The Purpose and Limits of Social Health Insurance

This contribution seeks to answer two related questions. First, what is the purpose of social health insurance? Or put in slightly different terms, what are the reasons for social (or public) health insurance to exist, even to dominate private health insurance in most developed countries? And second, what are the limits of social health insurance? Can one say that there is "too much" social health insurance in the following two senses: Should the balance be shifted towards the private alternative? And is the degree of coverage excessive?social health insurance, private health insurance, insurance coverage

Spatial Effects in Willingness-to-Pay: The Case of Two Nuclear Risks

This paper examines the spatial dimension of marginal willingness to pay (MWP) for reduction of nuclear risks through increased insurance coverage. The effect of distance from a nuclear power plant on individuals’ MWP is ambiguous. MWP is expected to decrease with distance because the risk of being affected by an accident decreases. However, if individuals choose their residential location taking the operational risk into account, MWP is predicted to first increase and later decrease with distance from the nuclear power plant. On the other hand, there are risks associated with transportation and disposal of nuclear waste where distance should matter only in the vicinity of the plant. These theoretical predictions are tested with data collected using a stated choice experiment. The predictions are largely confirmed by the evidence.stated choice experiment, liability insurance, nuclear accident, willingness to pay

Is the Welfare State Sustainable? Experimental Evidence on Citizens’ Preferences for Redistribution

The sustainability of the welfare state ultimately depends on citizens’ preferences for income redistribution. They are elicited through a Discrete Choice Experiment performed in 2008 in Switzerland. Attributes are redistribution as GDP share, its uses (the unemployed, old-age pensioners, people with ill health etc.), and nationality of beneficiary. Estimated marginal willingness to pay (WTP) is positive among those who deem benefits too low, and negative otherwise. However, even those who state that government should reduce income inequality exhibit a negative WTP on average. The major finding is that estimated average WTP is maximum at 21% of GDP, clearly below the current value of 25%. Thus, the present Swiss welfare state does not appear sustainable.Income redistribution, preferences, willingness to pay, welfare state, sustainability, discrete choice experiments

Income redistribution: how to divide the pie?

In this paper, we elicit preferences of Swiss citizens for the allocation of income redistribution to different uses through a Discrete Choice Experiment performed in 2008. Neustadt and Zweifel (2009} provide an estimate of the total desired amount of income redistribution as a share of disposable income. Here, we estimate marginal willingness-to-pay values for types of recipients (old-age pensioners, people with ill health, the unemployed, working poor, and families with children) and their nationality (Swiss, citizens of western European countries, others). Hypotheses derived from the insurance motive for redistribution receive some empirical support.Income redistribution, preferences, willingness to pay, discrete choice experiments, conjoint analysis, social status

Is the Welfare State Sustainable? Experimental Evidence on Citizens' Preferences for Redistribution

The sustainability of the welfare state ultimately depends on citizens' preferences for income redistribution. They are elicited through a Discrete Choice Experiment performed in 2008 in Switzerland. Attributes are redistribution as GDP share, its uses (the unemployed, old-age pensioners, people with ill health etc.), and nationality of beneficiary. Estimated marginal willingness to pay (WTP) is positive among those who deem benefits too low, and negative otherwise. However, even those who state that government should reduce income inequality exhibit a negative WTP on average. The major finding is that estimated average WTP is maximum at 21% of GDP, clearly below the current value of 25%. Thus, the present Swiss welfare state does not appear sustainable.Income redistribution; welfare state; sustainability; preferences; willingness to pay; discrete choice experiments

Economic Well-Being, Social Mobility, and Preferences for Income Redistribution: Evidence from a Discrete Choice Experiment

In this paper, preferences for income redistribution in Switzerland are elicited through a Discrete Choice Experiment (DCE) performed in 2008. In addition to the amount of redistribution as a share of GDP, attributes also included its uses (working poor, the unemployed, old-age pensioners, families with children, people in ill health) and nationality of beneficiary (Swiss, Western European, others). Willingness to pay for redistribution increases with income and education, contradicting the conventional Meltzer-Richard (1981) model. The Prospect of Upward Mobility hypothesis [Hirschman and Rothschild (1973); Benabou and Ok (2001)] receives partial empirical support.Income redistribution, preferences, willingness to pay, discrete choice experiments, stated choice, economic well-being, social mobility

Flat-of-the-Curve Medicine – A New Perspective on the Production of Health

Health economists have studied the determinants of the expected value of health status as a function of medical and nonmedical inputs, often finding small marginal effects of the former. This paper argues that both types of input have an additional benefit, viz. a reduced variability of health status. Using OECD health data for 24 countries between 1960 and 2004, medical and nonmedical inputs are found to reduce the variability of life expectancy. While the evidence supports the "flat-of-the-curve medicine" hypothesis with respect to the expected value of life expectancy and its variability, healthcare expenditure is comparatively effective in reducing variability.production of health, control over health status, Gini coefficient

How Much Internalization of Nuclear Risk Through Liability Insurance?

An important source of conflict surrounding nuclear energy is that with a very small probability, a large-scale nuclear accident may occur. One way to internalize the financial risks associated with such an accident is through mandatory liability insurance. This paper presents estimates of the willingness to pay for increased financial security provided by an extension of coverage, based on the `stated choice' approach. A Swiss citizen with median characteristics may be willing to pay 0.08 cents per kwh to increase coverage beyond the current CHF 0.7 bn. (US$0.47 bn.). Marginal willingness to pay declines with higher coverage but exceeds marginal cost at least up to a coverage of CHF 4 bn. (US$ 2.7 bn.). An extension of nuclear liability insurance coverage therefore may be effciency-enhancing.risk, nuclear energy, liability insurance, internalization

Is the Welfare State Sustainable? Experimental Evidence on Citizens' Preferences for Redistribution

The sustainability of the welfare state ultimately depends on citizens’ preferences for income redistribution. They are elicited through a Discrete Choice Experiment performed in 2008 in Switzerland. Attributes are redistribution as GDP share, its uses (the unemployed, old-age pensioners, people with ill health etc.), and nationality of beneficiary. Estimated marginal willingness to pay (WTP) is positive among those who deem benefits too low, and negative otherwise. However, even those who state that government should reduce income inequality exhibit a negative WTP on average. The major finding is that estimated average WTP is maximum at 21% of GDP, clearly below the current value of 25%. Thus, the present Swiss welfare state does not appear sustainable.income redistribution, welfare state, sustainability, preferences, willingness to pay, discrete choice experiments

A Pharmaceutical Innovation – Is it Worth the Money? Whose Money?

This study seeks to provide evidence for deciding whether or not a pharmaceutical innovation should be included in the benefit list of social health insurance. A discrete choice experiment (DCE) was conducted in Germany to measure preferences for modern insulin therapy. Of the 1,100 individuals interviewed in 2007, 200 suffered from type 1 diabetes, 150 from insulin-treated type 2 diabetes, and 150 from insulin-naive type 2 diabetes. The long-acting insulin analogue ”Insulin Detemir” is compared to human insulin as the status quo. The DCE contains two price attributes, copayment and increased contributions to health insurance. As one would expect, non-affected non-diabetics and insulin-naive diabetics exhibit higher willingness-to-pay (WTP) values through copayment (adjusted for probability of contracting diabetes), while affected type 1 and insulin-treated type 2 diabetics have higher WTP through increased contributions. However, WTP values exceed the extra treatment cost in both financing alternatives, justifying inclusion of the innovation in the benefit list from a cost-benefit point of view.Health insurance, discrete-choice experiment, preferences, diabetes