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Amy Finkelstein - One of the best experts on this subject based on the ideXlab platform.
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The Interaction of Public and Private Insurance: Medicaid and the Long-Term Care Insurance Market
American Economic Review, 2008Co-Authors: Jeffrey R Brown, Amy FinkelsteinAbstract:We show that even incomplete public Insurance can crowd out Private Insurance demand. We estimate that Medicaid could explain the lack of Private long-term care Insurance for about two-thirds of the wealth distribution, even if no other factors limited the market's size. Yet Medicaid provides incomplete consumption smoothing for most individuals. Medicaid's crowd-out effect stems from the large implicit tax (about 60–75 percent for a median-wealth individual) that Medicaid imposes on Private Insurance. An implication is that public policies designed to stimulate the Private Insurance market will have limited efficacy as long as Medicaid's large implicit tax remains. (JEL G22, I18, I38)
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the interaction of public and Private Insurance medicaid and the long term care Insurance market
The American Economic Review, 2008Co-Authors: Jeffrey R Brown, Amy FinkelsteinAbstract:A long tradition in public finance examines how public programs can crowd out Private activ? ity in areas as diverse as education, savings, and Insurance, among others. These studies typi? cally focus on aggregate economic implications, particularly for government expenditures and national savings. In this paper, we demonstrate that crowd-out can also have an important effect on individual welfare. Specifically, we show that the provision of even very incomplete public Insurance can crowd out more comprehensive Private policies by imposing a large implicit tax on Private Insurance benefits, thus potentially increasing overall risk exposure for individuals. We examine the interaction of public and Private Insurance for one of the largest uninsured financial risks facing the elderly in the United States: long-term care expenditures. At $135 bil? lion in 2004, long-term care expenditures represented over 8.5 percent of total health expendi? tures/or all ages, or roughly 1.2 percent of GDP. Moreover, real long-term care expenditures are projected to triple over the next 35 years due to rising medical costs and the aging of the baby boomers. Only 10 percent of the elderly, however, have any Private long-term care Insurance, and one-third of expenditures are paid for out of pocket (Congressional Budget Office (CBO) 1999; CBO 2004; Brown and Finkelstein 2007). One potential explanation for the small size of the Private market is that the public Insurance provided by Medicaid may crowd out demand for Private Insurance. Medicaid was designed to provide long-term care Insurance for the poor elderly. Mark V. Pauly (1989,1990) has established the qualitative result that, as an incomplete but publicly funded source of long-term care insur? ance, Medicaid has the potential to reduce substantially demand for Private long-term care insur? ance, even among the nonpoor. Our work builds on this insight by quantifying the magnitude of Medicaid's crowd-out effect and the incomplete nature of Medicaid coverage. We also illustrate the mechanism behind Medicaid's crowd-out effect, and are, therefore, able to assess the likely impact of alternative policies on Private Insurance demand. We develop a utility-based model of a 65-year-old risk-averse individual who chooses an opti? mal intertemporal consumption path in the presence of uncertainty about long-term care expen? ditures. We calibrate the model using data on the distribution of long-term care expenditure risk, common state Medicaid rules, and the prices and coverage of typical Private long-term care Insurance policies.
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the interaction of public and Private Insurance medicaid and the long term care Insurance market
National Bureau of Economic Research, 2004Co-Authors: Jeffrey R Brown, Amy FinkelsteinAbstract:We show that the provision of even incomplete public Insurance can substantially crowd out Private Insurance demand. We examine the interaction of the public Medicaid program with the Private market for long-term care Insurance and estimate that Medicaid can explain the lack of Private Insurance purchases for at least two-thirds and as much as 90 percent of the wealth distribution, even if comprehensive, actuarially fair Private policies were available. Medicaid's large crowd out effect stems from the very large implicit tax (on the order of 60 to 75 percent for a median wealth individual) that Medicaid imposes on the benefits paid from Private Insurance policies. Importantly, Medicaid itself provides an inadequate mechanism for smoothing consumption for most individuals, so that its crowd out effect has important implications for overall risk exposure. An implication of our findings is that public policies designed to stimulate Private Insurance demand will be of limited efficacy as long as Medicaid continues to impose this large implicit tax.
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The interaction of partial public Insurance programs and residual Private Insurance markets: evidence from the US Medicare program.
Journal of health economics, 2004Co-Authors: Amy FinkelsteinAbstract:A ubiquitous form of government intervention in Insurance markets is to provide compulsory, but partial, public Insurance coverage and to allow voluntary purchases of supplementary Private Insurance. This paper investigates the effects of such programs on Insurance coverage for the risks not covered by the public program, using the example of the US Medicare program. I find that Medicare does not have substantial effects-in either direction-on coverage in residual Private Insurance markets. In particular, there is no evidence that Medicare is associated with reductions in Private Insurance coverage for prescription drug expenditures, an expenditure risk not covered by Medicare. Medicare is, however, associated with a shift in the source of prescription drug coverage, from employer-provided coverage to Medicare HMOs.
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The Interaction of Partial Public Insurance Programs and Residual Private Insurance Markets: Evidence from the U.S. Medicare Program
2002Co-Authors: Amy FinkelsteinAbstract:A ubiquitous form of government intervention in Insurance markets is to provide compulsory, but partial, public Insurance coverage and to allow voluntary purchases of supplementary Insurance on the Private market. Yet we know little about the effects of such programs on total Insurance coverage and on welfare. A primary concern is that the compulsory public Insurance program - designed to counter the effects of adverse selection in the Private Insurance market - may in fact exacerbate adverse selection pressures in the residual Private Insurance market. Theoretically, however, these programs may either improve or impair the functioning of the residual Private Insurance market. To examine this question empirically, I investigate the effect of the U.S. Medicare program - which provides partial public health Insurance to individuals aged 65 and over - on the Private Insurance market for prescription drugs, a benefit not provided by the public program. The results suggest that Medicare does not have substantial spillover effects on residual Private Insurance markets. In particular, there is no evidence that Medicare is associated with increased adverse selection problems in the residual Private health Insurance market.
Zirui Song - One of the best experts on this subject based on the ideXlab platform.
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Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change At Age Sixty-Five.
Health affairs (Project Hope), 2016Co-Authors: Jacob Wallace, Zirui SongAbstract:To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by Private Insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers-including governments. We examined how spending differed between Medicare and Private Insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from Private Insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter-or 32.4 percent-upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare's purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with Private Insurance, which pays higher provider prices than Medicare does.
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traditional medicare versus Private Insurance how spending volume and price change at age sixty five
Health Affairs, 2016Co-Authors: Jacob Wallace, Zirui SongAbstract:To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by Private Insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers—including governments. We examined how spending differed between Medicare and Private Insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from Private Insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter—or 32.4 percent—upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry int...
David L. Skaggs - One of the best experts on this subject based on the ideXlab platform.
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access to care for the adolescent anterior cruciate ligament patient with medicaid versus Private Insurance
Journal of Pediatric Orthopaedics, 2012Co-Authors: Tiffanie R Pierce, Charles T Mehlman, Junichi Tamai, David L. SkaggsAbstract:PURPOSE To determine the potential impact of type of health Insurance on access to outpatient orthopaedic care for an adolescent patient with an acute anterior cruciate ligament (ACL) tear. METHODS The offices of 42 orthopaedic surgeons in the Greater Cincinnati area, to include Ohio, Indiana, and Kentucky were contacted on 2 separate occasions describing a fictitious 14-year-old male with an acute ACL tear. The 2 calls were separated by a period of 2 to 4 weeks. The independent variable was the patient's Insurance status, reported as either Medicaid or Private Insurance. Statistical comparison of the rates of successful appointment scheduling was performed through the Fisher exact test. RESULTS Thirty-eight of 42 Orthopaedic surgery practices (90%) offered the Privately insured 14-year-old ACL patient an appointment within 2 weeks, while only 6 of 42 (14%) offered the Medicaid patient such an appointment. The difference in these rates was statistically significant (P<0.0001) with the odds of getting an appointment with Private Insurance being 57 times higher than that with Medicaid (95% confidence interval: 12.87, 288.62). CONCLUSIONS Access to orthopaedic care for children on Medicaid continues to be a problem in the United States. Previous pediatric studies have documented that the reason for these discrepancies in access are related primarily to Medicaid reimbursement rates (approximately 23% of Private Insurance). Ours is the first study to show that these same limitations exist for teenagers with acute knee injuries likely to require surgery.
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Access to urologic care for children in California: Medicaid versus Private Insurance
Urology, 2005Co-Authors: Andrew H. Hwang, Margaret M. Hwang, Hui-wen Xie, Brian E. Hardy, David L. SkaggsAbstract:Objectives To compare the access to urologic care for a child with cryptorchidism insured by Medi-Cal versus one insured by Private Insurance. Medi-Cal (California State Medicaid) is a joint state and federal health Insurance program that plays a significant role in providing healthcare coverage to low-income children. Methods A total of 54 randomly chosen urology offices throughout California were surveyed by telephone to determine whether the office accepted pediatric patients, accepted Medi-Cal, and when the earliest appointment date would be for a patient with Medi-Cal versus one with Private Insurance. Results Of the 46 practices that accepted pediatric patients, 96% offered a new patient appointment to a child with Private Insurance, but only 41% were willing to offer an appointment to a child with Medi-Cal (P
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Access to Orthopedic Care for Children With Medicaid Versus Private Insurance in California
Pediatrics, 2001Co-Authors: David L. Skaggs, Samantha M. Clemens, Michael G. Vitale, J. D. Femino, Robert M. KayAbstract:To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and by Private Insurance. Fifty randomly chosen offices of orthopedic surgeons were telephoned with the following scenario: "My 10-year-old son broke his arm last week during a vacation" followed by a request for an appointment that week. Each office was called twice with an identical script except for Insurance status: once with Medi-Cal and once with Private Insurance. All 50 offices offered an appointment to see the child with Private Insurance within 7 days. Only 1 of the same 50 offices offered an appointment to see the child with Medi-Cal within 7 days. Of the offices that would not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal. Timely access to orthopedic care was available in 100% of offices polled to a child with Private Insurance versus in 2% of offices to a child with Medi-Cal. This is a significant difference. Lack of timely orthopedic care may result in poor outcome, ie, if a fracture is not properly aligned in the first few weeks, a permanent deformity may result. Although causation cannot be established from this study, we suspect that Medi-Cal reimbursement rates below the cost of office overhead may be of significance. Although federal guidelines require that payments must be sufficient to enlist enough providers so that services to Medi-Cal recipients are available to the same extent as those available to the general population, this study finds that that children with Medi-Cal Insurance have significantly less access to timely orthopedic care.
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access to orthopedic care for children with medicaid versus Private Insurance in california
Pediatrics, 2001Co-Authors: David L. Skaggs, Samantha M. Clemens, Michael G. Vitale, J. D. Femino, Robert M. KayAbstract:Objective. To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and by Private Insurance. Study Design. Fifty randomly chosen offices of orthopedic surgeons were telephoned with the following scenario: “My 10-year-old son broke his arm last week during a vacation” followed by a request for an appointment that week. Each office was called twice with an identical script except for Insurance status: once with Medi-Cal and once with Private Insurance. Results. All 50 offices offered an appointment to see the child with Private Insurance within 7 days. Only 1 of the same 50 offices offered an appointment to see the child with Medi-Cal within 7 days. Of the offices that would not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal. Conclusions. Timely access to orthopedic care was available in 100% of offices polled to a child with Private Insurance versus in 2% of offices to a child with Medi-Cal. This is a significant difference. Lack of timely orthopedic care may result in poor outcome, ie, if a fracture is not properly aligned in the first few weeks, a permanent deformity may result. Although causation cannot be established from this study, we suspect that Medi-Cal reimbursement rates below the cost of office overhead may be of significance. Although federal guidelines require that payments must be sufficient to enlist enough providers so that services to Medi-Cal recipients are available to the same extent as those available to the general population, this study finds that that children with Medi-Cal Insurance have significantly less access to timely orthopedic care.
Emmanuel Saez - One of the best experts on this subject based on the ideXlab platform.
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optimal taxation and social Insurance with endogenous Private Insurance
American Economic Journal: Economic Policy, 2010Co-Authors: Raj Chetty, Emmanuel SaezAbstract:We characterize welfare gains from government intervention when the Private sector provides partial Insurance. We analyze models in which adverse selection, pre-existing information, or imperfect optimization create a role for government intervention. We derive formulas that map existing empirical estimates into quantitative predictions for optimal policy. When Private Insurance generates moral hazard, standard formulas for optimal government insur- ance must be modified to account for fiscal externalities. In con- trast, standard formulas are unaffected by "informal" Private Insurance that does not generate moral hazard. Applications to health and unemployment show that formal Private market insur- ance can significantly reduce optimal government benefit rates. (JEL D82, G22, H21, H23, J65)
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optimal taxation and social Insurance with endogenous Private Insurance
NBER Chapters, 2010Co-Authors: Raj Chetty, Emmanuel SaezAbstract:This paper characterizes the welfare gains from redistributive taxation and social Insurance in an environment where the Private sector provides partial Insurance. We analyze stylized models in which adverse selection, pre-existing information, or imperfect optimization in Private Insurance markets create a role for government intervention. We derive simple formulas that map reduced-form empirical estimates into quantitative predictions for optimal tax and social Insurance policy. Applications to unemployment and health Insurance show that taking Private market Insurance into account matters significantly for optimal benefit levels given existing empirical estimates of the key parameters. (This abstract was borrowed from another version of this item.)
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optimal taxation and social Insurance with endogenous Private Insurance
2008Co-Authors: Raj Chetty, Emmanuel SaezAbstract:This paper characterizes the welfare gains from redistributive taxation and social Insurance in an environment where the Private sector provides partial Insurance. We analyze stylized models in which adverse selection, pre-existing information, or imperfect optimization in Private Insurance markets create a role for government intervention. We derive simple formulas that map reduced-form empirical estimates into quantitative predictions for optimal tax and social Insurance policy. Applications to unemployment and health Insurance show that taking Private market Insurance into account matters significantly for optimal benefit levels given existing empirical estimates of the key parameters.
Jacob Wallace - One of the best experts on this subject based on the ideXlab platform.
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Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change At Age Sixty-Five.
Health affairs (Project Hope), 2016Co-Authors: Jacob Wallace, Zirui SongAbstract:To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by Private Insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers-including governments. We examined how spending differed between Medicare and Private Insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from Private Insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter-or 32.4 percent-upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare's purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with Private Insurance, which pays higher provider prices than Medicare does.
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traditional medicare versus Private Insurance how spending volume and price change at age sixty five
Health Affairs, 2016Co-Authors: Jacob Wallace, Zirui SongAbstract:To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by Private Insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers—including governments. We examined how spending differed between Medicare and Private Insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from Private Insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter—or 32.4 percent—upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry int...
