The Welfare Effects of Restricted Hospital Choice in the US Medical Care Market

Managed care health insurers in the US restrict their enrollees' choice of hospitals to within specific networks. This paper considers the implications of these restrictions. A three-step econometric model is used to predict consumer preferences over health plans conditional on the hospitals they offer. The results indicate that consumers place a positive and significant weight on their expected utility from the hospital network when choosing plans. A welfare analysis, assuming fixed prices, implies that restricting consumers' choice of hospitals leads to a loss to society of approximately $1 billion per year across the 43 US markets considered. This figure may be outweighed by the price reductions generated by the restriction.

The Cost of Legal Restrictions on Experience Rating

We investigate the cost of legal restrictions on experience rating in auto and home insurance. The cost is an opportunity cost as experience rating can mitigate the problems associated with unobserved heterogeneity in claim risk, including mispriced coverage and resulting demand distortions. We assess this cost through a counterfactual analysis in which we explore how risk predictions, premiums, and demand in home insurance and two lines of auto insurance would respond to unrestricted multiline experience rating. Using claims data from a large sample of households, we first estimate the variance-covariance matrix of unobserved heterogeneity in claim risk. We then show that conditioning on claims experience leads to material refinements of predicted claim rates. Lastly, we assess how the households’ demand for coverage would respond to multiline experience rating. We find that the demand response would be large

Selection on Moral Hazard in Health Insurance

In this paper we explore the possibility that individuals may select insurance coverage in part based on their anticipated behavioral response to the insurance contract. Such "selection on moral hazard" can have important implications for attempts to combat either selection or moral hazard. We explore these issues using individual-level panel data from a single fi?rm, which contain information about health insurance options, choices, and subsequent claims. To identify the behavioral response to health insurance coverage and the heterogeneity in it, we take advantage of a change in the health insurance options offered to some, but not all of the ?firm's employees. We begin with descriptive evidence that is suggestive of both heterogeneous moral hazard as well as selection on it, with individuals who select more coverage also appearing to exhibit greater behavioral response to that coverage. To formalize this analysis and explore its implications, we develop and estimate a model of plan choice and medical utilization. The results from the modeling exercise echo the descriptive evidence, and allow for further explorations of the interaction between selection and moral hazard. For example, one implication of our estimates is that abstracting from selection on moral hazard could lead one to substantially over-estimate the spending reduction associated with introducing a high deductible health insurance option.Insurance markets, Adverse selection, Moral hazard, Health insurance

Discussion of ‘Post selection shrinkage estimation for high‐dimensional data analysis’

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136472/1/asmb2216_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136472/2/asmb2216.pd

A STATISTICAL EXAMINATION OF YIELD SWITCHING FRAUD IN THE FEDERAL CROP INSURANCE PROGRAM

An over-parameterized statistical yield-switching-fraud model is developed. Over-parameterized procedures are reviewed. Five percent of 206,952 producers (thirteen percent in one state) have suspicious yield patterns, elect higher coverage, and increase total multiple-unit indemnifications up to ten percent in some states and up to 30 percent at some coverage levels.Crop Production/Industries, Risk and Uncertainty,

Intra-and International Risk-Sharing in the Short Run and the Long Run

We investigate empirically how industrialized countries and U.S. states share consumption risk at horizons between one and thirty years. U.S. federal states share about 50 percent of their permanent idiosyncratic risk through cross-state capital income flows. While insurance against transitory fluctuations in output is virtually complete, OECD countries do not share any of their permanent idiosyncratic risk. Our results suggest that purely transaction cost based theories cannot explain the home bias, since the potential welfare gains from insurance against permanent shocks would by far outweigh that of insuring against transitory variation. We conclude that permanent and transitory shocks constitute two qualitatively different kinds of risk and that various forms of endogenous market incompleteness may render permanent shocks a lot harder to insure, in particular at the international level.consumption risk sharing, home bias, international business cycles, panel vector autoregressions

Rejoinder: Post Selection Shrinkage Estimation for High Dimensional Data Analysis

One fundamental ingredient of our work is to formally split the signals into strong and weak ones. The rationale is that the usual one-step method such as the least absolute shrinkage and selection operator (LASSO) may be very effective in detecting strong signals while failing to identify some weak ones, which in turn has a significant impact on the model fitting, as well as prediction. The discussions of both Fan and QYY contain very interesting comments on the separation of the three sets of variables. Regarding Assumption (A2) about the weak signal set S2, we admit that the original version was not as rigorous as it could have been, as it could have contained the variables in S3. We now propose the following Assumption (A2') that replaces (A2) in the original paper

Adverse selection in the U.S. health insurance markets: Evidence from the MEPS

We use the 2003/2004 Medical Expenditure Panel Survey in conjunctions with the 2002 National Health Interview Survey to test for adverse selection in the U.S. private health insurance market. The key idea is to test whether the individuals who are more exposed to health risks also buy insurance contracts with more coverage or higher expected payments. The critical statistical problem is that the extension of insurance is only measured for those who are insured and face positive health care expenditure. So there is a possible sample selection bias effect. The procedure used is based on a method suggested by Wooldridge (1995). The method also accounts for heterogeneity across individuals. The simultaneous account taken of both possible sources of bias is new for this kind of application.adverse selection, health insurance, risk profile