【保险学术前沿】Journal of Health Economics 2024年保险精选文章目录与摘要

声明：本系列文章基于原期刊目录和摘要内容整理而得，仅限于读者交流学习。如有侵权，请联系删除。

期刊介绍：

《Journal of Health Economics》（《健康经济学杂志》）是一本专注于健康和医疗保健经济学领域的学术期刊。该期刊成立于1982年，它涉及的主题包括健康服务的生产和供应、健康服务的需求和利用、健康服务的融资、健康的决定因素（包括健康投资和风险健康行为）、疾病不良后果、需求者、供应者和其他卫生保健机构的行为模型、政策干预的评估以及卫生政策的效率和分配等方面。该刊每年发行6期，平均每期发表文章10篇左右,2023年影响因子为3.4。

本期看点：

●长期护理保险：虽然公共长期护理保险政策在财政上成本高昂，并对劳动力市场产生负面影响，但在很大程度上可以抵消护理的个人成本，增加福利，尤其是对低收入者而言。

●公共医疗保险参保资格的增加能提高儿童的认知技能，并且对其行为结果也有改善作用，而各子群体中存在着明显的异质性影响。

●Medicaid扩张显著增加了Medicaid保险的等待名单参保人数和已故捐赠者器官移植接收人数，但对于居住在远离移植中心的候选人来说，机会仍然有限。

●医疗改革导致了种植业总投资和产出的长期增长，并伴随着家庭种植组合向风险较高作物的转移。此外，医疗改革通过减少债务和拖欠贷款改善了家庭的财务状况。

●英国通用信贷（The UK Universal Credit，是一项旨在帮助低收入、失业和无法工作的人群应对生活成本的财政支持）福利改革简化了福利制度，同时有力地激励了回归可持续就业，但没有给单身成年人和单亲父母带来相应的积极福利效应。

●利用澳大利亚的行政数据研究发现，取消保费补贴和增加保险税收罚款，对投保率的影响并不大。也没有显示出已参保人保险降级的迹象。

●父母健康冲击与子女中女性就业明显下降之间存在因果关系，这种关系在冲击后持续至少六年，但男性就业平均变化很小。

Marie Hull（北卡罗来纳大学格林斯伯勒分校）,Ji Yan（阿巴拉契亚州立大学）

摘要：While a large literature examines the immediate and long-run effects of public health insurance, much less is known about the impacts of total program exposure on child developmental outcomes. This paper uses an instrumental variable strategy to estimate the effect of cumulative eligibility gain on cognitive and behavioral outcomes measured at three points during childhood. Our analysis leverages substantial variation in cumulative eligibility due to the dramatic public insurance expansions between the 1980s and 2000s. We find that increased eligibility improves child cognitive skills and present suggestive evidence on better behavioral outcomes. There are notable heterogeneous effects across the subgroups of interest. Both prenatal eligibility and childhood eligibility are important for driving gains in the test scores at older ages. Improved child health is found to be a mediator of the impact of increased eligibility.

虽然大量文献研究了公共医疗保险的即时效应和长期效应，但大家对于医保项目总覆盖程度对儿童发育结果的影响并不了解。本文采用工具变量方法，来估算累积参保资格增加对儿童时期三个不同阶段所测认知及行为结果的影响。我们的分析利用了 20 世纪 80 年代至 21世纪期间公共保险大幅扩张所带来的累积参保资格方面的显著差异。我们发现，参保资格的增加能提高儿童的认知技能，并且有迹象表明其对行为结果也有改善作用。在我们所关注的各子群体中存在着明显的异质性影响。产前参保资格和儿童时期的参保资格对于提高儿童在较大年龄时的得分都很重要。研究还发现，儿童健康状况的改善是参保资格增加所产生影响的一个中介变量。

原文链接：https://www.sciencedirect.com/science/article/abs/pii/S0167629624000808

Kai Liu（剑桥大学）, Benjapon Prommawin（剑桥大学&清迈大学）, Fred Schroyen （挪威经济学院）

摘要：We study the effects of health insurance coverage on agricultural production decisions, examining the causal relationships by exploiting a health care reform and providing a theoretical framework to elucidate underlying mechanisms. We find that the reform led to long-run increases in total cultivation investments and output, accompanied by a shift in households’ cultivation portfolio towards riskier crops. We explain these findings using a model of agricultural investment, highlighting the important roles of health insurance in mitigating background medical expenditure risks and enhancing health. We also find that the reform improved households’ financial well-being through reduced debts and defaults on loans.

我们研究了医疗保险对农业生产决策的影响，通过利用医疗改革来检验因果关系，并提供了一个理论框架来阐明内在机制。我们发现，医疗改革导致了种植业总投资和产出的长期增长，并伴随着家庭种植组合向风险较高作物的转移。我们利用农业投资模型解释了这些发现，并强调了医疗保险在降低背景医疗支出风险和提高健康水平方面的重要作用。我们还发现，医疗改革通过减少债务和拖欠贷款改善了家庭的财务状况。

原文链接：https://www.sciencedirect.com/science/article/abs/pii/S0167629624000638

Thorben Korfhage（RWI莱布尼茨经济研究所），Björn Fischer-Weckemann（德国曼海姆ZEW研究所和波恩IZA研究所）

摘要：We estimate a dynamic structural model of labor supply, retirement, and informal caregiving to study short and long-term costs of informal caregiving in Germany. Incorporating labor market frictions and the German tax and benefit system, we find that in the absence of Germany’s public long-term insurance scheme, informal elderly care has adverse and persistent effects on labor market outcomes and, thus, negatively affects lifetime earnings and future pension benefits. These consequences of caregiving are heterogeneous and depend on age, previous earnings, and institutional regulations. Policy simulations suggest that while public long-term care insurance policies are fiscally costly and induce negative labor market effects, they can largely offset the personal costs of caregiving and increase welfare, especially for low-income individuals.

我们估算了一个劳动力供给、退休和非正式护理（informal caregiving）的动态结构模型，以研究德国非正式护理的短期和长期成本。结合劳动力市场的摩擦和德国的税收及福利制度，我们发现，在德国没有公共长期护理保险计划的情况下，非正式老年护理会对劳动力市场的结果产生不利且持续的影响，从而对终生收入和未来养老金福利产生负面影响。护理老人的后果是存在异质性的，取决于年龄、以前的收入和制度规定。政策模拟表明，虽然公共长期护理保险政策在财政上成本高昂，并对劳动力市场产生负面影响，但在很大程度上可以抵消护理的个人成本，增加福利，尤其是对低收入者而言。

原文链接：https://www.sciencedirect.com/science/article/pii/S0167629624000298

Nathan Kettlewell（悉尼科技大学）,Yuting Zhang（墨尔本大学）

摘要：In countries with dual public and private healthcare systems, individuals are often incentivized to purchase private health insurance through subsidies and penalty. We use administrative data from Australia to study how high-income earners respond on both the intensive and extensive margins to the simultaneous withdrawal of a premium subsidy, and the increase of a tax penalty. We estimate regression discontinuity models by exploiting discontinuous changes in the penalty and subsidy rates. Our setting is particularly interesting because means testing creates different incentives at the extensive and intensive margins. Specifically, we could expect to see higher take-up of insurance coupled with downgrading to less expensive plans. We find evidence that the penalty – despite being large in value – only has a modest effect on take-up. Our results show little evidence of downgrading, which is consistent with a low price elasticity for the high-income earners we study.

在拥有双重公共和私人医疗保健系统的国家，通常会通过补贴和罚款来激励个人购买私人医疗保险。我们利用澳大利亚的行政数据，研究高收入者对同时取消保费补贴和增加税收罚款（对于未购买私人医疗保险的人提供相应惩罚）如何在广度边际（是否购买）和深度边际（购买哪款产品）上做出反应。我们利用罚金和补贴率的不连续变化来估计回归不连续模型。我们的设定特别有趣，因为经济情况调查会在广度边际和深度边际产生不同的激励。具体地说，我们预期会有更多的人参加保险，同时降级到更便宜的保险计划。我们发现，尽管惩罚的力度很大，但对投保率的影响并不大。我们的结果几乎没有显示出降级的迹象，这与我们研究的高收入者的低价格弹性是一致的。

原文链接：https://www.sciencedirect.com/science/article/pii/S0167629624000080

Ajin Lee（密歇根州立大学）,Boris Vabson（哈佛医学院）

摘要：The US government increasingly provides public health insurance coverage through private firms. We examine associated welfare implications for beneficiaries, using a ‘revealed preference’ framework based on beneficiaries’ program attrition rates. Focusing on the Medicaid program in New York State, we exploit quasi-random variation in the initial assignment at birth to public versus private Medicaid based on birth weight. We find that infants assigned to private Medicaid at birth are less likely to subsequently leave Medicaid. We provide suggestive evidence that reduced attrition reflects beneficiary responses to improved program quality, rather than alternative mechanisms such as private Medicaid plans reducing re-enrollment barriers.

美国政府越来越多地通过私营公司提供公共健康保险覆盖。我们使用基于受益人计划流失率的“显示偏好”框架，来检查对受益人相关的福利影响。我们关注纽约州的Medicaid计划，利用出生时根据出生体重的公共与私营医疗补助的初始分配中的准随机变化。我们发现，出生时被分配到私营医疗补助的婴儿随后离开Medicaid的可能性较小。我们提供了潜在性证据，表明减少的流失反映了受益人对提高计划质量的反应，而不是其他机制，例如私营医疗补助计划降低了重新投保的障碍。

原文链接：https://www.sciencedirect.com/science/article/abs/pii/S0167629624000109

Jiayi Wen(厦门大学), Haili Huang(厦门大学)

摘要：This study examines the gender-specific and enduring impacts of parental health shocks on adult children’s employment in China, where both formal care and health insurance are limited. Using an event-study approach, we establish a causal link between parental health shocks and a notable decline in female employment, which persists for at least six years following the shock. Male employment, however, exhibits minimal change on average, although this conceals an increase among poor families, indicating a channel beyond heightened informal care. Our findings underscore the consequences of “growing old before getting rich” for developing countries.

本研究在中国的正规护理和医疗保险都有限的背景下，考察了父母的健康冲击对成年子女就业影响的性别差异和长期结果。采用事件研究方法，我们建立了父母健康冲击与女性就业明显下降之间的因果关系，这种关系在冲击后持续至少六年。然而，男性就业平均变化很小，尽管这一结果掩盖了在贫困家庭中也有增长的情况，表明除了加强非正规护理之外还有一个渠道。我们的发现强调了发展中国家“未富先老”的后果。

原文链接：https://www.sciencedirect.com/science/article/abs/pii/S0167629624000316

Bethany Lemont（俄亥俄大学）

摘要：Most transplant centers require candidates be insured before they can join the waitlist for a deceased donor organ. After the Affordable Care Act, many uninsured Americans gained improved access to Medicaid. I examine the effect of this increase in access to insurance and find that Medicaid expansions significantly increase Medicaid-insured waitlist registrations by 39% and deceased donor transplants received by 44%, but the increase in registrations is larger for candidates who live closer to a transplant center. Additionally I show that most of these registrations would have been privately insured otherwise but provide suggestive evidence that this is better explained by improved access to subsidized private coverage due to other ACA reforms than from candidates with private coverage before the ACA switching to Medicaid coverage after expansion. This suggests that although the ACA improved access to the transplantation system, access is still limited for candidates who live far from centers.

大多数移植中心要求候选人在加入等待名单以接受已故捐赠者的器官之前必须有保险。在《平价医疗法案》（ACA）实施后，许多没有保险的美国人获得了更好的医疗补助（Medicaid）资格。本文研究了这种保险资格增加的影响，发现Medicaid扩张显著增加了Medicaid保险的等待名单参保人数（增长39%）和已故捐赠者器官移植接收人数（增长44%），但参保人数的增长主要集中在居住在移植中心附近的候选人中。此外，本文还发现，这些参保人中的大多数原本可能会获得私人保险，但有证据表明，这更多是由于ACA的其他改革提高了获得补贴私人保险的机会，而不是原本有私人保险的参保人转向Medicaid。这表明，尽管ACA改善了移植系统的可获得性，但对于居住在远离移植中心的候选人来说，机会仍然有限。

原文链接：https://www.sciencedirect.com/science/article/pii/S0167629624000031

Mike Brewer（Resolution Foundation决议基金会），Thang Dang（图尔库大学；胡志明市经济大学），Emma Tominey（约克大学）

摘要：The UK Universal Credit (UC) welfare reform simplified the benefits system whilst strongly incentivising a return to sustainable employment. Exploiting a staggered roll-out, we estimate the differential effect of unemployment under UC versus the former system on mental health. Groups with fewer insurance possibilities – single adults and lone parents – experience a mental health deterioration of 8.4-13.9% standard deviations which persists into the subsequent year. For couples, UC partially or fully mitigates mental health consequences of unemployment. Exploring mechanisms, for single adults and lone parents, reduced benefit income and strict job search requirements dominate any positive welfare effects of the reduced administrative burden of claiming benefits.

英国通用信贷（UC）（The UK Universal Credit，是一项旨在帮助低收入、失业和无法工作的人群应对生活成本的财政支持）福利改革简化了福利制度，同时有力地激励了回归可持续就业。通过交错推导，我们估计了UC与前系统下失业对心理健康的不同影响。保险选择较少的群体——单身成年人和单亲父母——出现了8.4-13.9%的标准差的精神健康恶化，这种情况持续到下一年。对于夫妇来说，UC部分地或完全地减轻了失业对心理健康的影响。探索机制表明，对于单身成年人和单亲父母来说，减少的福利收入和严格的求职要求主导了福利申请行政负担的减少所带来的任何积极福利效应。

原文链接：https://www.sciencedirect.com/science/article/pii/S0167629624000857

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