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Mutual benefit societies evolved as the major provider for sickness, accident and life insurance in the late nineteenth and early twentieth centuries on both sides of the Atlantic. One of the major problems facing insurers was the risk of adverse selection, i.e. that unhealthy individuals had more incentives than healthy individuals to insure when priced for the average risk. By empirically examining whether longevity among insured individuals in a nationwide mutual health society was different from a matched sample of uninsured individuals, we seek to identify the presence of adverse selection. We find no compelling evidence showing that unhealthy individuals were more likely to insure, or reasons to believe that problems related to adverse selection would have been a major reason for government intervention in the health insurance market in Sweden. [ABSTRACT FROM AUTHOR]

The generalized risk-adjusted cost-effectiveness (GRACE) analysis method modifies standard cost-effectiveness analysis (CEA), the primary method currently used worldwide to value health improvements arising from healthcare interventions. Generalizing standard CEA, GRACE allows for decreasing or even increasing returns to health. Previous presentations of GRACE have relied extensively on Taylor Series expansion methods to specify key model parameters, including those that properly adjust for illness severity and preexisting disability, consequences of uncertain treatment outcomes, and the marginal rate of substitution between life expectancy and health-related quality of life. Standard CEA cannot account for these sources of value or cost in its valuation of medical treatments. However, calculations of GRACE measures based on Taylor Series are approximations, which may be poorly behaved in some contexts. This paper provides a new approach for implementing GRACE, using exact utility functions instead of Taylor Series approximations. While any proper utility function will suffice, we illustrate with three well-known functions: constant relative risk aversion (CRRA) utility; hyperbolic absolute risk aversion (HARA) utility, of which CRRA is a special case; and expo-power (EP) utility, of which constant absolute risk aversion (CARA) is a special case. The analysis then extends from two-period to multiperiod models. We discuss methods to estimate parameters of HARA and EP functions using two different types of data, one from discrete choice experiments and the other from "happiness economics" methods. We conclude with some reflections on how this analysis might affect benefit-cost analysis studies of healthcare interventions. [ABSTRACT FROM AUTHOR]

ObjectiveTo quantify the effect of the unemployment created by COVID-19 on access to (sales of) statin drugs in the United States population.MethodsApproximately half a billion transactions for statin drugs in the United States between January 2018 and September 2020 are analyzed. We studied the potential causal relation between abnormal levels of unemployment during the first wave of COVID-19 in the U.S. and abnormal levels of sales of statin products (both variables defined at the state/week level). Variables are analyzed using the Two-Stage Least Squares (2SLS) method, which exploits comparisons of statin sales between states where, given the occupational distribution of their workforce, unemployment was more structurally vulnerable to mobility restrictions derived from COVID-19 against states where it was less structurally vulnerable.ResultsWhile we do not find unemployment effects on statin sales on most of the population, our estimates link COVID-fueled unemployment with a sharp sales reduction among Medicaid-insured populations, particularly those in working age. For the period between March and August of 2020, these estimates imply a 31% drop of statin sales among this population.DiscussionCOVID-fueled unemployment may have had a negative and significant effect on access to statin populations among Medicaid-insured populations.

The Capitation Payment Unit (CPU) financing mechanism constitutes more than 70% of health spending in Colombia, with a budget allocation of close to 60 trillion Colombian pesos for the year 2022 (approximately 15.7 billion US dollars). This article estimates actuarially, using modern techniques, the CPU for the contributory regime of the General System of Social Security in Health in Colombia, and compares it with what is estimated by the Ministry of Health and Social Protection. Using freely available information systems, by means of statistical copulas functions and artificial neural networks, pure risk premiums are calculated between 2015 and 2021. The study concludes that the weights by risk category are systematically different, showing historical pure premiums surpluses in the group of 0–1 years and deficits (for the regions normal and cities) in the groups over 54 years of age. [ABSTRACT FROM AUTHOR]

We study the optimal design of social long-term care (LTC) insurance when the utility of informal caregivers is taken into account. Informal care is exchange-based. Children's cost of providing care is continuously distributed over some interval and is not observable. Parents choose a rule specifying transfers conditional on the level of informal care. We study first uniform provision of LTC and then a nonlinear policy depending on family transfers. In both cases, informal care increases with the children's welfare weight. Our theoretical analysis is completed by calibrated numerical solutions. Uniform public care should represent up to 40% of total care but its share decreases to about 30% as the weight of children increases. In the nonlinear case, public care increases with the children's cost of providing care at a faster rate when children's weight in social welfare is higher. It represents 100% of total care for families with high-cost children. [ABSTRACT FROM AUTHOR]

We present a comprehensive evaluation of the health impacts of the introduction and expansion of a large noncontributory health insurance program in Mexico, the Seguro Popular (SP), which provided access to health services without co-pays to individuals with no Social Security protection. We identify the program impacts using its rollout across municipalities between 2002 and 2010. In general, we do not detect significant effects on mortality (overall or at any age); the only exception is a reduction in infant mortality in poor municipalities for which intention-to-treat estimates show a 10 percent decline due to SP. This decline is attributable to reductions in deaths associated with conditions originating in the perinatal period, congenital malformations, diarrhea, and respiratory infections. In these poor municipalities, SP increased obstetric-related hospital admissions by 7 percent and hospital admissions among infants by 6 percent. There were no impacts on mortality or use of hospitals in rich municipalities. The decline in infant mortality rate caused by SP closed nearly all of the infant mortality rate gap between poor and rich municipalities. [ABSTRACT FROM AUTHOR]

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Aim/purpose – The aim of this study was to estimate the effect of health insurance on Out-of-Pocket (OOP) health care expenditure in Kenya. It is informed by persistence in the challenges of access and utilization of quality and affordable health care services. Previously, researchers have estimated the effects of different forms of health care financing on its demand and shown that affordability not only enhances access and use of health services but also cushions people against adverse financial risks associated with catastrophic health care spending.

The Health Gap documents the large and persistent health gaps that exist across and within relatively rich countries today. Marmot argues that in developed countries, poor health does not cause low incomes; rather, low socioeconomic status leads to poor health, but not because of proximate factors like differential health care access, which can explain only a small portion of these gaps. Therefore, to eliminate health gaps, policy should focus on the deep causes of disease: poverty, education, and occupational mobility, among others. While Marmot’s ethical arguments are quite compelling, his recommendations are too strong given the current evidence. Policies need to be based on a clearer understanding of why things work, when, and for whom. (JEL H51, I10, I13, I15, I18, I28)

We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills and bankruptcy, and reduce earnings, income, access to credit and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger less than 5 percent of all bankruptcies.

There is a growing body of knowledge on the complex effects of social protection on poverty in Africa. This article explores the pros and cons of a multidisciplinary approach to studying social protection policies. Our research aimed at studying the interaction between cash transfers and social health protection policies in terms of their impact on inclusive growth in Ghana and Kenya. Also, it explored the policy reform context over time to unravel programme dynamics and outcomes. The analysis combined econometric and qualitative impact assessments with national- and local-level political economic analyses. In particular, dynamic effects and improved understanding of processes are well captured by this approach, thus, pushing the understanding of implementation challenges over and beyond a 'technological fix,' as has been argued before by Niño-Zarazúa et al. (World Dev 40:163–176, 2012), However, multidisciplinary research puts considerable demands on data and data handling. Finally, some poverty reduction effects play out over a longer time, requiring longitudinal consistent data that is still scarce. [ABSTRACT FROM AUTHOR]

The Affordable Care Act (ACA) requires employers with at least 50 full-time-equivalent employees to offer "affordable" health insurance to employees working 30 or more hours per week. Employers who do not comply may face substantial penalties, but they can circumvent the mandate by reducing employees' weekly hours below the 30-hour threshold. We examine ACA's effects on short-hours part-time employment using difference-in-differences models. We find that the ACA increased low-hours, involuntary part-time employment by 500,000–700,000 workers in retail, accommodations, and food services, the industries in which employers are most likely to reduce hours if they choose to circumvent the mandate. [ABSTRACT FROM AUTHOR]

This study evaluates how healthcare employers' staffing decisions and labor demand respond to increased Medicaid eligibility using a database of more than 14 million job vacancies for healthcare workers. The results indicate that increased Medicaid eligibility leads to healthcare employers posting more job vacancies and hiring additional healthcare workers. Healthcare employers that typically hire lower-skilled workers appear to be the most responsive to Medicaid expansions. These results imply that there are providers that respond to Medicaid patients' needs but also highlight issues arising from Medicaid's low reimbursement rates. [ABSTRACT FROM AUTHOR]

The Affordable Care Act's Medicaid expansion ushered in substantial increases in enrollment in the public insurance program. I analyzed rural–urban differences in access to health insurance, financial access to primary care providers, use of preventive care, and use of emergency department for medical reasons that did not lead to hospitalization. Low‐income rural residents were found to have greater reduction in likelihood of uninsurance than their urban counterparts. While an increase in the likelihood of routine check‐ups was found to be significant only among rural residents, a decrease in the likelihood of repeated visits to the emergency departments for nonurgent reasons was only significant among the urban population. I highlight the importance of understanding rural experiences to reduce rural–urban health disparities. Related Content: Access to health care and rural worker productivity [ABSTRACT FROM AUTHOR]

We study the interaction of state and federal dependent health insurance mandates on young adult marriages. Using a new data set on state-level mandates, we show marriage restrictions of these laws reduced marriage likelihoods by about two percentage points. When the Affordable Care Act (ACA) was enacted, its mandate ended marriage restrictions, encouraging marriage among those previously eligible for state mandates. However, among those ineligible for state mandates, it discouraged marrying to obtain insurance through spouses. The combination of these contrasting ACA effects eliminated the marriage gap. We also find these marriage effects resulted in corresponding impacts on out-of-wedlock births. [ABSTRACT FROM AUTHOR]

In line with the wide recognition of the connection between socioeconomic status and health outcomes, attention in the recent literature is extending the static perspective to the dynamic implications of income on health. This study contributes to the growing literature on the income-health nexus by evaluating income dynamics on various self-rated health measures in the UK. We explore the impact of different indicators of income experiences on self-rated health and wellbeing outcomes using data from the 11 Waves of Understanding Society UK Household Longitudinal Study between 2009 and 2019. First, we estimate a fixed-effects ordered logit model for various health and wellbeing measures, allowing us to control for unobserved time-invariant heterogeneity. Second, we evaluate the effects of income trajectories by linking longitudinal household income to cross-sectional health outcomes. Our results confirm the general evidence of positive impacts of increasing family income on health. Besides, we find that stability in income position is strongly associated with improved health and wellbeing. On the other hand, income volatility increases the odds of reporting poor health outcomes, particularly for those in low-income households. Also, more years spent in a lower-income quartile reduces the odds of reporting improved self-rated health. Finally, the significant difference in the estimated effects of income before and after 2016 highlights the significant shifts in the effects of income trajectories on self-reported health and wellbeing following the National Living Wage policy implementation.

Medical divorce occurs when couples split up so that one spouse's medical bills do not deplete the assets of the healthy spouse. It has not been studied in the economics literature, but it has been discussed by attorneys and widely reported in the media. We develop a model of medical divorce that demonstrates that divorce is optimal when a couple's joint assets exceed the exempted asset level. We use the Affordable Care Act's Medicaid expansion which removed asset tests to qualify for Medicaid as exogenous variation in the incidence of divorce (as it was only implemented by some states). We find that the ACA expansion decreased the prevalence of divorce by 11.6% among those ages 50–64 with a college degree. These results are robust to numerous placebo checks including older subsamples (who qualify for Medicare regardless of assets) and earlier years (before the expansion was implemented). Our results suggest that Medicaid expansion reduced medical divorce. [ABSTRACT FROM AUTHOR]

This study examines the role of pawnshops as a risk-coping device in Japan in the early twentieth century, when the poor were very vulnerable to unexpected shocks such as illness. In contrast to European countries, Japanese pawnshops were the primary financial institution for low-income people up to the 1920s. Using data on pawnshop loans for more than 250 municipalities and exploiting the 1918–20 influenza pandemic as a natural experiment, we find that the adverse health shock increased the total amount of loans from pawnshops. This is because those who regularly relied on pawnshops borrowed more money from them than usual, and not because the number of people who used pawnshops increased. Our estimation results indicate that pawnshop loan amounts increased by approximately 7–10 percent due to the pandemic. These findings suggest that pawnshop loans were widely used as a risk-coping strategy. [ABSTRACT FROM AUTHOR]

Insurance companies are currently carrying out tasks related to building trust, image creation and giving distinctive features to intangible insurance services, which is associated with paying more attention to the packaging of the service than to the service itself. The packaging of the insurance service consists of people, the appearance of branches, the availability of insurance services and flexibility in customer service. For insurance companies, the knowledge of not only marketing practice, but also the knowledge about customer behaviours or factors affecting their loyalty is becoming important. The purpose of the article is to review the loyalty on the insurance services market in Poland and to examine the factors influencing it. The article discusses the methods of testing customer loyalty on the insurance services market. On the other hand, based on the results of the survey, factors affecting customer that may affect customer loyalty satisfaction are presented.

Using within-family variation from twins and siblings, I find that smokers earn approximately 16% less than nonsmokers. Possible explanations for this earning difference are addiction-related productivity declines and earning reductions from higher health insurance costs. To investigate further, I use variation in the provision of employer-supplied health insurance (ESHI) to examine the mechanism of whether the addiction or insurance component has a larger influence on earnings. While I generally observe a larger earning penalty for smokers with ESHI than smokers without ESHI, the earning difference is statistically indistinguishable from zero.

In this paper will be analyzed the application of the t-test against the nonparametric Mann - Whitney test in the analysis of health insurance benefit costs in the Republic of Srpska on large samples. This research aims to examine which method produces better results when testing statistical hypotheses. The adequacy of the statistical tests will be tested on primary health insurance cost data for 1,044,690 insureds in 2017. For two samples of size 4,000, the sampling distribution of the difference in two means has a skewness coefficient of 0.05 and a kurtosis coefficient of 3.09. Jarque - Bera test does not reject the hypothesis of normality of distribution with a p-value of 0.135. On the other hand, in the Mann - Whitney test, the real risk of the first species, when there is a difference in skewness between the samples, may be less than 0.001 compared to the nominal risk level of 0.05. Based on the results obtained, it is suggested to use the t-test instead of the Mann - Whitney test if the sample is large enough, which should be verified by the bootstrap method.