The Effects of Consumer-Directed Health Plans on Health Care Spending

We use unique data from an insurer that exclusively offers high-deductible, "consumer-directed" health plans to identify the effect of plan features, notably employer contributions to the spending account, on health care spending. Our results show that the marginal dollar contributed by the employer to the spending account is entirely spent on outpatient and pharmacy services. In contrast, out-of-pocket spending was not responsive to the amount the employer contributes to the spending account. Our results represent the first plausibly causal estimates of the components of consumer-driven health plans on health spending. The magnitudes of the effects suggest important health care spending consequences to higher employer contributions to spending accounts. Our findings are most directly relevant to health reimbursement arrangement plan designs, though our results are still of value to health savings account plan designs.     

Correlating Lévy processes with self-decomposability: applications to energy markets

Decisions in Economics and Finance - Based on the concept of self-decomposability, we extend some recent multidimensional Lévy models built using multivariate subordination. Our aim is to...     

Community rating and the market for private non-group health insurance

Prior research on adverse selection in health insurance markets has found only mixed evidence for adverse selection in group settings. We examine the impact of state community rating regulations enacted in the 1990s, which greatly limited insurers' ability to risk rate premiums, to determine if adverse selection is more evident in non-group insurance markets. Using data from large, national surveys we find evidence of a shift to a less healthy pool of non-group enrollees as a consequence of community rating. Community rating made healthy people 20 to 60% less likely to be insured by non-group health insurance; in addition, we found evidence that young and healthy people were 20 to 30% more likely to be uninsured as a result of community rating. We also find evidence that individuals in poor health were 35 to 50% more likely to be insured in the non-group market, but only limited evidence suggesting that persons in poor health were less likely to be uninsured. Our results are further supported by findings suggesting that non-group enrollees were sicker as a result of the community rating laws. Lastly, we find evidence suggesting that HMO penetration in the non-group market increased disproportionately in states that implemented community rating relative to states that did not.     

Balancing Retirement Security With the Needs of Frail Parents

Abstract

Caring for frail elderly parents can interfere with work responsibilities. People who provide care to their parents may need to take time off from work or retire altogether. However, reductions in labor supply at midlife can have serious implications for retirement wealth and, as a result, on economic well-being in later life. This paper examines how family support for the elderly can affect retirement savings by examining the relationship between labor supply, time help to parents, and financial assistance to parents. Using data from the Health and Retirement Study on a nationally representative sample of women ages 53–63, we found that women who helped their parents with personal care assistance worked significantly fewer hours than did those who did not help their parents, whereas those who provided financial assistance worked significantly more hours. Although few persons at midlife presently spend substantial amounts of time helping their elderly parents in any given year, for those who do, the costs can be high. Pressures on families are likely to mount in the near future as falling mortality and fertility rates continue to increase the proportion of the population that is very old and as women continue to play more important roles in the labor market.