Quantitative analysis of health insurance reform: Separating regulation from redistribution

Pashchenko, Svetlana; Porapakkarm, Ponpoje

doi:10.1016/j.red.2012.09.002

Cited by 97 publications

(100 citation statements)

References 33 publications

(58 reference statements)

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“…Several new papers study the importance of medical expense risk in general equilibrium, including Hansen, Hsu, and Lee (2012), Pashchenko and Porapakkarm (2013), and Imrohoroglu and Kitao (2012). Kopecky and Koreshkova (2014) find that old-age medical expenses and the coverage of these expenses provided by Medicaid have large effects on aggregate capital accumulation.…”

Section: Literature Reviewmentioning

confidence: 99%

Medicaid Insurance in Old Age

Nardi

French

Jones

2016

American Economic Review

123

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Many elderly households benefit from Medicaid, a means-tested, public health insurance program. Despite the increasing importance of Medicaid in the presence of an aging population and rising medical costs, very little is known about how Medicaid payments are distributed among the elderly and how the elderly value these payments. Which elderly households receive Medicaid transfers? How redistributive are these transfers and the taxes needed to finance them? What is the insurance value of these transfers? Is Medicaid of about the right size? How much would people lose if it were cut? These are important questions to answer before reforming the programs currently in place. In this paper we seek to fill this gap.We focus on single retirees, who comprise about 50 percent of people aged 70 or older and 70 percent of households aged 70 or older. We document new facts on Medicaid recipiency in the Assets and Health Dynamics Among the Oldest Old (AHEAD) data and show that, while the recipiency rate in the bottom income quintile is around 70 percent throughout retirement, the recipiency rate of higher-income

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Section: Literature Reviewmentioning

confidence: 99%

Medicaid Insurance in Old Age

Nardi

French

Jones

2016

American Economic Review

123

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“…The general results suggest that the health insurance can improve access to hospital, but the impact on OOP health expenditure reduction is paradoxical. For example, for the developed counties in the United States, Canada, Australia and so on, the empirical results indicate that healthcare programme indeed increases healthcare utilization among the poor (Sinclair and Smetters 2004;Goldman et al 2006,Kopecky and Koreshkova 2009,Pashchenko and Porapakkarm 2013, and crowds out medical spending for individuals with low wealth and low health status (Ariizumi 2008), but the OOP spending seems to have increased for the insured in urban areas (Suryahadi 2013). While in developing regions, most of the studies concluded the increasing coverage of health insurance has also increased hospital utilization (Cheng and Chiang 1997;Chen et al 2007) and lowered outpatient and inpatient treatment costs in Vietnam and Mexico (Wagstaff and Pradhan 2006;Galárraga et al 2010), particularly for the low-income households (Sheu and Lu 2014), However, Wagstaff (2010) found no impact of Vietnam's recent healthcare fund for the poor and on hospital utilization, although it does seem to have reduced OOP health spending.…”

Section: Impact Of Healthcare On Medical Expenditurementioning

confidence: 99%

Impact of healthcare insurance on medical expense in China: new evidence from meta-analysis

et al. 2017

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This paper is aimed to make sense of the real effect of implement of social healthcare insurance on one's medical expense in China. Due to previous studies drew various and inconsistent conclusions on this issue, this works intend to apply meta-analysis to the problem. For 31 related studies, we first implement an advanced conditional Dirichlet-based Bayesian semi-parametric model specific to meta-analysis, and come to a primary conclusion that healthcare possesses little probability reducing one's medical expense in China. Further, the authors conduct random effects meta-regression and find that heterogeneity exists among the observed effect sizes. Mixed effects model shows that the age variation may is actually the heterogeneity source. The coefficients for Nonold and Old are respectively 0.29 and 0.54, implying that when researching on the medical expense for the elderly, it is more likely to conclude the medical insurance could increase medical spending. The coefficients for IV and OLS are both National Center for Mathematics and Interdisciplinary Sciences, CAS, Beijing, China remarkably negative at 90% confidence level. This suggests when directly using Instrument Variable (IV) approach and OLS method to assess the implementation effect for the healthcare insurance, it is inclined to result in the reduced impact on medical expense. We deduce this is because this two methods can't solve the sample-selection bias when compared with the Two-part model and difference-in-difference (DID) model. Based on the results and discussion, we finally propose suggests for the government.

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“…The Cobb-Douglas function parameter α is set at 0.33, which corresponds to the 11 More details are available in Pashchenko and Porapakkarm (2013b). 12 Given that we have indivisible labor supply we cannot pin down this parameter using a moment in the data.…”

Section: Demographics Preferences and Technologymentioning

confidence: 99%

Cross-Subsidization in Employer-Based Health Insurance and the Effects of Tax Subsidy Reform

Pashchenko¹,

Porapakkarm

2013

SSRN Journal

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A major source of insurance coverage for non-elderly adults in the US is employer-based health insurance market. Every participant of this market gets a tax subsidy since premiums are excluded from taxable income. However, people have different incentives to participate in the employer-based pool -since premiums are independent of individual risk, high-risk individuals receive implicit cross-subsidies from low-risk individuals. In this paper we explore several ways to reform the tax subsidy by taking this implicit cross-subsidization into account. We construct a general equilibrium heterogeneous agents model and calibrate it using the Medical Expenditure Panel Survey Dataset. We find that even though the complete elimination of the tax subsidy leads to the unraveling of the employer-based pool, there is still room for substantial savings by targeting the tax subsidy. More specifically, the same level of risk-sharing in the employer-based market can be achieved at one third of the current costs if i) the tax subsidy is targeted only towards low-risk people who have weak incentives to participate in the pool, and ii) employer-based insurance premiums become age-adjusted. To improve welfare outcome of this reform the tax subsidy should also be extended to low-income individuals.

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Quantitative analysis of health insurance reform: Separating regulation from redistribution

Cited by 97 publications

References 33 publications

Medicaid Insurance in Old Age

Medicaid Insurance in Old Age

Impact of healthcare insurance on medical expense in China: new evidence from meta-analysis

Cross-Subsidization in Employer-Based Health Insurance and the Effects of Tax Subsidy Reform

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