Elderly responses to private health insurance incentives: Evidence from Australia.
Australia
elderly
private health insurance
tax rebates
Journal
Health economics
ISSN: 1099-1050
Titre abrégé: Health Econ
Pays: England
ID NLM: 9306780
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
revised:
24
07
2023
received:
28
04
2022
accepted:
11
08
2023
medline:
6
11
2023
pubmed:
29
8
2023
entrez:
29
8
2023
Statut:
ppublish
Résumé
Many governments with dual public and private health systems offer subsidies for private health insurance (PHI) with the aim to ease the burden on the public system. Understanding how elderly individuals respond to these PHI subsidies is important because they typically have greater health care needs but often struggle with the affordability of PHI. However, prior studies provide little guidance on this issue because they have mainly focused on the responses to PHI incentives among the general population. This paper leverages a unique age-specific policy intervention in Australia that provided higher rebates for individuals over the age of 65. Using administrative tax data, we examine how this policy affected PHI take-up decisions of elderly individuals under an event study difference-in-differences framework. We find that higher rebates led to a modest increase in PHI take-up. The estimated price elasticities of PHI demand were in the -0.1 to -0.2 range in the first 2 years of the policy. Moreover, the demand responses were more elastic among those with low incomes. Our findings indicate that a more targeted subsidy program, specially tailored to low-income elders, would yield greater effectiveness in increasing PHI take-up.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2730-2744Informations de copyright
© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.
Références
Australian Institute of Health and Welfare. (2017). Private health insurance use in Australian hospitals, 2006-07 to 2015-16. Retrieved from: https://www.aihw.gov.au/getmedia/f95e7fc9-db3f-4e7e-a5f5-38f2f69cd539/aihw-hse-196.pdf
Australian Institute of Health and Welfare. (2022). Elective surgery waiting times 2021-22. Retrieved from: https://www.aihw.gov.au/reports-data/myhospitals/sectors/elective-surgery
Australian Prudential Regulation Authority. (2022). Quarterly private health insurance statistics. Retrieved from: https://www.apra.gov.au/quarterly-private-health-insurance-statistics
Bilgrami, A., Cutler, H., Sinha, K., & Cheng, Z. (2021). The impact of means-tested premium rebates and tax penalties on the demand for private hospital cover in Australia. The Economic Record, 97(317), 170-211. https://doi.org/10.1111/1475-4932.12603
Buchmueller, T. C., Cheng, T. C., Pham, N. T. A., & Staub, K. E. (2021). The effect of income-based mandates on the demand for private hospital insurance and its dynamics. Journal of Health Economics, 75, 102403. https://doi.org/10.1016/j.jhealeco.2020.102403
Butler, J. R. G. (2002). Policy change and private health insurance: Did the cheapest policy do the trick? Australian Health Review, 25(6), 33-41. https://doi.org/10.1071/AH020033
Call, K. T., Davern, M. E., Klerman, J. A., & Lynch, V. (2013). Comparing errors in Medicaid reporting across surveys: Evidence to date. Health Services Research, 48(2pt1), 652-664. https://doi.org/10.1111/j.1475-6773.2012.01446.x
Cheng, T. C. (2014). Measuring the effects of reducing subsidies for private insurance on public expenditure for health care. Journal of Health Economics, 33, 159-179. https://doi.org/10.1016/j.jhealeco.2013.11.007
Davern, M., Klerman, J. A., Baugh, D. K., Call, K. T., & Greenberg, G. D. (2009). An examination of the Medicaid undercount in the Current Population Survey: Preliminary results from record linking. Health Services Research, 44(3), 965-987. https://doi.org/10.1111/j.1475-6773.2008.00941.x
DeLeire, T., Chappel, A., Finegold, K., & Gee, E. (2017). Do individuals respond to cost-sharing subsidies in their selections of marketplace health insurance plans? Journal of Health Economics, 56, 71-86. https://doi.org/10.1016/j.jhealeco.2017.09.008
Doiron, D., Fiebig, D. G., & Suziedelyte, A. (2014). Hips and hearts: The variation in incentive effects of insurance across hospital procedures. Journal of Health Economics, 37, 81-97. https://doi.org/10.1016/j.jhealeco.2014.06.006
Doiron, D., & Kettlewell, N. (2018). The effect of health insurance on the substitution between public and private hospital care. The Economic Record, 94(305), 135-154. https://doi.org/10.1111/1475-4932.12394
Duckett, S., & Nemet, K. (2019). The history and purposes of private health insurance. Grattan Institute.
Einarsdóttir, K., Kemp, A., Haggar, F. A., Moorin, R. E., Gunnell, A. S., Preen, D. B., Stanley, F. J., & Holman, C. D. (2012). Increase in caesarean deliveries after the Australian private health insurance incentive policy reforms. PLoS One, 7(7), e41436. https://doi.org/10.1371/journal.pone.0041436
Eldridge, D. S., Onur, I., & Velamuri, M. (2017). The impact of private hospital insurance on the utilization of hospital care in Australia. Applied Economics, 49(1), 78-95. https://doi.org/10.1080/00036846.2016.1192273
Ellis, R. P., & Savage, E. (2008). Run for cover now or later? The impact of premiums, threats and deadlines on private health insurance in Australia. International Journal of Health Care Finance and Economics, 8(4), 257-277. https://doi.org/10.1007/s10754-008-9040-4
Finkelstein, A. (2002). The effect of tax subsidies to employer-provided supplementary health insurance: Evidence from Canada. Journal of Public Economics, 84(3), 305-339. https://doi.org/10.1016/S0047-2727(00)00155-9
Frean, M., Gruber, J., & Sommers, B. D. (2017). Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act. Journal of Health Economics, 53, 72-86. https://doi.org/10.1016/j.jhealeco.2017.02.004
Frech, H. E., III, Hopkins, S., & Macdonald, G. (2003). The Australian private health insurance boom: Was it subsidies or liberalised regulation? Economic Papers, 22(1), 58-64. https://doi.org/10.1111/j.1759-3441.2003.tb00336.x
Gruber, J., & Washington, E. (2005). Subsidies to employee health insurance premiums and the health insurance market. Journal of Health Economics, 24(2), 253-276. https://doi.org/10.1016/j.jhealeco.2004.08.004
Hinde, J. M. (2017). Incentive(less)? The effectiveness of tax credits and cost-sharing subsidies in the Affordable Care Act. American Journal of Health Economics, 3(3), 346-369. https://doi.org/10.1162/ajhe_a_00078
Kaiser Family Foundation. (2021). Explaining health care reform: Questions about health insurance subsidies. Retrieved from: https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health-insurance-subsidies
Keenan, P. S., Cutler, D. M., & Chernew, M. (2006). The ‘graying’ of group health insurance. Health Affairs, 25(6), 1497-1506. https://doi.org/10.1377/hlthaff.25.6.1497
Kettlewell, N., Stavrunova, O., & Yerokhin, O. (2018). Premium subsidies and demand for private health insurance: Results from a regression discontinuity design. Applied Economics Letters, 25(2), 96-101. https://doi.org/10.1080/13504851.2017.1299094
King, D., & Mossialos, E. (2005). The determinants of private medical insurance prevalence in England, 1997-2000. Health Services Research, 40(1), 195-212. https://doi.org/10.1111/j.1475-6773.2005.00349.x
Klerman, J. A., Ringel, J. S., & Roth, B. (2005). Under-reporting of Medicaid and Welfare in the Current Population Survey. RAND Working Paper Series No. WR-169-3. Available at SSRN: https://ssrn.com/abstract=754364
López Nicolás, Á., & Vera-Hernández, M. (2008). Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model. Journal of Health Economics, 27(5), 1285-1298. https://doi.org/10.1016/j.jhealeco.2008.06.006
Noon, J. M., Fernandez, L. E., & Porter, S. R. (2019). Response error and the Medicaid undercount in the current population survey. Health Services Research, 54(1), 34-43. https://doi.org/10.1111/1475-6773.13058
OECD. (2004). Private health insurance in OECD countries.
Palangkaraya, A., & Yong, J. (2005). Effects of recent carrot-and-stick policy initiatives on private health insurance coverage in Australia. The Economic Record, 81(254), 262-272. https://doi.org/10.1111/j.1475-4932.2005.00260.x
Palangkaraya, A., & Yong, J. (2007). How effective is "lifetime health cover" in raising private health insurance coverage in Australia? An assessment using regression discontinuity. Applied Economics, 39(11), 1361-1374. https://doi.org/10.1080/00036840500486532
Palangkaraya, A., Yong, J., Webster, E., & Dawkins, P. (2009). The income distributive implications of recent private health insurance policy reforms in Australia. The European Journal of Health Economics, 10(2), 135-148. https://doi.org/10.1007/s10198-008-0111-8
Polidano, C., Carter, A., Chan, M., Chigavazira, A., To, H., Holland, J., Nguyen, S., Vu, H., & Wilkins, R. (2020). The ATO longitudinal information files (ALife): A new resource for retirement policy research. The Australian Economic Review, 53(3), 429-449. https://doi.org/10.1111/1467-8462.12388
Rodríguez, M., & Stoyanova, A. (2008). Changes in the demand for private medical insurance following a shift in tax incentives. Health Economics, 17(2), 185-202. https://doi.org/10.1002/hec.1248
Stavrunova, O., & Yerokhin, O. (2014). Tax incentives and the demand for private health insurance. Journal of Health Economics, 34, 121-130. https://doi.org/10.1016/j.jhealeco.2014.01.001
Wilkins, R., & Sun, C. (2010). Assessing the quality of the expenditure data collected in the self-completion questionnaire. HILDA Project Discussion Paper Series No. 1/10.