Perspectives Articles: Exploring Stakeholder Perspectives on What Is Affordable Health Care

Health care expenditures have accounted for increasing proportions of the U.S. gross domestic product, and the rate of growth of health care expenditures has increased over the past two decades. These two measures of assessing whether the level of health care expenditures is affordable may be appropriate in the aggregate for the United States but are not appropriate to assess whether individual stakeholder groups can afford their particular level of spending on health care. Health care is an economic good that differs from other economic goods, as it involves life and death issues, and invokes a call for a moral authority. This article explores definitions of what is affordable health care from the perspective of different stakeholders and suggests that other measures are needed to assess whether or not health care is affordable for stakeholders as one definition is not appropriate for all stakeholders.     

Forecasting Social Security Actuarial Assumptions

Abstract

This paper presents a forecasting model of economic assumptions that are inputs to projections of the Social Security system. Social Security projections are made to help policy-makers understand the financial stability of the system. Because system income and expenditures are subject to changes in law, they are controllable and not readily amenable to forecasting techniques. Hence, we focus directly on the four major economic assumptions to the system: inflation rate, investment returns, wage rate, and unemployment rate. Population models, the other major input to Social Security projections, require special demographic techniques and are not addressed here.

Our approach to developing a forecasting model emphasizes exploring characteristics of the data. That is, we use graphical techniques and diagnostic statistics to display patterns that are evident in the data. These patterns include (1) serial correlation, (2) conditional heteroscedasticity, (3) contemporaneous correlations, and (4) cross-correlations among the four economic series. To represent patterns in the four series, we use multivariate autoregressive, moving average (ARMA) models with generalized autoregressive, conditionally heteroscedastic (GARCH) errors.

The outputs of the fitted models are the forecasts. Because the forecasts can be used for nonlinear functions such as discounting present values of future obligations, we present a computer-intensive method for computing forecast distributions. The computer-intensive approach also allows us to compare alternative models via out-of-sample validation and to compute exact multivariate forecast intervals, in lieu of approximate simultaneous univariate forecast intervals. We show how to use the forecasts of economic assumptions to forecast a simplified version of a fund used to protect the Social Security system from adverse deviations. We recommend the use of the multivariate model because it establishes important lead and lag relationships among the series, accounts for information in the contemporaneous correlations, and provides useful forecasts of a fund that is analogous to the one used by the Social Security system.     

Overview

Abstract

From the inception of Social Security in 1935 to the present time, a variety of measures for evaluating the actuarial status of the program have been employed. In addition, how the results of these measures have been displayed and interpreted has also evolved. These results have had great influence on policymakers’ and the general public’s perceptions of the financial condition of the program. This paper is intended to be an update of my earlier paper on the same subject, that is, a historical review of the development of these methods and their interpretation. The paper closes with suggestions as to future changes in the measurement methods, in the light of possible future changes in the program itself.     

The Workplace on the Verge of the 21st Century

Almost exactly ten years ago, the now extinct U.S. Congress, Office of Technology Assessment (OTA) released a major report -- The Electronic Supervisor: New Technology, New Tensions. This report describes a number of new technologies available to management in its ongoing search to ensure that labour performs its required job to management's rigid specifications. Social issues raised with respect to electronic monitoring included privacy, fairness, quality of working life, and stress-related illnesses. The study was also concerned with drug testing, genetic screening, polygraph testing, as well as a variety of technologies for eavesdropping and monitoring. It seems to be appropriate to evaluate the analyses and recommendations made in the report and to extend the evaluation to current technologies.     

Effects of Information on Consumers' Willingness to Pay for Golden Rice

We examine the effects of information on consumer bidding behavior using a uniform‐price auction with four units supply for golden rice. Our findings show that mean willingness to pay (WTP) bids are highest under positive information, followed by no information, negative information, and unexpectedly lowest with two‐sided information. Participants might have put more weight on the negative when faced with both positive and negative information. There is also a minor difference in WTP with respect to the reference price between positive information and no information. Furthermore, the marginal effect on WTP of positive information vis‐à‐vis no information is minimal. This suggests that the positive information faced by consumers might not be compelling enough to drastically increase WTP bids for a genetically modified product such as golden rice.     

Labour Markets and Flexibility in the 1990s: The Europe-USA opposition revisited

Economists' contest on labour market flexibility has quickly pivoted around the stylised trade off between more flexibility and growth on the one hand and increased inequality of income on the other, the welfare implications of this trade off being too often assumed rather than verified. This article uses the essays collected in the Special Issue on Labour Markets and Flexibility in the 1990s of the International Review of Applied Economics to challenge the terms of this trade off as well as the related welfare assumptions. Some of the most popular tenets in the literature are assessed in the light of the evidence and the arguments put forward by the authors contributing to the Special Issue, in particular, the notion that the European labour market is rigid, the contention that more flexibility is imposed by international competition, or that labour market regulation weakens both employment and output growth, the belief that the main welfare cost of flexibility is increased inequality of earnings or the fear that flexibility may be primarily 'female'.     

Institutional deficit and health outcomes in post-communist states

In this paper we draw upon the unique natural experiment of post-communist transitions to show how the interaction between democratization and economic liberalization impacts health. We argue that, if occurring simultaneously, these transformations reduce overall uncertainty and thus improve health. Two concrete mechanisms are at work: first, people suffer less from stress-related diseases, and second, they start investing more in their own health. To capture the proposed theoretical mechanisms, we use stress-caused mortality and private expenditures on health as our dependent variables. Empirically, we employ mediation analysis with country and time fixed effects. We find that, ceteris paribus, democratization and economic liberalization exert a cumulatively positive impact upon health. Our findings should be relevant to other countries that undergo politico-economic transitions.