China's agenda for an old-age insurance program in rural areas

Based on a field study conducted in August 1993 by the author, this article discusses the experimental program of old-age insurance in rural areas of China. The achievements made so far, the feasibility of old-age insurance in rural areas, and the problems encountered by the program are discussed. Policy recommendations regarding maintenance of the value of the premium, legislation, management of the program, and continuation of the family support system are proposed. It is emphasized that China urgently needs to establish a universal old-age insurance program and other social support services for the elderly. This would be akin to building a new Great Wall to help solve the serious problems of aging, reverse the trend of a high male-to-female sex ratio at birth, and further reduce fertility levels in less developed rural areas.     

China's Agenda for an Old-Age Insurance Program in Rural Areas

Based on a field study conducted in August 1993 by the author, this article discusses the experimental program of old-age insurance in rural areas of China. The achievements made so far, the feasibility of old-age insurance in rural areas, and the problems encountered by the program are discussed. Policy recommendations regarding maintenance of the value of the premium, legislation, management of the program, and continuation of the family support system are proposed. It is emphasized that China urgently needs to establish a universal old-age insurance program and other social support services for the elderly. This would be ain to building a new Great Wall to help solve the serious problems of againg, reverse the trend to a high male-to-female sex ratio at birth, and further reduce fertility levels in less developed areas.     

EFFICIENCY IN A PURE CURRENCY ECONOMY WITH INFLATION

Individuals who are buffeted by stochastic shocks will wish to substitute consumption intertemporally. To effect this substitution they can enter into insurance contracts, or they can use money. This paper investigates the connection between optimum insurance and Friedman's [1969] concept of the optimum quantity of money, using a simplified version of Lucas's [1980] pure currency economy. Monetary efficiency and efficient insurance are equivalent here. An example is presented in which an efficient monetary equilibrium exists. Contrary to Bewley's [1983] conjecture, in the example the efficient rate of return on real balances is less than the internal rate of discount.     

Questions and answers on health insurance benefit issues

This Issue Brief addresses eight topics in the areas of health insurance and health care costs. Using a question and answer format, the discussion draws largely on EBRI research and the EBRI Databook on Employee Benefits, third edition. In 1993, U.S. expenditures on health care were $884.2 billion, and they are projected to reach $2,173.7 billion by 2005, increasing at a projected average annual rate of 7.8 percent. Health care spending accounted for 13.9 percent of Gross Domestic Product (GDP) in 1993 and is projected to reach 17.9 percent of GDP by 2005. Among the factors contributing to the increase in health care costs are the growth in the number of individuals with traditional reimbursement health insurance coverage, the rapid expansion of technology and treatment options, and demographic factors such as the aging of the population. In 1993, employers, both public and private, spent $235.6 billion on group health insurance, accounting for 6.2 percent of total compensation. Group health insurance is the fastest growing component of total compensation, increasing at an average annual rate of 13.7 percent from 1960 to 1993. An increasing number of employees are required to make a cash contribution to their health insurance plan premium. In 1993, 61 percent of full-time employees in medium and large private establishments who participated in an employee only health insurance plan were required to make a contribution to the premium, up from 27 percent in 1979. In 1993, 185.3 million persons under age 65 had health insurance coverage, while 40.9 million people--or about 18.1 percent of the nonelderly population--received neither private health insurance nor publicly financed health coverage. Of those individuals who had health insurance coverage, 60.8 percent, or 137.4 million persons, received their health insurance through an employment-based plan. In 1993, 15.2 percent of the nonelderly population without health insurance coverage were noncitizens. In six states noncitizens represented a higher proportion of the total uninsured population than individuals in the nation as a whole. An increasing number of employers are self-funding their health insurance plans. In 1994, 74 percent of employers with 500 or more employees self-funded their health insurance plans, up from 63 percent in 1993. An estimated 22 million full-time employees in private industry and state and local governments participated in a self-funded employment-based health insurance plan.(ABSTRACT TRUNCATED AT 400 WORDS)     

The Insurance Industry in Jordan

This paper examines the structure and performance of the insurance industry in Jordan during the period of 2000–2005. The Jordanian insurance industry is free of state ownership in both primary insurance and reinsurance markets and has been spared the pervasive premium, product, investment, and reinsurance controls that have bedeviled the insurance markets of so many developing countries around the world. Despite these positive features, the insurance industry is not developed, which mainly reflects the underdevelopment of life insurance that has annual premiums of only 0.27 percent of GDP. In contrast, the level of general insurance is comparable to that of several other developing countries in the region. To overcome this situation a major modernization effort should be undertaken.      

Paying for the health and social care of the elderly

The aging population of Japan is causing serious concern among social policymakers. The most urgent issue is to find a way to pay for the health and social care of the frail elderly. After universal coverage of pension and health insurance was achieved, but just before the economic growth rate was considerably slowed, in part, because of the oil crisis, the Japanese government more than doubled pension benefits and made medical care for the elderly free. Since the early 1980s, the government has tried hard to cut and control these benefits, only with moderate success. With a consumption tax rate of only 5%, rather than the proposed 7%, the government is now considering establishing a new health and social care insurance scheme for the elderly to finance the increasing cost of their care.     

Payroll taxes for social security in the United States: The future of fiscal and social policy illusions

This paper examines the validity of common assumptions about the basis of public support for the U.S. social security program. Various rationales for the social insurance approach are summarized and critically assessed. A review of public opinion surveys from 1935–1981 shows: (1) the distinction between social insurance and public assistance was not regarded as important by the public in the program's early years; (2) most Americans are now aware that the system operates on a pay-as-you-go basis; (3) there is widespread feeling that social security payroll taxes are too high, but at the same time a majority of the population thinks program benefits should be maintained or increased; and (4) serious doubt about the program's future is widespread, with many workers believing that there will not be sufficient money left for their own pensions when they retire. The paper concludes that the explanation of social security's enduring popular appeal and the phenomenon of mass toleration of rising payroll taxes is more closely tied to the perception that the program serves a deserving clientele, rather than a result of the social insurance approach.     

Paying for the Health and Social Care of the Elderly

The aging population of Japan is causing serious concern among social policymakers. The most urgent issue is to find a way to pay for the health and social care of the frail elderly. After universal coverage of pension and health insurance was achieved, but just before the economic growth rate was considerably slowed, in part, because of the oil crisis, the Japanese government more than doubled pension benefits and made medical care for the elderly free. Since the early 1980s, the government has tried hard to cut and control these benefits, only with moderate success. With a consumption tax rate of only 5%, rather than the proposed 7%, the government is now considering establishing a new health and social care insurance scheme for the elderly to finance the increasing cost of their care.     

Does Health Insurance Premium Exemption Policy for Older People Increase Access to Health Care? Evidence from Ghana

Aging in Sub-Saharan Africa causes major challenges for policy makers in social protection. Our study focuses on Ghana, one of the few Sub-Saharan African countries that passed a National Policy on Aging in 2010. Ghana is also one of the first Sub-Saharan African countries that launched a National Health Insurance Scheme (NHIS; NHIS Act 650, 2003) with the aim to improve access to quality health care for all citizens, and as such can be considered as a means of poverty reduction. Our study assesses whether premium exemption policy under the NHIS that grants non-payments of annual health insurance premiums for older people increases access to health care. We assessed differences in enrollment coverage among four different age groups (18–49, 50–59, 60–69, and 70+). We found higher enrollment for the 70+ and 60–69 age groups. The likelihood of enrollment was 2.7 and 1.7 times higher for the 70+ and 60–69 age groups, respectively. Our results suggest the NHIS exemption policy increases insurance coverage of the aged and their utilization of health care services.     

STICKY WAGES AND IMPLICIT CONTRACTS: A TRANSACTIONAL APPROACH

Sticky wages have been explained in the recent implicit contracts literature as a risk shifting device. Risk averse employees purchase insurance via an implicit contract from risk neutral firms. This paper offers an alternative explanation of the phenomenon. Various alternative organizational forms for labor markets are analyzed from a transactions cost viewpoint. Observed labor market institutions (including sticky wages) are seen as ways to economize on transactions costs. In fact, it is argued that sticky wages would be observed even if workers were risk neutral. Thus the emphasis on risk shifting in the implicit contracts literature seems misplaced.
A fall (in price) arising from temporary distress will be attended probably with no correspondent fall in the rate of wages: for the fall in price, and the distress, will be understood to be temporary, and the rate of wages, we know, is not so variable as the price of goods.     

MANDATORY RETIREMENT AS A CLAUSE IN AN EMPLOYMENT INSURANCE CONTRACT

This paper postulates the existence of an "employment insurance contract" in which firms insure the employment of workers, at a predetermined wage, against potential, age related declines in productivity. To limit its liability the firm establishes an age limit to its promise ––– the mandatory retirement age. It is demonstrated that Pareto-efficient contracts exist which involve mandatory retirement at a specific age. The existence of these contracts, including mandatory retirement, increases workers' life-time utility and encourages the accumulation of human capital. Empirical results are consistent with the predictions of the model.     

The Receipt of Transfer Payments by Immigrants in Sweden

Using the native-born as a benchmark, this article examines the reliance of immigrants on Sweden's social safety net. Both in the raw data, and after conditioning on a number of explanatory variables, we find that there are differences between immigrants and natives regarding participation in the Swedish income security system. We also find that there are differences in this respect between immigrants from different regions as well as between more recent and earlier cohorts of immigrants. As regards unemployment insurance benefits and cash labour market assistance, no clear pattern can be discerned in the results. In the case of early retirement pension and social assistance, however, the picture looks different. Immigrants arriving at an early date from typical labour immigration regions are over-represented in early retirement. Immigrants, especially non-European immigrants with a recent date of arrival, are over-represented among recipients of social assistance. The overall conclusion is that the immigrants' total rate of participation in the income security system is determined by their rate of unemployment and their state of health. On the other hand, the distribution of their participation among the different components of the income security system is highly dependent on their length of residence in Sweden and where they come from.     

The adequacy of college health insurance coverage

This analysis of private health insurance plans offered in 100 four-year colleges and universities in 1988 indicates a tremendous diversity in plan options, benefits covered, cost-sharing requirements, and catastrophic protections. Consistent with relatively low premium prices, most student health insurance plans offer limited benefits and expose students to significant out-of-pocket medical cost liabilities. Only a minority of schools use financial incentives, such as preferred provider arrangements, to integrate their health insurance plans with their university health service system. We conclude that universities should carefully reexamine the adequacy of their health insurance plans and their relationship to student health centers. As more students rely on student health insurance as their only source of coverage, the quality of these plans assumes an even greater importance.     

CONTRACTING, CONTINGENCIES AND SINGLE-FAMILY HOUSE PRICES

This paper investigates the relationship between single-family house prices and contingent terms in contracts. Since contingencies create uncertainty, the market should exact a price premium. The results indicate that the contracting for property rights affects house prices in the predicted ways.     

Index insurance and climate risk management: Addressing social equity

Fair distribution of benefits from index insurance matters. Lack of attention to social equity can reinforce inequalities and undermine the potential index insurance holds as a tool for climate risk management that is also pro‐poor. The aims of this article are to: (a) examine social equity concerns raised by index insurance in the context of climate risk management, (b) consider how greater attention can be paid to social equity in index insurance initiatives, and (c) reflect on the policy challenges raised by taking social equity into account as a mechanism for climate risk reduction. The article draws on learning from the CGIAR's Research Program on Climate Change, Agriculture and Food Security (CCAFS) and presents the cases of the Index Based Livelihoods Insurance (IBLI) and Agriculture and Climate Risk Enterprise Ltd. (ACRE) in East Africa. It proposes a framework for unpacking social equity related to equitable access, procedures, representation and distribution within index insurance schemes. The framework facilitates identification of opportunities for building outcomes that are more equitable, with greater potential for inclusion and fairer distribution of benefits related to index insurance. The article argues that systematically addressing social equity raises hard policy choices for index insurance initiatives without straightforward solutions. Attention to how benefits and burdens of index insurance are distributed, suggests the unpalatable truth for development policy that the poorest members of rural society can be excluded. Nevertheless, a focus on social equity—facilitated by the framework—opens up opportunities to ensure index insurance is linked to more socially just climate risk management. At the very least, it may prevent index insurance from generating greater inequality. Taking social equity into account, thus, shifts the focus from agricultural systems in transition per se to systems with potential to incorporate societal transformation through distributive justice.     

ERISA and health plans

This Issue Brief is designed to provide a basic understanding of the relationship of the Employee Retirement Income Security Act of 1974 (ERISA) to health plans. It is based, in part, on an Employee Benefit Research Institute-Education and Research Fund (EBRI-ERF) educational briefing held in March 1995. This report includes a section by Peter Schmidt of Arnold & Porter, a section about multiemployer plans written by Judy Mazo of The Segal Company; and a section about ERISA and state health reform written by Kala Ladenheim of the Intergovernmental Health Policy Project. Starting in the late 1980s, three trends converged to make ERISA a critical factor in state health reforms: increasingly comprehensive state health policy experimentation; changes in the makeup of the insurance market (including the rise in self-insurance and the growth of managed care); and increasingly expansive interpretations of ERISA by federal courts. The changing interpretations of ERISA's relationship to three categories of state health initiatives--insurance mandates, medical high risk pools, and uncompensated care pools--illustrate how these forces are playing out today. ERISA does have a very broad preemptive effect. Federal statutes do not need to say anything about preemption in order to preempt state law. For example, if there is a direct conflict, it would be quite clear under the Supremacy Clause [of the U.S. Constitution] that ERISA, or any federal statue, would preempt a directly conflicting state statute. States can indirectly regulate health care plans that provide benefits through insurance contracts by establishing the terms of the contract. And they also raise money by imposing premium taxes. But they cannot do the same with respect to self-funded plans. That is one of the factors that has caused a great rise in the number of self-funded plans. State regulation [of employee benefits] can create three kinds of problems: cost of taxes, fees, or other charges; cost of dealing with substantive, possibly inconsistent, benefit standards; and cost of identifying, understanding, and complying with the regulations themselves.     

A limit theorem on the dual core of a distributive social system

I consider abstract social systems where the distribution of wealth is an object of common concern. I study, in particular, the systems where liberal distributive social contracts consist of the Pareto-efficient distributions that are unanimously preferred to the initial distribution. I define a Dual Distributive Core from a process of decentralized auction on the budget shares of Lindahl associated with net transfers, operated by coalitions aiming at increasing the value of the public good for their members while maintaining their utility levels. I establish that the dual distributive core converges, as the number of distributive agents becomes large relative to the number of agent types, to a typically finite number of distributive liberal social contracts, which correspond to the Lindahl equilibria that are unanimously preferred to the initial distribution. This process of decentralized auction provides a theoretical foundation for contractual policies of redistribution. The comparison with the usual notion of core with public goods (Foley 1970) yields the following results in this context: the Foley-core is a subset, generally proper, of the set of liberal distributive social contracts; it does not contain, in general, distributive Lindahl equilibria.     

Trends in Employee Wage and Health Insurance Compensation for Employer-Sponsored Health Insurance (ESI) Coverage

Health insurance coverage continues to be an important benefit of employment and employer-sponsored insurance is the most prominent form of health coverage in the US. We examine trends in both employer and employee contributions to the costs of health insurance premium between 2002 and 2005 and assess these contributions relative to changes in worker wages. We do this for the US overall and for the 50 states plus the District of Columbia. We found a significant increase of 15.5% in the share of total compensation going toward health benefits (from 12.3–14.2%) for workers with individual coverage and an increase of 13.5% (from 20.6–23.4%) for workers with family coverage. Wages over this time period decreased 3.0% for workers with individual coverage and increased 0.8% for workers with family coverage.     

Collective Bargaining and Alcoholism:

In this project 106 collective bargaining contracts were analyzed to identify union-management responses to the problem of alcoholism in the workplace. The original contracts were collected by the Bureau of Labor Statistics and published on microfiche by the Microfilming Corporation of America. The contracts in this set were executed between 1977 and 1982, and cover all private sector employers with over 900 employees in Michigan. The purpose of this study was to determine the present state of collective bargaining language as a basis for identifying how employers in a unionized setting handle the problem of alcoholism at the work site. The authors discovered that alcoholism is most frequently dealt with in the disciplinary procedure. Clauses dealing with insurance benefits are the next most frequent site. There is evidence of alcoholism increasingly becoming an area for labor-management cooperation. The paper concludcs with some suggestions as to how EAP practitioners can enhance the success of programs in a unionized setting.