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The health care safety net and health insurance: A theoretical and empirical investigation.

机译：卫生保健安全网和健康保险：理论和实证研究。

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摘要

The large and growing uninsured population poses an alarming threat to the U.S. health care system. This paper explores one of the less cited causes of the lack of health insurance -- the health care safety net. The safety net is a component of the U.S. health care delivery system that aims to provide medical services to the vulnerable patients (e.g. people without health insurance) regardless of their ability to pay. Available through both private and public health care providers who operate under the legal mandate or an explicit open-door policy, such medical care is usually provided free of charge or at a substantial discount. The implicit assumption of the safety net programs is that the demand for such services is largely the result of uncontrollable economic and health conditions, making the health insurance unaffordable. However, this assumption misses a fundamental maxim in the economic approach to human behavior, which implies that the decision not to purchase health insurance is ultimately a matter of choice, and that such a choice is influenced by the availability of various insurance alternatives, including the health care safety net.;I developed an analytical model which incorporates the utilization of safety net into the demand for health insurance paradigm. The economics literature dealing with the uninsured issues has been treating the lack of health insurance as a "corner solution" to the market insurance problem with its value assumed to be exogenous to the insurance decision. My model tries to analyze the null-insurance choice as an "interior solution" implicating the individual preference to the alternatives to market insurance, such as the safety net and self-insurance, which are often neglected in the literature. I showed that the safety net healthcare resources can act as a substitute to market insurance, similar to the classical form of self-insurance. However, contrary to what prior literature modeled as self-insurance, this free-cost alternative can lead to a "safety net moral hazard". Accordingly, an otherwise insured individual may choose to drop or eschew the insurance coverage and free-ride on the safety net program.;Equally important is the empirical part of my study, which offers a quantitative assessment of the magnitude of the "safety net moral hazard" problem in U.S. The calibrated simulation bearing on the above theoretical model indicates that about 15.75% of the current uninsured population, or 7.2 million people in U.S., can attribute their lack of health insurance to the existing safety net system. My empirical model based on a unique dataset that links multiple national surveys (Community Tracking Study Household Survey, Area Resource File, AHRQ Safety Net Monitoring Data Book) has verified the crowding-out effect with significant and robust evidence. The model employed a comprehensive set of measures of the county level safety net accessibility, all of which showed significant negative impact on the tendency of insurance purchase by the county residents. On average, the presence of local safety net resources can reduce the probability of individual insurance coverage by as much as 2.57%.
机译：不断增长的无保险人口对美国医疗保健系统构成了惊人的威胁。本文探讨了缺乏医疗保险的被引用较少的原因之一-医疗保健安全网。安全网是美国医疗服务提供系统的组成部分，旨在为易受伤害的患者（例如没有医疗保险的人）提供医疗服务，而不论其支付能力如何。通过法律授权或明确的开放政策运营的私人和公共卫生保健提供者都可以使用这种医疗服务，通常会免费或以大幅折扣提供此类医疗服务。安全网计划的隐含假设是，对此类服务的需求在很大程度上是不可控制的经济和健康状况的结果，从而使健康保险难以承受。但是，这种假设没有达到人类行为经济学方法的基本准则，这意味着不购买健康保险的决定最终是一个选择问题，而且这种选择受到各种保险备选方案（包括医疗保险）的可用性的影响。我开发了一个分析模型，该模型将安全网的利用纳入对健康保险范式的需求中。有关未保险问题的经济学文献一直将缺乏健康保险视为市场保险问题的“关键解决方案”，其价值被认为是保险决策的外来因素。我的模型试图将零保险选择作为一种“内部解决方案”进行分析，这意味着个人倾向于市场保险替代品，例如安全网和自我保险，而这在文献中经常被忽略。我证明安全网医疗资源可以替代市场保险，类似于经典的自我保险形式。但是，与现有文献中将其模型化为自我保险的情况相反，这种免费的替代方案可能导致“安全净道德风险”。因此，另外一个被保险人可以选择放弃或避开安全网计划的保险范围和搭便车。同样重要的是我的研究的实证部分，该部分对“安全网道德”的规模进行了定量评估。美国的“危害”问题基于上述理论模型的校准模拟表明，目前约有15.75％的未保险人口（即美国720万人）可以将其医疗保险的缺乏归因于现有的安全网系统。我的经验模型基于链接多个国家调查（社区追踪研究家庭调查，区域资源文件，AHRQ安全网监测数据手册）的独特数据集，已通过大量可靠的证据验证了挤出效应。该模型采用了一套全面的县级安全网可达性措施，所有这些措施均对县居民购买保险的趋势产生了显着的负面影响。平均而言，当地安全网资源的存在可以使个人保险覆盖率降低多达2.57％。

著录项

  • 作者

    Qin, Xuezheng.;

  • 作者单位

    State University of New York at Buffalo.;

  • 授予单位 State University of New York at Buffalo.;
  • 学科 Economics General.;Economics Labor.;Economics Theory.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 123 p.
  • 总页数 123
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 经济学;劳动经济;经济学;
  • 关键词

  • 入库时间 2022-08-17 11:38:25

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