择和正向分配效应的双重检验

当前,灵活就业人员医疗保险发展不充分与不平衡的问题格外突出,这不仅会制约医保制度公平性与可持续能力的提高,同时会阻碍经济社会的全面、协调和可持续发展。本文运用中国劳动力动态调查数据(CLDS),研究灵活就业人员参加医保的决定因素以及受益归属,从而为新时期医保制度顶层设计提供决策依据。结果表明:一方面,无论是在参保决策还是险种决策阶段,灵活就业人员的健康风险显著正向影响参保状态,说明逆向选择效应显著存在;另一方面,低收入的参保人利用了更多优质的医疗服务,获得了更多的医保基金补偿,并显著改善了健康状况,因此医保发挥了积极的正向分配作用。但是过高的保障水平,在改善医疗可及性的同时会激发道德风险,从而加剧逆向选择问题并阻碍正向分配效应,对更加公平可持续医保制度的建立造成负面影响。     

农业巨灾损失及保险模式选择

我国是农业灾害十分频繁的国家,农业巨灾对农业部门造成重大损失,使农民因灾致贫、返贫,加强对农业的补偿和保险已迫在眉睫。加入WTO后,现行的农产品补贴政策受到限制,建立农业灾害政策性保险是一种非常合理而有效的举措。分析我国农业巨灾损失情况和农业保险开展现状,旨在探讨农业巨灾保险性质和适合我国国情的农业巨灾保险模式。     

Perceptions of Home Insurance and Policy Directions: Comparing Mexican Americans and Non-Hispanic White Americans

With prior research on home insurance largely focused on supply side practices, we know little about demand side attributes of this market, especially about consumer perceptions of insurance. This article demonstrates that, despite seemingly more equitable industry practices, ethnic homeowners (Mexican Americans in this study), relative to the majority White population, have a greater tendency to view home insurance as a cost burden (as opposed to coverage against potential damages and injuries) and, hence, are more vulnerable to living with minimal or no home insurance coverage. The findings suggest that this disparity is attributable to cultural differences rooted in diverse structural and institutional circumstances in which ethnic homeowners often find themselves situated. The role of ethnic identity is salient even after accounting for personal, household, property, mortgage, and natural calamity factors. New directions for policy are proposed to address the situation by informing and empowering vulnerable consumers.     

“Natural” and “Fresh”: An Analysis of Food Label Claims in Internationally Packaged Foods in Singapore

Food claims invite controversies on account of their potential to mislead consumers while at times masquerading as health information devices. In the United States, Europe, and Australia/New Zealand, scholars have extensively studied the prevalence of food claims, the regulatory repercussions, and effects of such claims on consumers’ food perceptions and dietary choices. Our study is an attempt to address a gap in related research focused on Asia by situating the inquiry in Singapore where consumers are exposed to a wide variety of such claims due to the universality of food imports. This study examines the state of food claims by the food product’s region of origin, and focus specifically on the use of terms “natural” and “fresh” on food labels. We present recommendations for food marketing policymakers and practitioners.     

Health insurance coverage during the COVID-19 pandemic: The role of Medicaid expansion

Using data from the US Census Bureau's Household Pulse Survey, we analyzed the likelihood of loss of health insurance and enrollment into new health coverage during the early months of the COVID-19 pandemic. Loss of employment was associated with a significant increase in the likelihood of loss of health insurance and, specifically, an increase in the likelihood of employer-sponsored health insurance. However, individuals in Medicaid expansion states experienced a lower likelihood of loss of health insurance compared with individuals in nonexpansion states. At the same time, there was a statistically significant increase in Medicaid enrollment in expansion states, by 3.2 percentage points. Reemployment or acquiring employment was associated with a gain in health insurance coverage. During an economic downturn, eligibility, and coverage gaps leave many without affordable coverage options, and the pandemic will likely bring renewed attention to gaps in Medicaid coverage in nonexpansion states.     

Unemployment insurance system at risk: Snapshot of a troubled partnership

The unemployment insurance (UI) system in the United States is in trouble. Millions in tax dollars are going to undeserving claimants due to fraud and, more often, mistakes or poor UI claims management. State administration of UI is suffering from a lack of both financial and human capital. At the same time, too many employers are overpaying unemployment taxes, not only because of fraud and abuse, but also because they have opted out of the system. Additionally, many employers are failing to respond to UI requests for documentation and are choosing not to contest claims, as they believe the system is hopelessly skewed against them.     

黑龙江省煤炭基地养老保险制度研究

黑龙江省煤炭基地在发展迅速的同时,如何走出一条适合煤炭基地发展的养老保险之路,是当前亟待解决的问题。黑龙江省煤炭基地养老保险制度存在着基本养老金倒挂现象,养老保险基金空账运营,养老保险覆盖面低等问题。完善黑龙江省煤炭基地养老保险制度,应积极推进养老保险扩面和征缴工作,建立多渠道筹集养老保险基金的机制,发展企业年金制度,规范管理社保基金,促进覆盖城乡基本养老保险体系建设进程的加快。