Essays On Health Insurance Plan Design
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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.
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.
Two Essays On Price Limits And One Essay On Health Insurance
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Author : Shawn McFarland
language : en
Publisher:
Release Date : 2020
Two Essays On Price Limits And One Essay On Health Insurance written by Shawn McFarland 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.
The first two essays study the special quote (SQ) and limit up-limit down (LULD) rules. These rules are short duration price limits rules on the Tokyo Stock Exchange (SQ) and US stock exchanges (LULD). We present a novel research design where we create pseudo-event samples to test stock market behavior in the absence of these rules. The first essay examines price limit effects on delayed price discovery and the magnet effect. We find that neither SQ nor LULD delay price discovery. SQ exhibits evidence of the magnet effect at the upper price limit while LULD has no magnet effect. The second essay focuses on volatility spillover following a price limit event and microstructure noise during flash crashes. Consistent with previous findings regarding daily static price limits, we find little evidence that either SQ or LULD calm market volatility. Also, we find little evidence that LULD reduces intraday volatility during periods of extreme volatility such as flash crashes. The third essay strives to develop a more efficient, lower-cost health insurance/underwriting system. We divide healthcare coverage into three tiers. Tier 1 consists of low severity healthcare claims that occur regularly for essentially all people. Tier 2 covers relatively lower frequency and higher cost healthcare claims that present lower, more predictable underwriting risk and rarely involves prolonged, year to year, underwriting risks. Tier 3 involves catastrophic low frequency but high severity healthcare underwriting risks that may require larger volume insurers to achieve diversification through a more stable distribution of benefits. Tier 3 claims often result in the long term and expensive future healthcare needs risks often terminating with the death of the insured. We show empirically that annual health care expense is a function of claim frequency and claim severity. Further, we show that claim frequency and claim severity are interrelated and that their covariant relation is non-homogeneous across the entire distribution of health care claims. Finally, we show that by segmenting health care insurance underwriting based on these three tiers, cumulative health insurance premiums are reduced. We propose policy recommendations to address social interests including affordable care and universal coverage..
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.
Three Essays In Health Economics And Public Policy
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Author : Olga V. Milliken
language : en
Publisher:
Release Date : 2008
Three Essays In Health Economics And Public Policy written by Olga V. Milliken and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008 with Health insurance categories.
Three Essays In Health Economics And Industrial Organization
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Author : Jee-Hun Choi
language : en
Publisher:
Release Date : 2020
Three Essays In Health Economics And Industrial Organization written by Jee-Hun Choi 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.
This dissertation consists of three essays in the field of health economics and industrial organization, focusing on the policies on public health insurance in the United States. The first chapter investigates the impact of expanding public health insurance through private insurers on equilibrium insurance market outcomes. Using the Arkansas All-Payer Claims Database, I measure the impact of the Affordable Care Act (ACA) insurance expansions on hospital reimbursement rates and premiums for non-ACA private plans, including employer-sponsored insurance plans not directly affected by the ACA. Using a Nash bargaining model based on the Ho and Lee (2017) framework, I find that the publicly-subsidized expansion decreases hospital reimbursement rates by 5.3% and insurance premiums by 0.6% for privately-insured enrollees who are not covered by the ACA. This spillover effect on reimbursement rates is driven by the increased bargaining leverage of insurers participating in the expansion. The increase in leverage results mainly from the change in the composition of enrollees, which goes hand-in-hand with enrollment increase as a result of the expansion. The second chapter, co-authored with Claire Lim, explores the linkages between government ideology in U.S. states and geographic variation in Medicaid program design and operations. Medicaid eligibility criteria tend to be more generous in liberal states. Simultaneously, fee-for-service reimbursement rates for physician services have been notably lower in liberal states. These two patterns lead to the following question: to what extent does the partisan composition of the government drive eligibility and reimbursement over time? If cost-saving measures accompany eligibility expansion, then what are their consequences for resource allocation? We explore long-run linkages among partisan composition of the government, eligibility, cost-saving measures, and expenditures for the Medicaid expansion from the mid-1990s to 2010. Our analysis consists of four steps. First, we analyze how much the partisan composition of the state government drives eligibility expansion. Second, we explore the tradeoff between breadth of eligibility and fee-for-service reimbursement rates. Third, we investigate driving forces behind the evolution of the delivery systems, i.e., Medicaid managed care diffusion. Fourth, we analyze the resulting patterns of per-enrollee spending. We find that the partisan composition of the state house played a critical role in the relatively later stage of eligibility expansion and the reduction of fee-for-service reimbursement rates over time. While the HMO penetration in the private insurance market drove the Medicaid managed care diffusion, the diffusion also tends to go hand in hand with the reduction of fee-for-service reimbursement rates. Finally, Medicaid per-enrollee spending increased substantially over time despite the adoption of cost-saving measures. This unintended consequence was due to the systematic changes in HMO practices that coincided with the eligibility expansion. The third chapter, co-authored with Claire Lim, investigates determinants of government subsidy in the U.S. health care industry, focusing on the Medicaid Disproportionate Share Hospital (DSH) program. We find that the amount of Medicaid DSH payment per bed increases significantly with increase in hospital size for government hospitals. This is partially explained by the distinctive role that large government hospitals play in the provision of care to the indigent population. However, costs, financial conditions, or types of services by themselves are not enough to explain DSH payments. Large government hospitals tend to have a higher ratio of DSH payments to Medicaid and uninsured costs. The difference in the DSH payment-to-cost ratio across ownership types increases significantly with increase in hospital size. We argue that these key patterns are unlikely to be driven by unobserved heterogeneity, using the Altonji-Elder-Taber-Oster method. Our results on payment-to-cost ratios are consistent with targeting by the state government to counterbalance disparities in hospitals' capability to cross-subsidize across patient types.
Essays On The Economics Of Public Sector Retirement Programs
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Author : Gregory Quick Leiserson
language : en
Publisher:
Release Date : 2013
Essays On The Economics Of Public Sector Retirement Programs written by Gregory Quick Leiserson 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.
This thesis investigates the influence of retiree health and pension policies on the retirement decisions of public sector employees. Chapter one documents the central role of eligibility for subsidized retiree health insurance. Using administrative records obtained from the Pennsylvania State Employees Retirement System, the analysis finds that the well-documented spike in the separation rate at the normal retirement age almost completely disappears in the population of workers not yet eligible for subsidized retiree health insurance. A second set of results exploits quasi-experimental variation in plan design to show that increasing the service requirement for subsidized retiree health insurance stretches the distribution of separations: early separations occur earlier and late separations occur later. Chapter two presents a structural analysis of the retirement decision for the same employees. Existing models of the retirement decision treat eligibility as a fixed characteristic of the worker rather than one that evolves over the career. This chapter estimates a model of life-cycle labor supply and uses it to simulate labor supply behavior under different health and pension policies. Changes in the eligibility requirements for subsidized retiree health insurance induce dramatic changes in retirement timing that would be missed in models that do not account for an employer's eligibility criteria. Chapter three turns to the defined benefit pension plans common in the public sector. These plans create complicated incentives in favor of continued work at some ages and in favor of retirement at others. The strength of these incentives depends on many factors, such as the age of initial employment and the number of years on the job. Because employees differ along these dimensions, the value of the pension benefits earned over the course of a career varies substantially-even among employees with the same total earnings. This chapter investigates the incentive effects and distributional consequences of four stylized plan designs. It derives simple formulas for the accrual rate of pension wealth and the distribution of benefits under each of the plans and uses these formulas to gain insight into the incentives and risks they create.
Essays In Health Economics
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Author : Ausmita Ghosh
language : en
Publisher:
Release Date : 2018
Essays In Health Economics written by Ausmita Ghosh 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.
My dissertation is a collection of three essays on the design of public health insurance in the United States. Each essay examines the responsiveness of health behavior and healthcare utilization to insurance-related incentives and draws implications for health policy in addressing the needs of disadvantaged populations. The first two essays evaluate the impact of Medicaid expansions under the Affordable Care Act (ACA) on health and healthcare utilization. The Medicaid expansions that included full coverage of preconception care, led to a decline in childbirths, particularly those that are unintended. In addition, these fertility reductions are attributable to higher utilization of Medicaidfinanced prescription contraceptives. The second essay documents patterns of aggregate prescription drug utilization in response to the Medicaid expansions. Within the first 15 months following the policy change, Medicaid prescriptions increased, with relatively larger increases for chronic drugs such as diabetes and cardio-vascular medications, suggesting improvements in access to medical care. There is no evidence of reductions in uninsured or privately-insured prescriptions, suggesting that Medicaid did not simply substitute for other forms of payment, and that net utilization increased. The effects on utilization are relatively higher in areas with larger minority and disadvantaged populations, suggesting reduction in disparities in access to care. Finally, the third essay considers the effect of Medicaid coverage loss on hospitalizations and uncompensated care use among non-elderly adults. The results show that coverage loss led to higher uninsured hospitalizations, suggesting higher uncompensated care use. Most of the increase in uninsured hospitalizations are driven by visits originating in the ED - a pattern consistent with losing access to regular place of care. These results indicate that policies that reduce Medicaid funding could be particularly harmful for patients with chronic conditions.
Essays On Insurance
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Author : Raymond Peter Kluender
language : en
Publisher:
Release Date : 2018
Essays On Insurance written by Raymond Peter Kluender 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 thesis consists of three chapters on the economics of health insurance. In the first chapter, Carlos Dobkin, Amy Finkelstein, and Matthew Notowidigdo and I use an event study approach to examine the economic consequences of hospital admissions in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills, and bankruptcy, and reduce earnings, income, access to credit, and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger fewer than 5 percent of all bankruptcies in our sample. In the second chapter, Evan Mast and I investigate an information friction in Medicare Advantage-beneficiaries pay two premiums, and one is much more salient. We find a larger demand elasticity for the salient versus non-salient premium. A model of insurer plan design produces simulated premiums matching the observed distribution using these "behavioral" elasticities, but not when assuming equal elasticities across the two premiums. Removing the friction increases enrollment in low-premium plans, increasing consumer surplus $5/year with supply fixed and $73/year when including a supply response. In the final chapter, I use difference-in-differences and triple-difference methods to understand the effects of the Affordable Care Act Medicaid expansion on a number of labor supply indicators and find no significant evidence of a labor supply response.
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.