scholarly journals Does Public Insurance Crowd out Private Insurance?

1996 ◽  
Vol 111 (2) ◽  
pp. 391-430 ◽  
Author(s):  
D. M. Cutler ◽  
J. Gruber
Keyword(s):  
Private Insurance ◽  
Public Insurance ◽  
Crowd Out

scholarly journals Take-Up of Public Insurance and Crowd-out of Private Insurance Under Recent CHIP Expansions to Higher Income Children

2011 ◽  
Author(s):  
Carole Roan Gresenz ◽  
Sarah Edgington ◽  
Miriam Laugesen ◽  
José Escarce
Keyword(s):  
Private Insurance ◽  
Public Insurance ◽  
Crowd Out

scholarly journals Take-Up of Public Insurance and Crowd-Out of Private Insurance under Recent CHIP Expansions to Higher Income Children

2012 ◽  
Vol 47 (5) ◽  
pp. 1999-2011 ◽  
Author(s):  
Carole Roan Gresenz ◽  
Sarah E. Edgington ◽  
Miriam Laugesen ◽  
José J. Escarce
Keyword(s):  
Private Insurance ◽  
Public Insurance ◽  
Crowd Out

Participation in a Public Insurance Program: Subsidies, Crowd-Out, and Adverse Selection

2002 ◽  
Vol 39 (3) ◽  
pp. 243-257 ◽  
Author(s):  
Stephen H. Long ◽  
M. Susan Marquis
Keyword(s):  
Adverse Selection ◽  
Health Program ◽  
Private Insurance ◽  
Public Insurance ◽  
Public Programs ◽  
Basic Health ◽  
Insurance Program ◽  
Private Market ◽  
Crowd Out ◽  
Design Characteristics

This paper examines how varying the level of subsidies affects participation in a public insurance program, crowd-out of private insurance, and adverse selection. We study the experience in Washington's Basic Health program in 1997. Findings show that adverse selection is not a problem in voluntary public programs. Increasing subsidies have only modest effects on participation in subsidized programs, though the gains are not at the expense of the private market. Overall participation in the subsidized plan is also modest, even though participants benefit from it. The challenge to policymakers is to find program design characteristics, beyond subsidies, that attract the uninsured.

Consequences of SCHIP Expansions for Household Well-Being

2010 ◽  
Vol 13 (1) ◽  
Author(s):  
Lindsey Leininger ◽  
Helen Levy ◽  
Diane Schanzenbach
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Private Insurance ◽  
Well Being ◽  
High Rate ◽  
Fiscal Year ◽  
Consumer Expenditure ◽  
Public Insurance ◽  
Crowd Out ◽  
Uninsured Children

About 7.4 million children were covered by the State Children’s Health Insurance Program (SCHIP) at some point during fiscal year 2008. Many of these children would probably have had private coverage in the absence of SCHIP; recent estimates of the extent of “crowd-out” associated with SCHIP are about 60 percent (Gruber and Simon 2008). The high rate of crowd-out means that the program is not as effective as it could be at reducing the number of uninsured children and has been a political liability for the program. Both political concerns and policy research focusing on crowd-out in SCHIP build on more than a decade of similar attention to the crowd-out associated with the Medicaid expansions of the late 1980s and early 1990s. While there is little doubt that expanding eligibility for public insurance to children who are not poor will lead some to substitute public for private coverage, this substitution should increase total resources available to these households in two ways. First, those who drop private coverage in order to enroll their children in SCHIP can take whatever they had been spending on health insurance and spend it on something else. Second, public insurance requires less cost-sharing than a typical private insurance policy, providing first-dollar coverage with minimal co-payments. This means that switching from private to public coverage reduces a family’s out-of-pocket medical spending, freeing up even more of the family’s resources for other uses. From the perspective of a low-income family, then, crowd-out is a windfall. In this paper we ask: what do these families do with the additional resources? We address this question with an empirical analysis of consumption data from the Consumer Expenditure Survey. We find that eligibility for SCHIP is associated with an increase in overall expenditure, and most of this increase is allocated to consumption of transportation or saving for retirement. These results suggest that the SCHIP expansions substantially improved the material well-being of the low-income families it is intended to assist – including those who had previously been paying for their own coverage. This evidence should allow a better accounting of the benefits and not just the costs of recent expansions in public health insurance programs.

Social versus Private Insurance

2018 ◽  
Author(s):  
Pierre Pestieau ◽  
Mathieu Lefebvre
Keyword(s):  
Social Insurance ◽  
Private Insurance ◽  
Population Ageing ◽  
Fiscal Competition ◽  
Public Insurance ◽  
The Public ◽  
Social Risks ◽  
The Family ◽  
Private And Public

This chapter looks at the role of the public versus the private sector in the provision of insurance against social risks. After having discussed the evolution of the role of the family as support in the first place, the specificity of social insurance is emphasized in opposition to private insurance. Figures show the extent of spending on both private and public insurance and the chapter presents economic reasons to why the latter is more developed than the former. Issues related to moral hazard and adverse selection are addressed. The chapter also discusses somewhat more general arguments supporting social insurance such as population ageing, unemployment, fiscal competition and social dumping.

Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

2021 ◽  
pp. 000348942110157
Author(s):  
Jennifer L. McCoy ◽  
Ronak Dixit ◽  
R. Jun Lin ◽  
Michael A. Belsky ◽  
Amber D. Shaffer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Private Insurance ◽  
Chronic Otitis Media ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Median Income ◽  
Public Insurance ◽  
Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

Abstract P076: Increased Burden Of Chronic Illness Among Insured Compared To Uninsured Sudden Death Victims

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Reaves Houston ◽  
Susan Keen ◽  
Chelsea Deitelzweig ◽  
Hannah Jones ◽  
Sarah Laible ◽  
...  
Keyword(s):  
Health Insurance ◽  
Chronic Illness ◽  
Sudden Death ◽  
Private Insurance ◽  
Chronic Illnesses ◽  
Categorical Variables ◽  
Insurance Status ◽  
Public Insurance ◽  
Status Data ◽  
Lower Frequencies

Introduction: Lack of health insurance is associated with reduced access to medical care and increased mortality. Chronic illness is associated with sudden death, a major cause of natural death. Insurance status of sudden death victims has not been characterized. Hypothesis: Uninsured compared to insured sudden death victims will have more chronic illnesses. Methods: From 2013-2015, emergency medical services-attended out of hospital deaths among ages 18-64 in Wake County, NC were screened to adjudicate sudden deaths. Medical records were reviewed for demographic, clinical, and health insurance status data. Insurance status was characterized as private, public, or no insurance. Cases were excluded from the analysis if no information on insurance was available. Comparisons of demographic and clinical characteristics were made between the three insurance status groups using Student’s t-test and ANOVA for continuous and categorical variables, respectively. Results: Of 399 cases of sudden death, insurance status data was available for 130: 25 (19.2%) had no insurance, 62 (47.7%) had public insurance, 31 (23.8%) had private insurance, and 12 (9.2%) had insurance of unknown type. Uninsured victims had lower frequencies of hypertension, hyperlipidemia, and chronic respiratory disease than those with private or public insurance, and lower frequencies of diabetes mellitus, mental illness, and substance abuse than those publicly insured (Table 1). No significant differences were found in coronary artery disease, age, gender, race, marital status, or years of education. Conclusion: Uninsured sudden death victims have less chronic illnesses than those insured. This counterintuitive finding suggests that uninsured sudden death victims have undiagnosed chronic illnesses that are treatable and preventable and contribute to their death. Our results suggest that expanding health insurance among working age adults may reduce the incidence of sudden death.

The Economics of Long-Term Care

2013 ◽  
Vol 14 (2) ◽  
pp. 343-375 ◽  
Author(s):  
Luigi Siciliani
Keyword(s):  
Long Term Care ◽  
Private Insurance ◽  
Care Home ◽  
Significant Proportion ◽  
Empirical Work ◽  
The United States ◽  
Ageing Population ◽  
Public Insurance ◽  
Term Care

Abstract Long-term care expenditure is expected to rise, driven by an ageing population. Given that public long-term care expenditure is high in many OECD countries, governments are increasingly concerned about its future growth. This study focuses on three relevant issues. First, we discuss factors that affect the growth of long-term expenditure and its projections. These include demographics, the balance in provision between informal and formal care, whether higher life expectancy translates into higher disability, the interrelation between health and long-term care, and whether long-term care suffers from Baumol’s disease. Second, given that a significant proportion of long-term care expenditure is nursing- and care-home expenditure, we discuss the role of government regulation aimed at ensuring that individuals receive appropriate quality of care in such institutions. We focus in particular on price regulation, competition, and the non-profit sector; these have been the subject of considerable empirical work (mainly in the United States). Third, we discuss the relative merits of public and private insurance. Countries differ greatly in their approach. Some countries have nearly exclusively public insurance but in others this is small. We consider the conditions under which public insurance can overcome the limitations of a private insurance market.

Characteristics of Patients Who Attend the 7- to 10-Day Postpartum Visit for Blood Pressure Evaluation

2021 ◽  
Author(s):  
Maggie Tallmadge ◽  
Mary Christine Livergood ◽  
Alina Tvina ◽  
Sarah Evans ◽  
Jennifer McIntosh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Race And Ethnicity ◽  
Private Insurance ◽  
Chronic Hypertension ◽  
Postpartum Visit ◽  
Public Insurance ◽  
Maternal Characteristics ◽  
Lower Odds ◽  
Black Race ◽  
Cesarean Birth

Objective To assess maternal characteristics that predict attendance of postpartum blood pressure evaluation in patients with hypertensive disorders of pregnancy (HDP). Study Design A retrospective case–control study of patients with HDP delivering at a single academic institution (2014–2018). Diagnosis of HDP included gestational hypertension, chronic hypertension, preeclampsia, and superimposed preeclampsia. Univariable and multivariable analyses were used to determine maternal characteristics independently associated with attendance of the 7- to 10-day postpartum blood pressure evaluation. Results Of the 1,041 patients included in the analysis, 603 (57.9%) attended the 7- to 10-day postpartum blood pressure check. Maternal sociodemographic, clinical, and obstetric factors differed significantly between patients who attended the postpartum blood pressure visit and those who did not. In univariable analyses, nulliparity, non-Hispanic black race and ethnicity, public insurance, HDP with severe features, cesarean birth, gestational age at delivery, receipt of magnesium, mild-range blood pressures on day of discharge, and initiation of antihypertensive medication were associated with attendance of the 7- to 10-day postpartum visit. In multivariable analysis, factors significantly associated with higher odds of attending the blood pressure visit were nulliparity (adjusted odds ratio [aOR]: 1.58; 95% confidence interval: [CI]: 1.14–2.17), severe HDP (aOR: 1.94, 95% CI: 1.44–2.61), and cesarean birth (aOR: 1.92, 95% CI: 1.43–2.59). In contrast, factors associated with lower odds of attendance were non-Hispanic black race and ethnicity compared with non-Hispanic white (aOR: 0.68, 95% CI: 0.47–0.97), and public insurance (aOR: 0.65, 95% CI: 0.45–0.93) compared with private insurance. Conclusion Clinical factors such as nulliparity, severe HDP, and cesarean birth were associated with higher rates of postpartum blood pressure evaluation attendance, whereas sociodemographic factors such as maternal non-Hispanic black race and ethnicity and public insurance were associated with lower odds of postpartum blood pressure check attendance. Key Points

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