The political economy of rationing in social health insurance

Due to the rapid progress in medical technology social insurance systems will soon no longer be able to grant health services without limits but must employ non-price rationing devices. This raises the question how these limits will be determined. Here we consider a direct democracy where the size of the social health insurance plan is determined in a popular referendum using simple majority rule. Moreover, two different kinds of rationing are distinguished according to whether additional private purchases of health care are allowed. For both systems we examine the size of the social insurance system in a political equilibrium, and we compare the results in particular with respect to their distributional effects.Funding for this research from the Norwegian Research Council under the Ruhrgas Scholarship Scheme and valuable comments by two anonymous referees are gratefully acknowledged.     

Federal mortgage insurance and the characteristics of intraurban movers in the United States

This paper examines the social, economic, demographic and locational characteristics of the clients of the Federal Housing Administration's mortgage insurance program. The program has been accused of fostering the development of white middle class suburbs and nonwhite central cities. The data used in this analysis are from 1976 and 1977, and indicate that the mortgage insurance program is less suburb oriented than private financing of houses in the same price range. White homebuyers under the program are more likely to purchase suburban homes than nonwhite, however. This is a result of a variety of actors in the housing market of which the Federal Housing Administration is one. The paper concludes with comments on what kinds of people use the program and ways to ensure that the users benefit from the insurance.     

Occupational risks, social insurance and investments in education

A link between social insurance and education policy is explored. Due to moral hazard full insurance against disability is not feasible. When high- and low-risk individuals can be identified second-best social insurance system entails cross-subsidies from the low-risk group to the high-risk group. Implementation of this second-best insurance however distorts the human capital investment decisions when education qualifies for a low risk job. Therefore, the second-best social insurance together with an education subsidy is a welfare improving policy. An education policy also has the role of establishing dynamic consistency of the government's policy. Received: 16 October 1998/Accepted: 8 September 1999     

建设有中国特色的农村社会养老保险制度

本文通过分析中国目前的社会经济状况和人们对农村社会养老保险的认识,得出中国现在还不具备建立农村社会养老保险制度,但根据我国现实情况人口老龄化,家庭赡养方面的诸多问题以及集体经济的衰弱,觉得中国又迫切需要建立社会养老保险制度.针对条件不足和客观需要之间的矛盾,提出建立有中国特色的农村社会养老保险制度,对其应遵循的原则和具体实施中的一些环节发表自己的看法.     

The labor market effects of national health insurance: evidence from Taiwan

This paper investigates the impacts of national health insurance on the labor market, by considering the case of Taiwan, which implemented national health insurance in March 1995. Taiwan’s national health insurance is financed by premiums, which are proportional to an employee’s salary. These premiums may introduce distortions to the labor market. Based on repeated cross-sections of individual data we find that, on average, private sector employees’ work hours declined relative to their public sector counterparts, whereas their relative wage rates were almost unchanged with the introduction of national health insurance. The results suggest that neither private sector employers nor their employees were able to shift their premium burden to each other.      

Gender differences in predictors of late-life health insurance knowledge

For many older adults having access to affordable health care is a major concern. The present study's goal was to examine what factors were related to individuals' knowledge of late-life health insurance. A total of 131 women and 116 men (all aged 55-71) answered questions about private, Medicare, Medigap, and long-term care insurances. In addition, they answered demographic, personality, and health status questions. Results revealed that different factors are related to men's and women's knowledge of late-life health insurance options implying genderspecific educational interventions would be more effective than current educational interventions.     

社会保险制度供给与私营企业诉求的差异分析

我国当前社会保障制度的激励功能存在着一定的缺失,保障供给与企业需求及承担能力存在一定差异。本文通过对浙江私营企业社会保险诉求的实际调查,对影响私营企业参保的因素进行了数据分析,为社会保险制度供求均衡的改进提供了实证支撑。     

Correlations,causes and heuristics in surveys of life satisfaction

Satisfaction with life domains is more highly correlated with interpersonal than with intrapersonal comparisons (Emmons and Diener, 1985). The hypothesis of the present studies is that the high correlations reflect inferences of social comparison from global satisfaction. Paradoxically, such inferences are most likely in private domains (love life, friends), where social information is scarce and relatively unimportant as a determinant of satisfaction. Study I replicates the Emmons-Diener findings, but also finds that subjects judge recent changes more important than social standing as a determinant of life satisfaction, especially in private domains. Study II examines an order effect in judgments of satisfaction. As hypothesized the correlation between social comparison and global satisfaction is higher (in private domains only) when global satisfaction is judged first than when the order of judgment is reversed.     

Metropolitan social structure,labor markets,and fertility

This paper develops and examines a community-level model of fertility, incorporating both sociological and economic theoretical perspectives. Data from several government and private sources are analyzed in a series of reduced-form, multivariate regression models. Generally, the results demonstrate that while the conceptual relationships from both schools receive some empirical support, the social structural characteristics (such as social class, religious and ethnic composition) offer somewhat greater explanatory power. In a subsequent analytic stage, principal components analysis is employed in order to estimate a series of revised models, clarifying some inconsistencies found when employing a more “naive” model testing strategy.     

Utilization of Infertility Treatments: The Effects of Insurance Mandates

Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this article, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more-educated women should be more likely to be directly affected by the mandates than younger women and less-educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance, which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more-educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.     

提前退休模式与行为及其影响因素——基于中国综合社会调查数据的分析

文章基于2008年中国综合社会调查数据,对城镇人口提前退休模式与行为及其影响因素进行了分析。主要结论是:(1)提前退休模式与行为存在显著的性别差异,女性比男性距离法定退休年龄更近时退休,表现出较为明显的集聚特征,法定退休年龄对女性退休模式与行为的影响更大;(2)随着中国家庭子女数量的减少,劳动力市场灵活性的逐步增强,人们劳动参与意愿和可能性都会显著提升,提前退休的可能性越来越小,而且不断提高的受教育程度也会使女性提前退休的可能性减小;(3)中国的社会保障制度对男性提前退休有显著影响,对女性则不显著。与养老保险制度相比,医疗保险与失业保险制度对男性提前退休的影响更大,基本医疗保险制度的完善会增加提前退休的可能性,失业保险制度的完善更有可能增强男性的工作意愿,降低提前退休的可能性。     

Household structure and consumption insurance of the elderly

This paper examines the role of household formation in providing consumption insurance to the elderly. Using data from the Consumer Expenditure Surveys, raw tabulations of per adult equivalent consumption indicate that the elderly who live alone have higher levels of well-being relative to those who live with others. This is misleading, however, because the decision to live alone is clearly endogenous. The empirical estimation accounts for this endogeneity using data from the Panel Study of Income Dynamics. The results provide evidence that household formation plays a significant role in maintaining consumption levels. Without the opportunity to live with others, the welfare gap measured by the difference between per adult equivalent consumption levels of dependent and independent livers would be even larger. These findings suggest that co-residing with others effectively supplements social security, pensions, and private savings and helps the elderly to smooth consumption in old age.

新农保中地方财政补贴责任的区域比较研究

2009年9月国务院发布的《国务院关于开展新型农村社会养老保险试点的指导意见》中明确规定了地方财政对新农保所承担的补贴责任,鉴于地区经济发展水平不同,东部地区在基础养老金发放上较中西部地区承担了更多的财政责任。从未来几年新农保覆盖率逐渐扩大至全覆盖的角度出发,在补贴随经济发展不断提高的基础上研究新农保补贴给三个地区所增加的财政负担,并进行了区域比较,提出了各地增加新农保补贴的可行性。     

Voluntary income sharing and the design of unemployment insurance

This paper uses a model of search unemployment to discuss the interaction between publicly provided insurance and informal insurance through voluntary income sharing, e.g., between spouses. Income sharing reduces the optimal level of public unemployment insurance. While it is always individually rational for partners to share income, the effect of voluntary income sharing on welfare will be negative unless partners can either observe each other's search behavior or are sufficiently altruistic towards each other. The model is also used to examine a family-based policy. The welfare gains from using such policy are argued to be small. Received: 14 December 2000/Accepted: 5 November 2001     

农村社会养老保险研究综述

农村社会养老保险政策推行十多年来 ,在实践上取得了丰富的经验 ,在理论上也积累了大量的文献资料。对这些文献研究的焦点问题 ,如农村社会养老保险建立的必要性和可行性、存在的问题、实践中的区域差异、今后发展的对策和建议等进行整理和总结 ,并分析需要进一步研究的问题 ,对农村社会养老保险今后的发展能起到一定的启示和借鉴作用     

新型农村社会养老保险可能面临的主要问题与政策建议

新型农村社会养老保险经过多年的各地积极探索之后,2009年国务院决定在全国开展新型农村社会养老保险试点．这意味着全国统一的新农保制度即将建立。新农保具有鲜明的特征,如强调政府责任、基础养老金的普惠性、个人账户积累等。但同时,新农保在试点过程中也可能遇到一些问题,如如何落实集体补助、如何实现个人账户基金保值增值、如何体现社会统筹等。解决新农保试点中可能遇到的问题,应考虑对相关政策安排作出适当调整。     

Targeting,Universalism, and Single-Mother Poverty: A Multilevel Analysis Across 18 Affluent Democracies

We examine the influence of individual characteristics and targeted and universal social policy on single-mother poverty with a multilevel analysis across 18 affluent Western democracies. Although single mothers are disproportionately poor in all countries, there is even more cross-national variation in single-mother poverty than in poverty among the overall population. By far, the United States has the highest rate of poverty among single mothers among affluent democracies. The analyses show that single-mother poverty is a function of the household’s employment, education, and age composition, and the presence of other adults in the household. Beyond individual characteristics, social policy exerts substantial influence on single-mother poverty. We find that two measures of universal social policy significantly reduce single-mother poverty. However, one measure of targeted social policy does not have significant effects, and another measure is significantly negative only when controlling for universal social policy. Moreover, the effects of universal social policy are larger. Additional analyses show that universal social policy does not have counterproductive consequences in terms of family structure or employment, while the results are less clear for targeted social policy. Although debates often focus on altering the behavior or characteristics of single mothers, welfare universalism could be an even more effective anti-poverty strategy.     

Health insurance in the near elderly population

A number of studies have documented therising number of persons under age 65 who do not havehealth insurance. This paper focuses on the healthinsurance status of near elderly, those persons age 55through 64. A comparison age group, persons age 45through 54, is selected for benchmark purposes. Utilizing data from the 1996 Current PopulationSurvey, logistic regression is used to generateinsurance status prediction equations for both agegroups. Household characteristics, income, educationand employment are found to be significant predictorsof health insurance status, but fewer-than-expecteddifferences are found in comparing equations betweenthe two age groups. Results are discussed in thecontext of recent proposals to extend Medicarecoverage, the effect of Medicare policy changes on thenumber of near elderly persons without healthinsurance, and how prolonged periods of time withouthealth insurance may lead to an increased burden onMedicare as newly eligible Medicare recipients seekservices to address their pent-up demand for healthcare.     

关于城镇职工养老金制度改革现实取向的若干思考

由于人口老龄化和较高的工资替代率 ,城镇职工养老总额与职工工资总额的比例逐渐上升 ,因此 ,必须对我国的养老制度进行重构 :提高职工本人缴费数额 ,从现有的国有资产存量中“割一块”注入已退休职工和跨体制职工的养老金个人帐户。而改制成功必须具备三个条件 ,一是大力发展非银行金融机构确保养老金基金保值增值 ;二是发展补充养老保险与个人储蓄养老保险 ;三是要加强法制建设 ,确保养老金制度的有法可依     

Knowing One’s Lot in Life Versus Climbing the Social Ladder: The Formation of Redistributive Preferences in Urban China

This paper examines, how individual preferences for redistribution in general and redistribution to improve access to education, improve social protection for the poor, reduce income inequality and reduce unemployment depend on beliefs about what determines one’s lot in life and self-assessed prospects for climbing the social ladder in urban China. We find that beliefs about what determine one’s lot in life and subjective perceptions of future mobility are correlated with preferences for redistribution. We find that those who believe one’s lot in life is outside their control are generally more likely to favour redistribution. We show that this result is consistent with the existence of an altruism effect among the rich and entitlement effect among the poor. These findings are robust to the inclusion of control variables for the respondent’s personal characteristics and the location in which he or she lives.