انتخاب معکوس در بازارهای بیمه سلامت؟ شواهد از گروه کوچک اصلاحات بیمه سلامتی دولتی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|24377||2005||13 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Public Economics, Volume 89, Issues 9–10, September 2005, Pages 1865–1877
The past decade witnessed major changes in state laws governing the sale of health insurance to small employers. States took measures to restrict insurers' ability to distinguish between high and low-risk customers because of concern about the low rate of coverage among workers in small firms, the high prices in the small-group market and the absence of federal health reform. Using both individual-level and employer-level data, I test predictions about the effect of reforms on the employer-provided health insurance market. I estimate these effects for small firms and their workers using large firms and their workers in the same states, as well as large and small firms and their workers in non-reform states, as comparison groups. I find the reforms decreased the rate of employer coverage on average for workers in small firms by less than two percentage points. Within small firms, low-expenditure individuals experienced a larger decline in the rate of coverage through their employer, while the coverage rate of high-expenditure individuals rose slightly in some specifications. There is also evidence that comprehensive reforms increased premiums slightly for small employers, and that most of this increase was passed on to workers through higher employee contributions.
Fearing that low health insurance coverage in small firms could be partly due to experience rating and redlining,1 many states introduced laws that restricted these practices in the small-group market. Inability to price and issue policies in accordance with risk could worsen informational asymmetry and resulting adverse selection relative to the unregulated market. Adverse selection is thought to generally reduce the insurance consumption of the low-risk groups, to transfer resources from the low-risk group to the high-risk group in cases where subsidized equilibria are sustained, or to result in a market failing to exist altogether. A simple model of insurance where employers buy policies on behalf of their heterogeneous workforce suggests that small group reforms may decrease coverage for the low-risk and increase coverage for the high-risk (see Simon, 2004), while the predicted changes are ambiguous for the market on average. This comprehensive empirical analysis of state attempts to standardize the terms of insurance across different risk types suggests that reforms have not succeeded in increasing coverage in small firms as a whole. Instead, they may have inadvertently led to a small overall decrease in coverage through an increase in premiums and employee contributions. This analysis also suggests that certain low-cost populations have suffered larger declines in coverage than others.
نتیجه گیری انگلیسی
The empirical results in this paper suggest that stringent small-group reforms have spread the costs associated with health risks more evenly across the market and may have unintentionally reduced insurance coverage through increased premiums and employee contributions. The analysis of both employer and individual data yields fairly consistent answers. Given that employers pass on about 75% of the premium hike as increased employee contributions, it appears that employee contributions serve the role of allowing employers to compensate workers efficiently. The results also suggest that young single men were particularly sensitive to premium changes in their take-up decisions, although the magnitude is larger than expected since the combination of gender, age and marital status were observable to insurers in half the reform states. Further research is needed with more detailed health risks than available in the CPS to fully understand the impact of reform by risk level. Specification checks indicate that the relationships emerging from my analysis represent more than chance correlation. Economic theories of insurance markets warn us that preventing insurers from distinguishing between different risk groups may worsen the availability of insurance for healthier individuals but not for those who are considered medically expensive. This analysis of small-group health insurance reform reveals the complexity of regulating a market subject to adverse selection. By changing the rules of conduct for insurers, states did not directly address what many argue is the single most important reason why small firms are uninsured—high prices. Several questions about the effects of government intervention in health insurance markets remain unanswered. If forcing insurers to treat all customers alike does not produce optimal results, then what will? Should government policy encourage small employers to band together in purchasing pools to take advantage of size as large firms do? The optimal design of insurance regulations that takes adverse selection behavior into account, and other solutions to reducing the medical uninsurance problem remain areas of high priority for future research.