Health Care Systems
Saturday, Jan. 4, 2020 10:15 AM - 12:15 PM (PDT)
- Chair: David Frisvold, University of Iowa
Private Health Insurance under Universal Health Care: Health, Labor, and Budget Considerations
AbstractUniversal healthcare is associated with desirable health and equity outcomes and often allows individuals to purchase supplementary private health insurance. While the purchase of private health insurance is clearly beneficial in the absence of public insurance, it is very challenging to evaluate individual costs and benefits when baseline coverage exists for everyone. This study reveals the hidden costs and unintended consequences of private health insurance under universal health care through a large unique tax panel data set over more than a decade. The problem of selection is approached through a regression kink design in conjunction with a policy implemented in Australia in the year 2000, punishing agents for delaying the purchase of private health until later in life. Following the policy-guided instrumentation of insurance purchase, it appears that private health insurance does not cause moral hazard. There is a zero effect on medical expenditures despite evidence of adverse selection. Having supplementary insurance does not change mortality or work expenses. There does seem to be a loss of gross income from private health insurance which is interpreted as foregone opportunity costs due to convenience. Insurance leads to increase in student debt which implies that premium payments crowd out debt repayments. Finally, there is evidence of habit persistence of private health insurance coverage which indicates that any government policy can exacerbate positive or negative effects of supplementary insurance.
The Effect of Expanding a Neonatal Intensive Care System on Infant Mortality and Long-Term Health Impairments
AbstractWe study the effects of the geographic expansion of a Neonatal Intensive Care Units (NICU) system and a Newborn Emergency Transportation System (NETS) on neonatal and infant mortality and long-term impairments. We utilize gradual expansion in Hungary, we use administrative and census data, and we identify the effect from longitudinal variation in access, using changing distance as an instrument. Improving access to give birth in a city with a NICU decreases 0-6-day mortality by 153/1000 (
The Effects of the 2010 Affordable Care Act Dependent Care Provision on Family Structure and Public Program Participation among Young Adults
AbstractWe investigate the effect of dependent care provision of the Affordable Care Act (ACA) on young adults’ family structure, as well as their participation in three public programs that have eligibility requirements related to family size and structure – WIC, SNAP, and TANF. The ACA dependent care provision opens up a new source of health insurance coverage for young adults who have a privately insured parent. This new availability of coverage may affect young adults’ costs and benefits associated with decisions about marriage and living arrangements, as well as decisions about childbearing. This is particularly true for women, who are more likely than men to obtain private health insurance coverage by being a dependent on another person’s plan. We use difference-in-difference (DD) methods and data from the 2008 Survey of Income and Program Participation (SIPP) to test whether the ACA dependent care provision is associated with family structure and public program participation among young adults. Our findings suggest that the ACA dependent care provision is associated with 10 percent and 15 percent reductions in the likelihoods of being married and of cohabiting, respectively, among young adults. The provision is associated with a 6 percent increase in the likelihood of being single. The ACA dependent care provision reduced the likelihood that the young adult had his/her own child in the household by about 6 percent, and is associated with a 12 percent reduction in the likelihood that the young adult is a single parent. We also find that the dependent care provision is associated with reductions in SNAP, WIC, and TANF participation.
Unintended Consequences of Health Care Reform in South Korea: Evidence from a Regression Discontinuity in Time Design
AbstractIn June 2007, the South Korean government, hoping to reduce the state's share of health care costs, passed an amendment to the state-run health care system to transition from a copay system to a coinsurance system for outpatient services. This new policy effectively increased the out-of-pocket health care costs of outpatient services to South Koreans from 22 percent to 30 percent. This paper estimates the impact of the health insurance reform on outpatient health care utilization. Using a regression discontinuity in time design, I find that the abolition of the copayment program significantly increased system-wide outpatient health care utilization by up to 90 percent and reduced medical expenditures by 23 percent per visit. The copayment abolition incentivized beneficiaries to obtain more medical treatments during the grace period and enroll in supplemental private health insurance covering patient-sharing medical costs, allowing access to more medical services with lower marginal costs. Therefore, the abolition of the copayment and emergence of supplemental private insurance caused moral hazard and adverse selection problems, leading South Korea to become the country with the highest per capita utilization of outpatient health services worldwide since 2012.
Why Are the Elderly Vulnerable to Cheating? Evidence from a Survey Experiment
AbstractThere is a big market for non-drug healthcare products in developing countries. Many illegal or unhealthy healthcare products target the elderly with exaggerated effect. This study explores why the elderly is vulnerable to cheating. A survey experiment was conducted by randomizing the order of two panels of questions. The control group first answered questions on purchase interest and then questions on health problems. The treatment group did the reverse – the questions on health problems are expected to raise the attentiveness of health issues for those with them. By comparing the treatment group and the control group with poor versus good health condition, this study finds that the elderly with poor health condition in the treatment group expressed stronger desire to purchase healthcare products with impossible health effect after their health problems were emphasized. What’s more important, the elderly were also more vulnerable to deception in health-independent deceptive marketing. Because the elderly are more likely to have health problems, and therefore they are more concerned about their health, this study explains why the elderly are likely to be cheated in both the healthcare market and the general market.
- I1 - Health