دانلود مقاله ISI انگلیسی شماره 10632
عنوان فارسی مقاله

# اثر پوشش مدیکر غیر فعال در بازار بیمه خصوصی

کد مقاله سال انتشار مقاله انگلیسی ترجمه فارسی تعداد کلمات
10632 2010 8 صفحه PDF سفارش دهید 6680 کلمه
خرید مقاله
پس از پرداخت، فوراً می توانید مقاله را دانلود فرمایید.
عنوان انگلیسی
The effect of Medicare coverage for the disabled on the market for private insurance
منبع

Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)

Journal : Journal of Health Economics, Volume 29, Issue 3, May 2010, Pages 418–425

کلمات کلیدی
اقتصاد بهداشت - درمان
پیش نمایش مقاله

#### چکیده انگلیسی

We investigate whether the removal of high-cost individuals from private insurance markets leads to greater coverage for individuals who are similar but not as high cost. Using data on insurance coverage from the Panel Study of Income Dynamics, we estimate the effect of the extension of Medicare to the disabled on the private insurance coverage of non-disabled individuals. We find that the insurance coverage of individuals who had a health condition that limited their ability to work increased significantly in states with high versus low rates of disability.

#### مقدمه انگلیسی

Using an important policy natural experiment, we have estimated the extent to which subsidies to cover high-cost individuals affect insurance coverage of others. According to our point estimates, extension of Medicare to an additional 0.5 percentage point of the population through the Social Security Disability Insurance program led to an increase in private insurance coverage of between 7.8 and 13.3 percentage points among individuals who described themselves as limited in the kind or amount of work that they can do. In 1980, these work-limited individuals were 15.7% of the total population. Thus, extending Medicare to an additional 0.5 percentage points of the population increased total insurance coverage by 1.2 (=0.157 × 7.8) to 2.1 (=0.157 × 13.3) percentage points. Subtracting off the 0.5 points due to the direct effect of the program gives a range for the spillover effect of 0.7 (=1.2 − 0.5) to 1.6 (=2.1 − 0.5) percentage points. Our results can be used to calculate the marginal “target efficiency” of extending Medicare to the disabled in the 1970s. Gruber (2003), for example, suggests evaluating such programs in terms of a “bang for the buck” — the total government spending per dollar of insurance cost covered (that is, the cost per newly insured weighted by the cost of those who are gaining insurance). Medicaid expansions to low-income adults, according to Gruber, have a budget cost of $1.30 per dollar of previously uncovered health costs. The budget cost exceeds$1.00 because of crowding-out of private coverage; for every $1.00 the government spends to newly insure someone with Medicaid, it must also give insurance to some number of individuals who would have had private coverage. Using the midpoint of our range of estimates of the extent of crowding-in of the non-disabled population of 1.15 percentage points (1.15 = ((0.7 + 1.6)/2)) per 0.5 percentage points of Medicare expansion, the formula for the target efficiency of the program is: View the MathML source Turn MathJax on where λ is the extent of crowding-out of private insurance by Medicare; cd is the cost of public insurance for a newly covered disabled person; and cn is the cost of private insurance for a newly covered non-disabled person. As the formula shows, one cannot calculate the target efficiency of the policy without information on extent of crowding-out of the program, the health spending of the newly covered disabled individuals, and the health spending of the newly covered non-disabled individuals. However, it is possible to calculate the conditions under which it is more target-efficient than a typical Medicaid expansion,5 or under which it achieves a target efficiency of less than one dollar per dollar of previously uncovered health costs — that is, no target efficiency cost. For example, assuming complete crowding-out of private insurance coverage (λ = 1) for the disabled, the target efficiency of the program reduces to 0.5cd/1.15cn. Thus, even with 100% crowd-out, the program is still more target-efficient than a typical Medicaid expansion, as long as 0.5cd/1.15cn < 1.3, or (cn/cd) > 0.33; the program has no target efficiency cost at all as long as 0.5cd/1.15cn < 1, or (cn/cd) > 0.43. In 2003, Medicare reimbursed$6471 per disabled enrollee in the program, while the annual premium for a conventional, single-person employer-sponsored insurance policy was \$3576 (Kaiser Family Foundation, Employer Health Benefits 2003 Survey), yielding an estimate of (cn/cd) of 0.553. Hence, at recent values of cn and cd, the program is highly target-efficient. The extent to which our estimates of the effects of the extension of Medicare can be extrapolated to future targeted subsidies remains an open question. Although our point estimates are quite large, several factors suggest caution in applying them out-of-sample. First, our estimates are measured with considerable error: the lower 95% confidence bound in most specifications is approximately half the size of the point estimate. In addition, the extension of Medicare to the disabled arguably removed the most seriously chronically ill from the private insurance pool, and removed them completely; the people who would be covered by most proposed policies are likely to be less costly over the long run than SSDI recipients, and are likely to be subsidized less than fully. Future work might seek to account for these differences and use these estimates to simulate the effects of programs that are similar but not identical to the extension of Social Security to the disabled.