مقاله انگلیسی رایگان در مورد بیمه اجتماعی، بیمه درمانی خصوصی و رفاه فردی – الزویر 2017

This paper studies the impact of social insurance on individual choices and welfare in a dynamic general equilibrium model with uncertain medical expenses and individual health insurance choices. I find that social insurance (modeled as the combination of a minimum consumption floor and the Medicaid program) does not only distort saving and labor supply decisions, but also has a large crowding out effect on the demand for private health insurance. However, despite the distorting effects, the net welfare consequence of eliminating social insurance is still negative in most cases. In addition, the large crowding out effect on private health insurance suggests that the existence of social insurance programs may be one reason why some Americans do not buy any health insurance.

Introduction

Means-tested welfare programs in the United States, such as Medicaid, TANF and SNAP, provide American households with a social “safety net” that guarantees a minimum consumption floor and provides public health insurance for the poor.1 Total spending on these programs is large and it has been the fastest growing component of US government spending over the past few decades. Making up only 1.2% of GDP in 1964, by 2004 it had grown to approximately 5% of GDP, more than the cost of any other single public program (e.g., Social Security, Medicare). Meanwhile, policy makers have often proposed to reform the means-tested programs.2 Despite this, there are relatively few studies that quantitatively evaluate the impact of means-tested social insurance on individual choices and welfare, compared to the large literature that uses dynamic life-cycle models to quantitatively examine other public programs such as Social Security.3 This paper attempts to fill this gap in the literature. Does the US social insurance system improve individual welfare? Conventional wisdom says that social insurance can improve individual welfare because it insures poor households against large negative shocks. However, some economists have argued that the social insurance programs may discourage work and thus reduce labor supply (e.g. Moffitt, 2002), and other economists find that social insurance discourage private saving and thus reduce capital accumulation (Hubbard, Skinner, and Zeldes, 1995). Furthermore, some recent empirical studies suggest that the social insurance programs may have crowded out the demand for private insurance.4 Therefore, the net welfare consequence of social insurance depends on the relative importance of the above-described mechanisms. In this paper, I develop a dynamic general equilibrium model with heterogenous agents and incomplete markets to formalize all these relevant mechanisms and study the net welfare consequence of social insurance. Different from standard incomplete markets models, which usually do not model health insurance or assume exogenous health insurance coverage, I endog enize the individual choices of health insurance coverage. As a result, the model can capture the crowding out effect of social insurance on the demand for private health insurance. In the model, agents face medical expense shocks, labor income shocks, and survival risks over the life cycle. In each period, agents endogenously determine their labor supply, and decide whether to take up employer-sponsored health insurance if it is offered and whether to purchase individual health insurance from the private market. Different from some earlier studies on social insurance (such as Hubbard et al., 1995), I separate Medicaid from other social insurance programs in the model, that is, the social insurance system is modeled as a combination of a minimum consumption floor and a means-tested public health insurance program (like the US Medicaid program).5 This modelling choice is motivated by the fact that after the 1996 welfare reform, the Medicaid program was separated from the other major means-tested programs such as TANF/AFDC, and was allowed to impose different eligibility criteria. In addition, the model includes a pay-as-you-go Social Security program and a Medicare program.