Essays On Health Insurance Markets

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Essays On Health Insurance Markets

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Author : Kevin David Frick
language : en
Publisher:
Release Date : 1996

Essays On Health Insurance Markets written by Kevin David Frick and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1996 with categories.

Three Essays On Competition And Health Insurance Markets

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Author : Juan Gabriel Fernandez
language : en
Publisher:
Release Date : 2012

Three Essays On Competition And Health Insurance Markets written by Juan Gabriel Fernandez and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with categories.

Abstract: Health care systems are complex organizations. Multiple agents interact in different settings to provide health care, each one of them with different objectives and information. How markets are organized and which actions are allowed, has a direct impact on the incentives agents face when making health care choices. In this dissertation, I study the determinants and effects of these choices on market outcomes, focusing on private health insurance markets. The first chapter provides insights about health insurance markets in which workers, rather than firms, choose insurance plans in an imperfect competition setting. Using a unique dataset that includes every person enrolled in private plans in Chile in 2009, I estimate underlying preference parameters over health insurance features. I find large heterogeneity in the valuation of these features across age-sex-groups and individual types. Individual characteristics play an important role on health plan choices and therefore, can be used by insurers to design plans targeted to specific groups and for patient selection. The second chapter presents a theoretical model where private insurers compete with a free public alternative to attract clients. Using a two-type model I show that if private insurance companies offer a non-rationing alternative and the public system rationing is done through random selection, an efficiency trap may exist. A marginal increase in the budget allocated to the public system can potentially reduce the expected welfare for all types. This result extends to a model with multiple types, but the negative welfare impact is offset by a crowding-in effect among the rich. Finally, the third chapter provides a general analytical framework that can be used to evaluate risk selection under different health care models. The model is based on the interactions between the four key agents present in every health care system: sponsors, health plans, providers and customers. This framework is used to review risk selection in four countries in the Americas -Canada, Chile, Colombia, and the U.S.-, showing how regulatory policies both create and ameliorate it, and in some cases are as important as risk adjustment, risk sharing and risk selection strategies for reducing risk selection.

Essays On Health Insurance And Annuities

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Author : Mark Shepard
language : en
Publisher:
Release Date : 2015

Essays On Health Insurance And Annuities written by Mark Shepard and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2015 with categories.

Insurance creates an important source of economic well-being by providing for beneficiaries in times of need. But because a variety of forces may inhibit the proper functioning of insurance markets, governments are deeply involved through regulation, subsidies, and direct provision of insurance. This dissertation studies insurance demand, supply, and the role of policy in two types of markets of direct interest to policymakers: health insurance and annuities. I highlight the importance of both traditional market failures (adverse selection and moral hazard) and less standard factors like limited competition (market power) and puzzlingly low insurance demand to influence insurance market outcomes.

Essays On The Economics Of Health Insurance Markets

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Author : Richard Domurat
language : en
Publisher:
Release Date : 2018

Essays On The Economics Of Health Insurance Markets written by Richard Domurat and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018 with categories.

This dissertation includes three chapters on the health insurance markets established by the Affordable Care Act (ACA), known as exchanges. Chapter 1 estimates the demand for each plan in the California exchange using a discrete choice model. The model incorporates heterogeneity in consumer preferences and in product characteristics, including hospital and primary care physician (PCP) networks. Endogeneity of prices is addressed using networking hospital costs as instruments, and prices for any given plan can vary across consumers within a market. Consumers are highly sensitive to prices, with market shares declining by 3%-5% for just a $1 increase in the premium. Demand also responds to hospital and PCP networks, but to a relatively small degree. Along the take-up margin, a $1 increase in premium subsidy increases take-up by 1.4%. Chapter 2 uses a structural model of demand and supply to examine how two insurance market regulations--community rating and risk adjustment--affect prices and enrollment in the ACA exchange in California. Without risk adjustment, community rating in the ACA would lead to a significant reduction in enrollment in desirable plans and in take-up overall. Risk adjustment under the ACA roughly restores relative shares across plans to what they would be without community rating; however, the reduction in take-up is not restored. An alternative risk adjustment method can increase enrollment by 3.0% and would have little impact on government spending. Chapter 3, written jointly with Isaac Menashe and Wesley Yin, examines the impact of information on insurance take-up in the ACA. We exploit experimental variation in the information mailed to 87,000 households in California's exchange to study the role of frictions in insurance take-up. We find that a basic reminder of the enrollment deadline raised enrollment by 1.4 pp (or 16 percent). Compared to the reminder alone, also reporting personalized subsidy benefits increases take-up among low-income individuals, but decreases take-up among higher-income individuals. This is despite reminder-only recipients eventually observing their subsidies before purchase. Finally, the letter interventions induced healthier individuals into the market, lowering aggregate spending risk by 5.9 percent, suggesting these interventions can improve both enrollment and average market risk.

Supplementary Products In The Health Insurance Market And Its Implications

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Author : Alexander Ellert
language : en
Publisher:
Release Date : 2013

Supplementary Products In The Health Insurance Market And Its Implications written by Alexander Ellert and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with categories.

Essays On Health Insurance Market Design And Labor Market Interactions

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Author : Naoki Aizawa
language : en
Publisher:
Release Date : 2014

Essays On Health Insurance Market Design And Labor Market Interactions written by Naoki Aizawa and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014 with categories.

Essays On Health Care Markets

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Author : Ami Ko
language : en
Publisher:
Release Date : 2017

Essays On Health Care Markets written by Ami Ko and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017 with categories.

The two chapters of my dissertation develop and estimate economic models to analyze the demand for and the provision of health care services. Specifically, I analyze the optimal design of health care markets to promote higher quality and lower cost, which can have profound implications for the well-being of people. The first chapter, "An Equilibrium Analysis of the Long-Term Care Insurance Market," uses a model of family interactions to explain why the long-term care insurance market has not been growing. By developing and estimating a structural model of family interactions, I study how family care affects the workings of the long-term care insurance market. I argue that private information about the availability of family care induces adverse selection where individuals with limited access to family care heavily select into insurance coverage. I demonstrate that pricing on family demographics substantially mitigates adverse selection by reducing the amounts of private information. I propose child demographic-based pricing as an alternative risk adjustment that could decrease the average premium, invigorate the market, and generate welfare gains. The second chapter, "Partial Rating Area Offering in the ACA Marketplaces," joint with Hanming Fang, studies insurance companies' plan offering decisions in the marketplaces established by the Patient Protection and Affordable Care Act of 2010 (ACA). Under the ACA, insurance companies can vary premiums by "rating areas" which usually consist of multiple counties. In a given rating area, the ACA mandates uniform pricing for all counties, but, it does not mandate universal offering. We first demonstrate that it is not uncommon to observe insurance companies selling plans to only a subset of counties within a rating area. Using both theoretical and empirical approaches, we find evidence that partial rating area coverage is explained by insurers' incentive to risk screen consumers. While the ACA allows price discrimination based on rating areas and not on counties, we argue that insurers are effectively price discriminating consumers based on counties by endogenously determining their service area within a rating area.

Essays On Health Insurance Plan Design

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Author : Chenyuan Liu
language : en
Publisher:
Release Date : 2020

Essays On Health Insurance Plan Design written by Chenyuan Liu and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020 with categories.

Health care markets have great economic importance and represent a large share of GDP in the U.S. Health insurance plans play a key role in the efficiency of these markets. My dissertation studies the design of health insurance contracts and how they affect market efficiency. Chapter 1 of my dissertation the prevalence of financially dominated options in health plan menus. We analyze Kaiser Family Foundation data on health plans that firms offer to their employees. For firms offering both a high-deductible and lower-deductible health plan, 62 percent of the time the high-deductible option has lower maximum spending risk for the employee. We estimate that the high-deductible plan dominates at roughly half of firms. We identify adverse-selection pricing as a likely mechanism for these surprising patterns and discuss implications for our understanding of the value of plan choice in employer-sponsored health insurance. Chapter 2 of my dissertation identifies both theoretically and empirically a new channel of sorting in insurance markets under asymmetric information: sorting by plan design. A model allowing for rich contract designs predicts high-risk individuals will sort into risk-minimizing straight-deductible plans, while lower-risk individuals prefer plans that trade higher maximum expenditure risk for coverage against small losses. Analyzing data from the ACA Exchange, I find that within coverage tiers, plans vary significantly along multi-dimensional cost-sharing attributes. Further, straight-deductible plans attract higher-risk enrollees than other designs as the model predicts. I discuss how these insights can inform discussions around the standardization of insurance plans. Chapter 3 of my dissertation studies the effects of capitated payment models on physicians' treatment decisions in the treatment of lower back pain in the U.S. We use a large employer-sponsored health insurance claim database from 2003 to 2006, and leverage capitation variation within the plan and physician to mitigate selection concerns. We find that the treatment intensity of capitated patients is 5 to 10 percent lower than otherwise similar non-capitated patients, mainly from therapy, diagnostic testing, and drugs. We also find no evidence of increased readmission rates for capitated patients.

Three Essays On Access And Welfare In Health Care And Health Insurance Markets

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Author : Nathaniel Denison Mark
language : en
Publisher:
Release Date : 2021

Three Essays On Access And Welfare In Health Care And Health Insurance Markets written by Nathaniel Denison Mark and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2021 with categories.

We use a model of health plan choice and subsequent utilization to estimate household preferences in both markets and predict premiums and costs under a counterfactual pooled market. We find that integration mitigates adverse selection issues in the individual market, while decreasing government and employer expenditures on premium subsidies. Small group households benefit from lower premiums for low coverage plans in the merged market. However, they face higher premiums for high coverage plans and are constrained to a smaller set of insurance options. Thus, the effects of integration on small group households are heterogeneous.

Essays On Insurance And Taxation

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Author : Marika Ilona Cabral
language : en
Publisher: Stanford University
Release Date : 2011

Essays On Insurance And Taxation written by Marika Ilona Cabral and has been published by Stanford University this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011 with categories.

This dissertation consists of four distinct essays. In an essay entitled "Claim Timing and Ex Post Adverse Selection: Evidence from Dental 'Insurance, ' " I explore the impact of strategic timing on insurance market allocations. If people can delay a claim just long enough to buy more insurance coverage in anticipation of it, severe adverse selection may result, and in extreme cases, this can lead to the complete unraveling of an insurance market. I study these forces by analyzing dental treatments and insurance, with the goal of understanding insurance in the market for dental care and also revealing lessons that apply to insurance markets more broadly. Using rich claim-level data from a large firm, my analysis reveals that the strategic delay of treatment and the associated adverse selection may be an important factor in explaining why so few people have dental coverage in the US and why typical dental "insurance" contracts provide so little insurance. More generally, my results suggest that insurance products without contract features designed to limit coverage for strategically delayed costs (e.g., open-enrollment periods, pricing pre-existing conditions) may generate unraveling. An essay entitled "The Hated Property Tax: Salience, Tax Rates, and Tax Revolts" (with Caroline Hoxby), explores the relationship between the salience of the property tax and observed property tax rates. We hypothesize that high salience explains the unpopularity of the property tax, the level of the property tax, and prevalence of property tax revolts. To identify variation in the salience of the property tax over local jurisdictions and over time, we exploit conditionally random variation in tax escrow, a method of paying the property tax that makes it much less salient. We find that areas in which the property tax is less salient are areas in which property taxes are higher and property tax revolts are less likely to occur. In an essay entitled "Private Coverage and Public Costs: Identifying the Effect of Private Supplemental Insurance on Medicare Spending" (with Neale Mahoney), we explore the impact of private supplemental insurance on Medicare spending. Private supplemental insurance to "fill the gaps" of Medicare, known as Medigap, is very popular. We estimate the impact of this supplemental insurance on total medical spending using an instrumental variables strategy that leverages discontinuities in Medigap premiums at state boundaries. Our estimates suggest that Medigap increases medical spending by 57 percent---or about 40 percent more than previous estimates suggest. Back-of-the-envelope calculations indicate that a 20 percent tax on premiums would generate combined revenue and savings of 6.2 percent of Medicare baseline costs. An essay entitled "The Effect of Insurance Coverage on Preventive Care" (with Mark Cullen), explores the effect of insurance coverage on preventive care utilization. Using health insurance claims data from a large company, this paper examines the implementation of an insurance benefit design which differentially increased the marginal price of curative care (non-preventive care) while decreasing the marginal price of prevention. We examine the effect of the differential price change on the use of preventive procedures. We reveal evidence consistent with an important negative cross-price effect; that is, increases in the price of curative care can depress preventive care utilization.