The Aggregate Demand for Private Health Insurance Coverage in the U.S.

This paper estimates the aggregate demand for private health insurance coverage in the U.S. using an error-correction model and by recognizing that people are without private health insurance for voluntary, structural, frictional, and cyclical reasons and because of public alternatives. Insurance coverage is measured both by the percentage of the population enrolled in private health insurance plans and the completeness of the insurance coverage. Annual data for the period 1966-1999 are used and both short and long run price and income elasticities of demand are estimated. The empirical findings indicate that both private insurance enrollment and completeness are relatively inelastic with respect to changes in price and income in the short and long run. Moreover, private health insurance enrollment is found to be inversely related to the poverty rate, particularly in the short-run. Finally, our results suggest that an increase in the number cyclically uninsured generates less of a welfare loss than an increase in the structurally uninsured.

Barriers to Timely Screening Colonoscopy

Objective: Colorectal cancer (CRC) can be largely prevented or effectively treated in its early stages, yet disparities exist in timely screening. The aim of this study was to explore the disparities in CRC screening on the basis of health insurance status including private, Medicare, Medicaid, and State Administered General Assistance (SAGA). Methods: A retrospective chart review for the period January 2000 to May 2007 (95 records) was conducted at two clinic sites; a private clinic and a university hospital clinic. All individuals at these sites who met study criteria (>50 years old with screening colonoscopy) were included. Age, gender, date of first clinic visit when screening referral was made, and date of completed procedure (screening colonoscopy) were recorded. Groups were dichotomized between individuals with private health insurance and individuals with public health insurance. Individuals with any history of CRC, known pre-cancerous conditions as well as family history of CRC requiring frequent colonoscopy were excluded from the study. Linear model analysis was performed to compare the average waiting time to receiving screening colonoscopy between the groups. T-test was performed to analyze age or gender related differences between the two groups as well as within each group. Results: The average waiting time (33 days) for screening colonoscopy in privately insured individuals was significantly lower than publicly insured individuals (200 days). The time difference between the first clinic visit and the procedure was statistically significant (p < 0.0001) between the two groups. There was no statistical difference (p=0.089) in gender between these groups (public vs. private). There were also no statistically significant gender or age related differences found within each group. Conclusions: Disparities exist in timely screening for CRC and one of the barriers leading to delayed CRC screening includes health insurance status of an individual. Even within the insured group, type of insurance plays major role. There is a negative correlation between public health insurance status and timely screening. Differences in access to medical care and delivery of care experienced by patients who are publicly insured through Medicaid, Medicare, and SAGA, suggests that the State of Connecticut needs to implement changes in health care policies that would provide timely screening colonoscopy. It is evident that health insurance coverage facilitates timely access to healthcare. Therefore, there is a need for increased efforts in advocacy for policy, payment and physician participation in public insurance programs. A state-wide comprehensive program involving multiple components targeting different levels of change such as provider, patients and the community should help reduce some of the observed causes of healthcare disparities based on the insurance status.

On Voters' Attitudes Towards Unemployment Insurance Subsidies across Regions: A Canadian Simulation

The Canadian unemployment insurance program is designed to reflect the varying risk of joblessness across regions. Regions that are considered low-risk areas subsidize higher risk ones. A region's risk is typically proxied by its relative unemployment rate. We use a dynamic, heterogeneous-agent model calibrated to Canada to analyze voters preferences between a uniformly generous unemployment insurance and the current system with asymmetric generosity. We find that Canada's unusual unemployment insurance system is surprisingly close to what voters would choose in spite of the possibilities of moral hazard and self-insurance through asset build-up.

Measuring Unemployment Insurance Generosity

In this paper, we develop a methodology to summarize the various policy parameters of an unemployment insurance scheme into a single generosity parameter. Unemployment insurance policies are multdimensional objects. They are typically defined by waiting periods, eligibility duration, benefit levels and asset tests when eligible, which makes intertemporal or international comparisons difficult. To make things worse, labor market conditions, such as the likelihood and duration of unemployment matter when assessing the generosity of different policies. We build a first model with such complex characteristics. Our model features heterogeneous agents that are liquidity constrained but can self-insure. We then build a second model that is similar, except that the unemployment insurance is simpler: it is deprived of waiting periods and agents are eligible forever with constant benefits. We then determine which level of benefits in this second model makes agents indifferent between both unemployment insurance policies. We apply this strategy to the unemployment insurance program of the United Kingdom and study how its generosity evolved over time.