essays in public finance and industrial organization a dissertation ...

More documents

Recommendations

Info

CHAPTER 2. HEALTH PLAN CHOICE 67 on patient cost sharing and primary care gatekeepers to control utilization. The other has an integrated and closed delivery system and requires little patient cost sharing. Estimates from the cost model suggest that these insurers have very different cost structures. While costs are similar between the two for individuals of average health, the integrated delivery system has higher costs for healthy enrollees and significantly lower costs for less healthy enrollees. On the demand side, we find that household preferences as well as health status affect plan choice. However, in contrast to other studies, we find that no single plan experiences systematic adverse selection. An interesting feature of our data is that the plans are not obviously ordered by coverage level: consumers have to trade off provider network restrictions against the level of cost sharing. This “horizontal” plan differentiation differentiates our setting from that of many other studies in which consumers choose how much coverage to purchase. We view this horizontal plan differentiation as the likely explanation for the lack of systematic adverse selection. This type of differentiation seems particularly salient given the recent evolution of the health insurance market. In 1987, approximately three-quarters of people with employer-sponsored health insurance had conventional coverage, under which plans differed primarily in their cost sharing. By 2007, in contrast, the market was domi- nated by managed care plans which use a mix of supply-side and demand-side utilization management (?). This evolution suggests that classic insights based on purely risk-based sorting may not adequately capture the dynamics of today’s market. 2 The inefficiencies we find are driven by two forces: heterogeneity in household preferences and the significant cost advantage of the integrated system for individuals in worse health. Our estimates suggest that although high risk households have some preference for flexibility, a large fraction would choose the integrated delivery system if they had to internalize the relevant cost differential between plans. Achieving this with a uniform contribution policy, however, would require that all households face a steep premium for the more flexible insurer. This in turn would create a welfare loss for lower risk households who value flexibility. While the exact numbers we estimate 2 ? stress that a broad view of heterogeneity in preferences is important for understanding many aspects of insurance markets.
CHAPTER 2. HEALTH PLAN CHOICE 68 are of course specific to our setting, the trade-off we identify may be relevant more broadly. This analysis suggests that the integrated model of health care delivery faces an important challenge in health insurance markets: current pricing policies make it difficult to target households for whom the integrated model promises substantial cost savings. Our analysis ties in to past work on health plan choice and the efficiency of health insurance markets. We draw on this work on health plan choice, which is summarized by ? and ?, in modeling how employee demand varies with observed and unobserved risk and preference characteristics. Our paper is more directly related to recent work that uses econometric methods to quantify the efficiency implications of adverse selection in health insurance markets (?????). Our paper points out that uniform pricing, as is commonly observed, may lead to inefficiency when enrollees of similar risk have different preferences for coverage. These other papers, in contrast, analyze alternative institutional features of health insurance markets that contribute to adverse selection. We relate both our empirical approach and our findings to these papers in Section 2.5.4. We emphasize that our analysis has some important limitations. First, it is based on a particular, and only moderately-sized, sample of workers and firms. To address this, we perform a variety of sensitivity analyses on our key parameter estimates, which we discuss in the last section. Second, we take plan offerings as given. This seems reasonable given that we are looking at small to medium size employers, but a broader analysis of pricing ideally would incorporate plan design. Third, we do not address issues of utilization behavior, or try to assess the relative social efficiency of health care utilization under the different plans in our data. Finally, our analysis is based on a static model, so we abstract from issues of dynamic insurance. We discuss this issue in the conclusion. 2.2 Health Plan Pricing and Market Efficiency We illustrate the relationship between pricing and market efficiency by adapting the model of ?. In their model, consumers are distinguished by their forecastable health
Page 1 and 2:
ESSAYS IN PUBLIC FINANCE AND INDUST
Page 3 and 4:
I certify that I have read this dis
Page 5 and 6:
insurance choice. Among other thing
Page 7 and 8:
Acknowledgements I am deeply thankf
Page 9 and 10:
Contents Preface iv Acknowledgement
Page 11 and 12:
2.5.3 The Value of Plan Choice ....
Page 13 and 14:
List of Tables 1.1 Asset Exemption
Page 15 and 16:
4.9 First Week Contract Spending fo
Page 17 and 18:
4.3 I.T. Contracting by Week ......
Page 19 and 20:
CHAPTER 1. BANKRUPTCY 2 of the dead
Page 21 and 22:
CHAPTER 1. BANKRUPTCY 4 relevant le
Page 23 and 24:
CHAPTER 1. BANKRUPTCY 6 superficial
Page 25:
CHAPTER 1. BANKRUPTCY 8 After treat
Page 29:
CHAPTER 1. BANKRUPTCY 12 newly edit
Page 32:
CHAPTER 1. BANKRUPTCY 15 bound of t
Page 37 and 38: CHAPTER 1. BANKRUPTCY 20 or coverag
Page 39 and 40: CHAPTER 1. BANKRUPTCY 22 homestead
Page 41 and 42: CHAPTER 1. BANKRUPTCY 24 log seizab
Page 43 and 44: CHAPTER 1. BANKRUPTCY 26 on the bas
Page 45 and 46: CHAPTER 1. BANKRUPTCY 28 to seizabl
Page 48 and 49: CHAPTER 1. BANKRUPTCY 31 CARA utili
Page 50 and 51: CHAPTER 1. BANKRUPTCY 33 Puzzle 3:
Page 52: CHAPTER 1. BANKRUPTCY 35 of income
Page 57 and 58: CHAPTER 1. BANKRUPTCY 40 TaxSim pro
Page 59 and 60: Payments CHAPTER 1. BANKRUPTCY 42 $
Page 61 and 62: OOP payments CHAPTER 1. BANKRUPTCY
Page 63 and 64: ln(seizable sssets) CHAPTER 1. BANK
Page 65 and 66: 50 60 70 80 90 100 Insurance covera
Page 67 and 68: Pr(WTP > premium) CHAPTER 1. BANKRU
Page 69 and 70: CHAPTER 1. BANKRUPTCY 52 Table 1.1:
Page 79 and 80: CHAPTER 1. BANKRUPTCY 62 Table 1.11
Page 81 and 82: CHAPTER 1. BANKRUPTCY 64 Table 1.14
Page 83: CHAPTER 2. HEALTH PLAN CHOICE 66 pl
Page 87: CHAPTER 2. HEALTH PLAN CHOICE 70 pl
Page 90 and 91: CHAPTER 2. HEALTH PLAN CHOICE 73 va
Page 92 and 93: CHAPTER 2. HEALTH PLAN CHOICE 75 An
Page 94 and 95: CHAPTER 2. HEALTH PLAN CHOICE 77 2.
Page 98 and 99: CHAPTER 2. HEALTH PLAN CHOICE 81 wh
Page 100 and 101: CHAPTER 2. HEALTH PLAN CHOICE 83 cr
Page 105 and 106: CHAPTER 2. HEALTH PLAN CHOICE 88 2.
Page 107 and 108: CHAPTER 2. HEALTH PLAN CHOICE 90 av
Page 109 and 110: CHAPTER 2. HEALTH PLAN CHOICE 92 ar
Page 111 and 112: CHAPTER 2. HEALTH PLAN CHOICE 94 le
Page 113 and 114: CHAPTER 2. HEALTH PLAN CHOICE 96
Page 115 and 116: CHAPTER 2. HEALTH PLAN CHOICE 98 ef
Page 117 and 118: CHAPTER 2. HEALTH PLAN CHOICE 100 2
Page 119 and 120: CHAPTER 2. HEALTH PLAN CHOICE 102 T
Page 121: CHAPTER 2. HEALTH PLAN CHOICE 104 T
Page 128 and 129: CHAPTER 2. HEALTH PLAN CHOICE 111 F
Page 130 and 131: CHAPTER 2. HEALTH PLAN CHOICE 113 6
Page 134 and 135:
Chapter 3 Private Coverage and Publ
Page 136 and 137:
CHAPTER 3. MEDIGAP 119 be of intere
Page 138 and 139:
CHAPTER 3. MEDIGAP 121 hazard for i
Page 140 and 141:
CHAPTER 3. MEDIGAP 123 have benefit
Page 145 and 146:
CHAPTER 3. MEDIGAP 128 We use boots
Page 147 and 148:
CHAPTER 3. MEDIGAP 130 of costs and
Page 149 and 150:
CHAPTER 3. MEDIGAP 132 policy that
Page 151 and 152:
CHAPTER 3. MEDIGAP 134 3.6.2 Causal
Page 153 and 154:
CHAPTER 3. MEDIGAP 136 3.6.3 Robust
Page 155 and 156:
CHAPTER 3. MEDIGAP 138 calculated u
Page 157 and 158:
CHAPTER 3. MEDIGAP 140 (10000,11000
Page 159 and 160:
CHAPTER 3. MEDIGAP 142 Table 3.2: S
Page 161 and 162:
CHAPTER 3. MEDIGAP 144 Table 3.4: H
Page 163 and 164:
CHAPTER 3. MEDIGAP 146 Table 3.6: S
Page 165 and 166:
CHAPTER 3. MEDIGAP 148 Table 3.8: R
Page 167 and 168:
CHAPTER 3. MEDIGAP 150 Table 3.10:
Page 169 and 170:
CHAPTER 3. MEDIGAP 152 Table 3.12:
Page 171 and 172:
CHAPTER 4. YEAR-END SPENDING 154 bu
Page 173 and 174:
CHAPTER 4. YEAR-END SPENDING 156 in
Page 176:
CHAPTER 4. YEAR-END SPENDING 159 To
Page 180 and 181:
CHAPTER 4. YEAR-END SPENDING 163 4.
Page 182 and 183:
CHAPTER 4. YEAR-END SPENDING 165 or
Page 184 and 185:
CHAPTER 4. YEAR-END SPENDING 167 ha
Page 186 and 187:
CHAPTER 4. YEAR-END SPENDING 169 It
Page 189:
CHAPTER 4. YEAR-END SPENDING 172 To
Page 192 and 193:
CHAPTER 4. YEAR-END SPENDING 175 0.
Page 194 and 195:
CHAPTER 4. YEAR-END SPENDING 177 Th
Page 196 and 197:
CHAPTER 4. YEAR-END SPENDING 179 to
Page 198 and 199:
CHAPTER 4. YEAR-END SPENDING 181 Co
Page 200 and 201:
CHAPTER 4. YEAR-END SPENDING 183 Fi
Page 202 and 203:
CHAPTER 4. YEAR-END SPENDING 185 Sp
Page 204 and 205:
CHAPTER 4. YEAR-END SPENDING 187 Ta
Page 206 and 207:
Page 208 and 209:
Page 210 and 211:
Page 212 and 213:
Page 214 and 215:
show all

essays in public finance and industrial organization a dissertation ...

Create successful ePaper yourself

Delete template?

Save as template?