In addition to the growing popularity of mental health parity laws at the state level, the federal government also succeeded in pressing for mental benefit parity nationwide in 1996. The Mental Health Parity Act (MHPA, effective in January, 1998) requires group insurance plans to apply the same lifetime and annual dollar limits to mental health coverage as those applied to physical health coverage. Group healthinsurance plans under the federal parity context include the plans provided by private and public sectors with more than 50 employees and the plans sold by health insurers to employers with more than 50 employees. Comparing the extent and scope of MHPA to state parity legislation, the former does not go well beyond the state full or nearly full parity because the statute applies only if mental health benefits are offered in an insurance plan. From this point of view, MHPA could be generally considered as a “mandate offering” law, or even a weaker one because it only requires equal dollar limits. However, state parity laws exempt self- insured employer-sponsored plans because of Employee Retirement Income Security Act (ERISA). This federal preemption cuts the potential affected workers with coverage by half. MHPA fills this regulatory gap and thus reaches more employees than parity at the state level.
The other study that considered the effects of specific age thresholds was conducted by Anderson et al. (2012). Using repeated cross-sectional data from the National Health Interview Survey (NHIS) from 1997 to 2007, they estimated a 4.1 percentage point increase in the proportion of young adults who became uninsured after reaching age 19, but a 7.1 percentage point increase out of those who were not enrolled in school. Their main research question, however, was whether turning age 19 had any effects on health care utilization. Based on hospital discharge data from six states, they found large reductions in both emergency room (40%) and inpatient admissions (61%) after turning age 19. Callahan and Cooper (2005) also examined the effect of insurance status and health care utilization and found that the uninsured were three to four times more likely to delay or forego medical care compared to those with healthinsurance. The previous work on insurance status and health care utilization suggest that large reductions in health care utilization may result as young adults become uninsured. If dependent insurance mandates expand coverage among young adults, the previous research suggests it may also result in large increases in hospital visits and possibly health status. More research could be done to understand the relationship between insurance coverage and the health status of young adults in both the short run and long run.
Other studies exploit the discontinuity of retirement status around the official retirement age set by governments. If this discontinuity of retirement is significant, and all factors but retirement are smooth around the official retirement, RDD (regression discontinuity design) may have the potential to identify the short-term causal effects of retirement on health. For example, Johnston and Lee (2009) uses a RDD based on the discontinuity at age 65 in the probability of retirement in England to estimate the impact of retirement on subjective and objective health. Their results indicate that retirement increases an individual’s sense of well-being and their mental health. In German pension system, 60 is the pension eligibility age for women, for unemployment and partial retirement, and for severely disabled people; age 65 is the standard pension age. Using a RDD and two pension ages as cutoffs, Eibich (2015) identifies the causal effects of retirement on health and the mechanisms behind the effects, and finds that retirement improves subjective health status and mental health, while reduces outpatient care utilization. Relieving from work- related stress, increased sleep duration, as well as frequent physical activities seem to be key mechanisms through which retirement affects health. However, since the retirement behavior is voluntary in developed counties relative to developing countries, sometimes the discontinuity of retirement status of developed countries is not sharp enough to apply RDD approach. In addition, there may have other significant changes around retirement age for elderly. For example, age 65 is also the Medicare eligibility cutoff in the U.S. This healthinsurance availability may confound, or cause impact of the retirement to be biased upward.
First of all, how do we contain cost of Medicaid programs? In the 90’s, Medicaid expenditures grew fast. In response to this, many states began to enroll large numbers of Medicaid patients in managed care programs. The first chapter examines the effect of Pennsylvania Medicaid manda- tory HMO program, HealthChoices program on the outcomes of pregnant women. I utilize the Pennsylvania Health Care Cost Containment Council inpatient data file and American Hospital Association survey data to perform difference-in-difference-in-difference estimation and find ro- bust results indicating that HealthChoices program helps Medicaid mothers reduce the incidence of preventable complications, utilization of C-section procedure and decrease the delivery charge. Second, how do we improve the access to a certain health care service. In January 2006, Medicare introduced a new prescription drug benefit through Part D, therefore lowering the out- of-pocket cost of prescription drug for Medicare beneficiaries. The second chapter uses data from the National Ambulatory Medical Care Survey (NAMCS), Medical Expenditure Panel Survey (MEPS) and the National Inpatient Sample from the Healthcare Cost and Utilization Project (NIS-HCUP) 2002-2004 and 2006-2009 and a difference-in-discontinuity approach to estimate the differential discrete jumps in outcomes at 65 years old for the sample after 2006 and before 2006. We find a 33% increase in the number of prescription drugs and a 55% increase in the number of generic drugs prescribed in physicians’ offices for each visit following policy implementation. We also find the existence of anticipatory effects for prescribing patterns before the adoption of Part D. We do not find evidence that Part D resulted in significant changes in medical expenditures
The intuition for why our optimal tax formula depends on macro em- ployment responses and macro and micro participation responses is the following. In the absence of unemployment and wage responses, behav- ioral responses to taxation only matter through their effects on the gov- ernment’s budget because they have no first-order effect on an individ- ual’s objective by the envelope theorem (Saez, 2001, 2002). However, the latter argument does not apply to wage and unemployment responses be- cause these responses are not directly chosen by individuals but rather are mediated at the market level. 20 Since the social welfare function is as- sumed to depend only on expected utilities, market spillovers due to wage and unemployment responses matter only insofar as macro responses of expected utility to taxes differ from micro responses. Moreover, since par- ticipation decisions depend only on expected utilities as well, these market spillovers are entirely captured by the ratio of macro over micro partici- pation responses. This is related to results in Kroft (2008) and Landais, Michaillat, and Saez (2015) who show that to evaluate optimal unemploy- ment insurance (UI), it is important to estimate the ratio of the micro and
The US Federal crop insurance program has received significant attention as far as the United States food and agricultural policies (e.g., Federal support programs) are concerned. There are ongoing policy debates about why the Federal government subsidizes crop insurance, which effectively rests on our understanding of the market context of insurance demand. Much concern revolves around the inadequate participation rates of the program. At the same time, there is mounting empirical evidence about how price sensitive producers in the United States are to participate in crop insurance, generally suggesting a wide range of elasticities. Research challenges remain, however, and the existing current evidence is relatively thin. More importantly, most of these studies fail to address the potential endogeneity of insurance premiums. The aim of this study has been to address these challenges and attempt to provide well-identified elasticity estimates that reflect current state of the world of the Federal crop insurance program, using a variety of methods. The data which spans 1989-2013 is an unbalanced panel: covering over 673 counties in the Corn Belt of the United States. We explore the fraction of planted acreage insured as our main outcome of interest. Our preferred model which exploits exogenous variations from major Federal subsidy policy changes provides a demand elasticity of -0.89. This estimate implies larger effects than suggested by previous estimates (see e.g., Goodwin 1993; and Smith and Baquet 1996; among others) which are based on less desirable econometric methodologies.
The welfare consequences reported in Table 2.1 were measured under the veil of igno- rance, before workers learn their initial health level. They mask very substantial hetero- geneity in how workers feel about these policies once their initial health status in period 0 has been revealed. Given the transfers across health types displayed in Figures 2.7 and 2.8 and the persistence of health status this is hardly surprising. Table 2.2 quantifies this heterogeneity by reporting dynamic consumption-equivalent variation measures, computed exactly as before, but now computed after the initial health status has been materialized. Broadly speaking, the lower a worker’s initial health status, the more she favors policies providing consumption insurance. For the middle two health groups the ranking of policies coincides with that in the second column of Table 2.1; households with excellent health prefer only the no prior conditions law (and thus only very moderate implicit transfers) to the unregulated equilibrium, whereas young households with fair health would support the simultaneous introduction of both policies. The differences in the preference for different policy scenarios across different h-households are quantitatively very large: whereas fair- health types would be willing to pay 54% of laissez faire lifetime consumption to see both policies introduced, households of excellent health would be prepared to give up 4.5% of lifetime consumption to prevent exactly this policy innovation.
Serra, Goodwin, and Featherstone (2003) used simultaneous equation probit models and farm level data to estimate the changes in the participation for crop insurance of Kansas farmers in 1993 through 2000. During this period, many policy changes happened as discussed earlier, such as the launch of the CAT coverage and the revenue protection program. The probability of purchasing crop insurance was estimated in the first stage and the choice of the coverage level was estimated in the second stage. The major crops in Kansas including wheat, corn, sorghum, and soybeans were estimated together in their study, and a normalized yield was used. The mean coefficient of variation of yields in the preceding 10 years was utilized to measure the production risk level. The results show that the relationship between premium rates and the demand for crop insurance is statistically insignificant in 1995 and 1996 when the mandatory requirement was applied. The results also show that the magnitude of elasticities of demand for crop insurance with respect to premium rate decreased by the end of the 1990s when new insurancepolicies were introduced and subsidy rates increased. They also found that the use of inputs has statistically insignificant effects on the demand for crop insurance.
Insurance coverage of smoking cessation treatment differs from cigarette taxes and smoking bans in two ways. First, taxes and bans raise the monetary and time cost of smoking while insurance coverage of smoking cessation therapies lowers the cost of cigarette substitutes. In this manner, SCT coverage is more similar to interventions that provide incentives to quit smoking (Volpp, Gurmankin Levy, Asch, Berlin, Murphy, Gomez, Sox, Zhu, and Lerman, 2006; Volpp, Troxel, Pauly, Glick, Puig, Asch, Galvin, Zhu, Wan, DeGuzman, Corbett, Weiner, and Audrain- McGovern, 2009; Gin, Karlan, and Zinman, 2010). Second, cigarette taxes and smoking bans reduce smoking along two possible margins — by preventing ini- tiation of smoking among non-smokers and by reducing smoking among current smokers. Insurance coverage of SCTs reduces smoking along the second margin only, by helping current smokers quit. While preventing initiation of smoking cir- cumvents its health consequences altogether, quitting smoking can reverse many of its negative healtheffects. Smokers who quit experience reductions in the health costs of smoking including lower risk of cancer, coronary heart disease, and stroke and benefit from more years of life (Novello, 1990; Ostbye, Taylor, and Jung, 2002; Ostbye and Taylor, 2004).
𝑌 𝑖𝑟𝑡 is the outcome of interests, the life satisfaction of an individual i in region r in year t as an indicator of subjective well-being in the survey date. 𝑈 𝑖𝑟𝑡 is a binary variable for exogenous unemployment, such as workplace closure, layoff, or for other exogenous reasons, and 𝑂𝐿𝐹 𝑖𝑟𝑡 is another binary variable for being out of the labor force, excluding those in the employment control group. 𝑋 𝑖𝑟𝑡 is a vector of individual characteristics, including female (ref: male), age, age squared (divided by 100), dummies of education level, proxy of physical health, number of children, the economic level of household measured by financial assets (Nikolova & Ayhan, 2018) and dummy of home ownership as in table 2. 𝛽 1 is the coefficient of interest, which is expected to be negative if being unemployed harms the subjective well-being of the unemployed and her spouse. 𝛼 𝑖 is the fixed effects of individual time-invariant traits, 𝜗 𝑡 is the yearly fixed effects of global shocks common to all regions in each year, 𝜏 𝑟 is the regional fixed effects of unchanging local influences on life satisfaction within regions and 𝜀 𝑖𝑟𝑡 is individual error terms. As Di Tella et al. (2003) do, region- specific yearly trends in 𝜌 𝑟𝑡 are also considered along with yearly regional fixed effects. To examine the mediating effects of the social security system, Unemployment Benefit (UB), additional models considering spillover effects to spouses with superscript s will be considered as below:
To implement the control function approch, we created several instrumental variables. USDA-RMA’s county-level crop insurance experience (summary of business) data report the amounts of subsidized premiums for policies with different characteristics. We divide all the policies in the data into 8 groups along the following three dimensions: optional versus non-optional units, low (below 70%) versus high (from 70% to 85%) coverage levels, and revenue-based versus yield based policies. We then created eight per acre subsidy variables for the 8 groups, one for each group. But in estimation below, we only use six (first-lagged) of them because two combinations (the combination of optional units, low coverage level coverage, and revenue-based policies and the combination of optional units, high coverage level, and yield-based policies) have relatively smaller number of observations and using them would result in a significant loss of of observations. Due partly to the fact that insurance premiums in a county are determined by producers’ liabilities in the county and the loss cost ratio (i.e., indemnities/liabilities) history of then county and then the subsidy amounts
This essay examines topics in health economics. The first study uses data obtained from the Health and Retirement Study (HRS) and the Rand HRS files, to examine the relationship between access to retiree healthinsurance (RHI) and the decision to leave one’s career job. This paper does not restrict attention to individual’s who choose to take a full retirement, as recent data indicates that only 51.4% of individuals leave a career job and fully retire, while nearly 25% leave their career job, and pursue a partial retirement. In this paper a Cox Proportional Hazard Model with time varying covariates is utilized to estimate the probability that an individual disengages from their career job, given they have not yet done so. Results indicate that those with access to RHI are significantly more likely to leave their career employer in all time periods than identical individuals without RHI.
Self-assessed health is reported on a five-point scale from one (=very bad) to five (=very good) and explains a part of the adverse selection against the public sector: after controlling for observables, individuals with higher self-assessed health are less likely to be hospitalised and more likely to choose private insurance. This self-selection of consumers is consistent with the idea that private insurers screen their applicants. Healthy individuals choose private contracts with high deductibles, in return for low insurance premiums, whereas sick individ- uals prefer public insurance, which involves moderate cost sharing. One caveat applies to this result, however. The observables which are included in X can potentially not control for all the differences between individuals that affect the relative price between public and private healthinsurance. It could be, therefore, that self-assessed health picks up a part of the effect of the observables, meaning that the coefficients above are an upper bound on the impact of the unobservable (for insurers) part of health status on healthinsurance choice and hospitalisations. I will return to this issue in Section 1.6.3.
The results presented here clearly show a negative e¤ect of crisis exposure in utero. We ran a DD estimation which shows a loss of 0.28 z-score points for the youngest children in our sample who were exposed in utero, compared to older children who were not. We …nd no such e¤ect for children who were born 0-24 months prior to the onset of the crisis. It is di¢ cult to have a clear prediction a priori as to which part of the crisis period would have the largest in utero e¤ect. As reported by Suryahadi et al. (2002), poverty rates were higher in 1998 than 1999, but our results show that children born the 12 months period beginning September 1st 1999 were no less severely a¤ected than children born the prior year. We know from medical literature that the body composition of the mother at conception is possibly more important than nutritional intake during gestation (Barker, 1998) and our results show that young Indonesian children su¤ered more towards the end of the crisis. One possible explanation of our results could be that as we move further into the crisis, the body composition of mothers increasingly deteriorate. It is also possible that as the crisis progresses, mothers increasingly understand it’s severity and therefore stress levels increase with time, We also found that urban children were much more a¤ected than rural children who were seemingly una¤ected until the tail end of the crisis. This result makes the attribution of the negative health e¤ects to the …nancial crisis more credible as the crisis hit urban areas the hardest.
With both data sets, I estimate difference-in-differences models as well as models with flexible time effects, which allow the effects of legal recognition changes to vary over time. Allowing the effects of these laws to vary over time is important for several reasons. First, marriage decisions are typically made years in advance, meaning we might not see the effects of these laws immediately. Second, we can test for effects before changes in legal recognition. This allows us to examine if differing time trends before the legal changes are a concern and to see if there is any evidence that people respond after the laws are passed but before they are enacted. Finally, the number of same-sex couples marrying is likely to be at its highest in the first few years because of pent-up demand. Time-flexible specifications can help us compare immediate effects to longer run effects.
Individual healthinsurance is a type of policy that covers the medical expenses of only one person. Unlike group insurance, you purchase individual insurance directly from an insurance company or through an insurance agent. When you apply for individual insurance, you are evaluated in terms of how much risk you present to the insurance company. This is generally done through a series of medical questions or a physical exam. Your risk potential will determine whether you qualify for insurance and how much your insurance will cost. Individual insurance is
Prenatal environment has increasingly been recognized as having an important effect on adult health and diseases. Although the link between fetal conditions and future diseases has been studied since the 1940s, it was not until the 1990s that the fetal origins hypothesis was proposed by Barker (1990; 1995). That gave a greater impetus to subsequent research on this temporal linkage. The fetal origins hypothesis states that a fetus faced with a compromised intrauterine environment not only would slow down its growth to reduce nutritional requirements but also might make developmental adaptations by modifying its structure and physiology in a durable fashion, leading to a higher risk of developing chronic diseases in later life. The word “programming” thus is used to describe the linkage between fetal life and long-term consequences (Lucas 1991). Over the past two decades, such an association has been strongly supported by hundreds of human and animal studies. 1 For example, epidemiologic studies in populations worldwide have found that poor fetal growth resulting in low birth weight increases the risk of developing diseases in adulthood, including cardiovascular disease, type 2 diabetes, glucose intolerance, and hypertension. Economic studies further interpret the hypothesis as a major explanation for the temporal relationship between early environment and non-health capital. 2
to avoid payoff scale effect, all the menus of choices for the three MPL designs are developed such that the overall expected payoffs from the three payoff-based MPL designs are very close to each other. Needless to say, each price- based MPL design is exactly equivalent to its corresponding payoff-based MPL design in terms of its expected payoffs. Regarding the endowment effect, it should be noted that there is no possibility for the so-called endowment effect, since the subjects are explicitly told several times that they cannot take the endowment with them outside the lab, and that they have to buy the widgets using the endowment. In order to avoid any potential learning effect, subjects are not shown the outcome (payoff) of each task at the end of each task while they are conducting the tasks. In fact, they are shown the outcomes (payoffs) at the end of the experiment when they can observe all the payoffs associated with each task as well as the payoff selected at random for the purpose of payment. In order to avoid any potential order effects (including both ‘fatigue effect’ and ‘practice effect’), each subject sees the six tasks in a random order set by the computer. For example, one subject might be assigned to do Task 6 first, and then Task 4 afterwards, and so on, while another subject might be assigned to do Task 2 first, and then Task 1 afterwards, and so on, which are not necessarily the same as the order listed on the table of content of the instructions. Everybody in the pool of subjects participated in all the six tasks, so there is no selection bias. And finally, we consider fixed effects by making within-subjects comparisons, in which design the same group of subjects serves in all the six treatments. Therefore, there is no concern about subjects not being the same individuals.
Legislators and policy makers have pointed out the fundamental flaw existing in the state’s legislation that limits the extent of liability faced by producers with regards to damages from spills. In light of this perceived regulation laxity, legislators have debated whether policy can be developed to enable better management for producers and society of the risks of animal lagoon failures and waste spills. Three policy alternatives have been proposed. The first option is the optimal market-based solution, which would consist of farmers buying private liability insurance against animal lagoon failures and related costs. The second policy option would consist of the establishment of a mandatory risk pool whereby producers would be taxed in accordance to their risks and potential damage from spills to form an indemnity fund that would be used to address costs associated with spills. The third alternative discussed consists of extending the federal crop insurance program to include a subsidized plan that would indemnify producers against the liability associated with animal waste spills. Such policy option was discussed as the 2000 Risk Protection Act was debated, but found limited support for the possibility of increased moral hazard (Goodwin and Hallstrom 2004).