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CHAPTER 2. HEALTH PLAN CHOICE 75 Another useful feature of the data is that we observe each employer during their first year of participation in the program. Insurers have little information on firm characteristics beyond that provided by the intermediary during the first year, allow- ing us to observe how plans bid when they have similar information on the likely risk of a group. 11 On the demand side, a large literature documents that health plan choices are highly persistent (e.g., ?), so observing choice behavior in the first year likely provides a good indication of steady-state demand and allows us to observe the plan characteristics and prices at the time of initial choice. The data’s main limitations are the fairly small number of observations and restricted set of employee characteristics relative to, say, the HR records of a large employer, and also the aggregated reporting of realized costs. The 11 firms have 2,044 covered employees and 4,652 enrollees (employees and their dependents). We observe five of the employers for two years, creating a total of 3,683 employee-years and 6,603 enrollee-years. Table 2.1 provides summary statistics on the covered employees, the enrollees, and the firms. Sixty-two percent of employees are female; the average age is just over forty. Fifty-eight percent of enrollees are female and enrollees are younger on average than employees, driven primarily by covered children. Twenty-eight percent of employees enroll in a plan that covers their spouse and 27 percent enroll in a plan that covers at least one child. Table 2.1 also presents risk scores at the employee, enrollee, and employer lev- els. A score of one represents an average individual in a nationally representative sample, and a score of two indicates that an individual’s expected health costs are twice the average. The average risk scores of employees and enrollees are 1.25 and 1.01, respectively. The difference reflects the lower expected expenditures for covered children. Average risk ranges widely across employers, from 0.63 to 1.91. One reason for the degree of variation is the small number of enrollees at some of the firms in our data. This variation plays a key role in our analysis. We use information on insurer bids and realized costs to estimate models of the relationship between costs and risk. 11 In a few cases, an employer had a prior contract with one of the insurers. We have examined whether incorporating this into our employee demand model affects our estimates and found it did not. One concern is that this situation could result in asymmetric information between the plans in the bidding, but we think this is unlikely to be an important problem.
CHAPTER 2. HEALTH PLAN CHOICE 76 Because insurers report both bids and costs at the employer level, variation across employers in average risk is necessary to identify these relationships. Table 2.2 provides information on the plans offered by the employers in our sample. Most employers offer all four plans, and all offer both HMOs and at least one other plan. On average, the integrated HMO is the least expensive plan and has the lowest enrollee contribution. This plan features high rates of coinsurance, a low deductible, and a low out-of-pocket maximum. The network PPO is on average the most expensive plan and has the highest employee contribution. It features lower coinsurance rates, higher deductibles and higher maximum expenditures. Roughly speaking, the other two plans fall between these extremes. While bids for each plan vary substantially across tiers, reflecting differences in expected expenditures, the bids for tiers other than employee only are simply scaled by a factor that is very similar across both plans and employers. Employee contributions also vary across tiers, with employees typically facing a greater fraction of the plan bid for dependent coverage. Variation in these contributions is important for the identification of our demand model. We discuss contributions in detail in the identification section. We summarize enrollment patterns in Table 2.3. The integrated HMO attracts by far the most enrollees with a 59% market share among employees and 60% market share among enrollees. We also find little evidence of extensive risk selection across the plans. The integrated HMO attracts a slightly younger population, and women, particularly women employees, disproportionately choose the network and integrated HMOs. But the differences across the plans in both average age and average risk score are small. This lack of sorting is not driven by heterogeneity across firms in the choice sets. If we condition on employers that offer both the PPO and the integrated HMO, for example, the average enrollee risk is 1.04 in both plans.
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ESSAYS IN PUBLIC FINANCE AND INDUST
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I certify that I have read this dis
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insurance choice. Among other thing
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Acknowledgements I am deeply thankf
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Contents Preface iv Acknowledgement
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2.5.3 The Value of Plan Choice ....
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List of Tables 1.1 Asset Exemption
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4.9 First Week Contract Spending fo
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4.3 I.T. Contracting by Week ......
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CHAPTER 1. BANKRUPTCY 2 of the dead
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CHAPTER 1. BANKRUPTCY 4 relevant le
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CHAPTER 1. BANKRUPTCY 6 superficial
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CHAPTER 1. BANKRUPTCY 8 After treat
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CHAPTER 1. BANKRUPTCY 12 newly edit
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CHAPTER 1. BANKRUPTCY 15 bound of t
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CHAPTER 1. BANKRUPTCY 20 or coverag
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CHAPTER 1. BANKRUPTCY 22 homestead
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CHAPTER 3. MEDIGAP 128 We use boots
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CHAPTER 3. MEDIGAP 130 of costs and
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CHAPTER 3. MEDIGAP 132 policy that
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CHAPTER 3. MEDIGAP 134 3.6.2 Causal
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CHAPTER 3. MEDIGAP 136 3.6.3 Robust
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CHAPTER 3. MEDIGAP 138 calculated u
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CHAPTER 3. MEDIGAP 140 (10000,11000
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CHAPTER 3. MEDIGAP 142 Table 3.2: S
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CHAPTER 3. MEDIGAP 144 Table 3.4: H
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CHAPTER 3. MEDIGAP 146 Table 3.6: S
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CHAPTER 3. MEDIGAP 148 Table 3.8: R
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CHAPTER 3. MEDIGAP 150 Table 3.10:
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CHAPTER 3. MEDIGAP 152 Table 3.12:
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CHAPTER 4. YEAR-END SPENDING 154 bu
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CHAPTER 4. YEAR-END SPENDING 156 in
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CHAPTER 4. YEAR-END SPENDING 159 To
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CHAPTER 4. YEAR-END SPENDING 163 4.
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CHAPTER 4. YEAR-END SPENDING 179 to
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