【保险学术前沿】Journal of Public Economics 2022年保险精选文章目录与摘要

声明：本系列文章基于原期刊目录和摘要内容整理而得，仅限于读者交流学习。如有侵权，请联系删除。

期刊介绍：

《Journal of Public Economics》（公共经济学杂志）鼓励对公共经济学问题做出原创性的科学贡献，特别强调现代经济理论和定量分析方法的应用。它为国际读者讨论感兴趣的公共政策提供了一个平台。该刊每年发行12期，平均每期发表文章10篇左右，2022-2023年影响因子为9.8。

本期看点：

● 道德风险： 允许消费者以信贷方式购买保险可能存在道德风险，据估计，道德风险的成本达到了公司利润的12%。

● 逆选择： 拥有更健康投保人且流动性更好的雇主更可能会不遵守2010 年《平价医疗法案》的相关法规，这种逆向选择使 2014 年的人均年度医疗成本增加了365 美元。

● 医疗保险： 私人医疗保险市场的消费者具有很强的惯性，消费者愿意支付数千美元来保住他们的医疗保险计划。患者对带有免赔额的医疗保险合同中的动态激励措施反应强烈，根据荷兰一家大型医疗保险公司的理赔数据，免赔额提高100欧元会使医疗支出在年初减少3%，全年减少6%。

● 强制性糖尿病医疗保险： 每10万人中与糖尿病相关的死亡人数，在强制性糖尿病医疗保险州比非强制州少约3.1例。分析表明，提高强制性医疗福利的利用率可以降低死亡率。

● 失业保险： 在美国，疫情期间收入下降的发生频率与大衰退时期相似，但分布情况不同。失业保险降低了低收入工作者遭遇大幅收入下降的可能性。

Francis Annan（乔治亚州立大学）

摘要：Helping individuals to buy insurance coverage in developing countries, for instance by allowing them to buy insurance on credit, may induce more risky behavior. Using rich administrative data on auto-insurance market in Ghana, and a policy reform that led to sizable reduction in demand by disallowing individuals to buy insurance on credit, I provide non-parametric evidence for the existence of moral hazard and recover lower bounds on the costs it imposes in this market. The estimated cost of moral hazard reach 12% of firm profits. The results have important implications for the study of market inter-linkages, bundling and credit-constraints.

帮助发展中国家的个人购买保险保障，例如通过允许他们以信贷方式购买保险，可能会诱导出更多风险行为。本文利用加纳汽车保险市场丰富的行政数据，以及一项因禁止个人信贷购买保险而导致需求大幅减少的政策改革，提供了关于道德风险存在的非参数证据，并恢复了该市场中道德风险所施加成本的下限估计。据估计，道德风险的成本达到了公司利润的12%。这些结果对市场相互联系、捆绑销售和信贷约束的研究具有重要意义。

原文链接：

https://www.sciencedirect.com/science/article/abs/pii/S0047272722000354

Coleman Drake（匹兹堡大学），Conor Ryan（宾夕法尼亚州立大学），Bryan Dowd（明尼苏达大学）

摘要：Consumers in private health insurance markets are highly inertial. The literature has repeatedly found consumers are willing to pay thousands of dollars to keep their health plan. However, the causes of inertia are not well understood, despite their importance in determining whether welfare can be improved by reducing inertia and which types of policies would be effective in doing so. Using administrative data from California’s Health Insurance Marketplace, we separately identify three sources of inertia—tastes for provider continuity, inattention, and hassle costs—using two-stage models of inattention and health plan choice. We find that eliminating inattention and hassle costs would reduce repeated health plan choice by 53 percentage points and that interventions to reduce inattention and hassle costs are complements. Inattention and hassle costs cost consumers over a billion dollars in foregone consumer surplus in 2018, roughly $1,790 per household per year or half the annual premium paid by the median household, with inattention accounting for the largest source of forgone surplus. We conclude that interventions to reduce inertial plan choice should jointly focus on hassle costs and particularly inattention, but not tastes for provider continuity.

私人医疗保险市场的消费者具有很强的惯性。文献多次发现，消费者愿意支付数千美元来保住他们的医疗保险计划。然而，人们对惯性的成因还不甚了解，尽管这些成因对于确定是否可以通过减少惯性来改善福利以及哪类政策可以有效地减少惯性非常重要。我们利用加利福尼亚州健康保险市场的行政数据，通过惯性和医疗计划选择的两阶段模型，分别找出了惯性的三个来源——对医疗服务提供者连续性的偏好、不重视和麻烦成本。我们发现，消除不重视和麻烦成本会使重复医疗计划选择减少 53 个百分点，而且减少不重视和麻烦成本的干预措施是相辅相成的。2018 年，不重视和麻烦成本使消费者损失了超过 10 亿美元的消费者盈余，每个家庭每年损失约 1790 美元，相当于中位数家庭每年支付保费的一半，其中不重视是损失盈余的最大来源。我们的结论是，减少惯性计划选择的干预措施应共同关注麻烦成本，尤其是不重视，但也不能忽视医疗服务提供者的连续性。

原文链接：

https://www.sciencedirect.com/science/article/abs/pii/S004727272200024X

Tobias J. Klein（蒂尔堡大学），Martin Salm（蒂尔堡大学），Suraj Upadhyay（蒂尔堡大学）

摘要：We develop a new approach to quantify how patients respond to dynamic incentives in health insurance contracts with a deductible. Our approach exploits two sources of variation in a differences-in-regression-discontinuities design: deductible contracts reset at the beginning of the year, and cost-sharing limits change over the years. Using rich claims-level data from a large Dutch health insurer we find that individuals are forward-looking. Changing dynamic incentives by increasing the deductible by €100 leads to a reduction in healthcare spending of around 3% on the first days of the year and 6% at the annual level. We find that the response to dynamic incentives is an important part of the overall effect of cost-sharing schemes on healthcare expenditures—much more so than what the previous literature has suggested.

我们提出了一种新方法来量化患者如何对带有免赔额的医疗保险合同中的动态激励措施做出反应。我们的方法利用了差分断点回归设计中的两个变化来源：免赔额合同在年初重置，费用分摊限额随年变化。利用荷兰一家大型医疗保险公司提供的丰富理赔数据，我们发现个人具有前瞻性。通过将免赔额提高 100 欧元来改变动态激励机制，会导致医疗支出在年初减少约 3%，全年减少 6%。我们发现，对动态激励措施的反应是费用分摊计划对医疗支出总体影响的重要组成部分，其影响程度远远超过了以往文献的研究。

原文链接：

https://www.sciencedirect.com/science/article/abs/pii/S0047272723001330

Jinyeong Son(德克萨斯大学奥斯汀分校)

摘要：In response to the growing concern over diabetes, state-mandated health insurance benefits for diabetes have become popular since the late 1990s. However, little is known about whether these mandates improve the health of people with diabetes. In this paper, I use data from the restricted-use Multiple Cause of Death Mortality database and the Behavioral Risk Factor Surveillance System to investigate the effects of these mandates on diabetes-related mortality rates, along with the underlying mechanisms behind the estimated effects. Using a difference-in-differences framework that leverages variation in the enactment of mandates both across states and over time, I find that approximately 3.1 fewer diabetes-related deaths per 100,000 occur annually in mandate states than in non-mandate states. The mechanism analysis suggests higher utilization of the mandated medical benefits caused these mortality improvements. These findings can inform the ongoing policy debate on strengthening or weakening coverage mandates, including Essential Health Benefits under the Affordable Care Act.

为了应对人们对糖尿病的日益关注，自20世纪90年代后期以来，国家规定的糖尿病医疗保险福利变得流行起来。然而，对于这些强制保险政策能否改善糖尿病患者的健康知之甚少。本文中使用来自限制使用的多死因死亡率数据库和行为风险因素监测系统的数据，来研究这些强制措施对糖尿病相关死亡率的影响，以及背后的潜在机制。使用双重差分框架，利用各州之间和一段时间内强制措施的实施差异，本文发现每年每100,000人中与糖尿病相关的死亡发生在强制保险州比非强制保险州少约3.1例。分析表明，提高对强制性医疗福利的利用率促成了死亡率改善的现象。这些发现可以为正在进行的关于加强或削弱强制性保险政策的争论提供信息，包括《平价医疗法案》规定的基本健康福利。

原文链接：

https://www.sciencedirect.com/science/article/abs/pii/S0047272722001645

Jeff Larrimore（联邦储备委员会）, Jacob Mortenson（税务联合委员会）, David Splinter（税务联合委员会）

摘要：This paper documents the magnitude and distribution of U.S. earnings changes during the COVID-19 pandemic and how fiscal relief offset lost earnings. We build panels from administrative tax data to measure annual earnings changes. The frequency of earnings declines during the pandemic were similar to the Great Recession, but the distribution was different. In 2020, workers starting in the bottom half of the distribution were more likely to experience an earnings decline of at least 10 percent. While most workers experiencing large annual earnings declines do not receive unemployment insurance, over half of beneficiaries were made whole in 2020, as unemployment insurance replaced a median of 105 percent of their annual earnings declines. After incorporating unemployment insurance, the likelihood of large earnings declines among low-earning workers was not only smaller than during the Great Recession, but also smaller than in 2019.

本文记录了COVID-19疫情期间美国收入变动的规模和分布，以及财政救助如何缓解收入损失。我们利用行政税收数据构建面板，以衡量年度收入变动。疫情期间收入下降的发生频率与大衰退时期相似，但分布情况不同。2020年，收入分布下半部分开始的工作者更有可能经历至少10%的收入下降。尽管大多数经历年度收入大幅下降的工作者并未获得失业保险，但在2020年，超过半数的受益者的收入得到了全额补偿，因为失业保险替代他们年收入下降量的中位数为105%。在失业保险下，低收入工作者遭遇大幅收入下降的可能性不仅比大衰退期间小，而且比2019年还小。

原文链接：

https://www.sciencedirect.com/science/article/pii/S0047272721002334

Winfried Koeniger(圣加仑大学), Carlo Zanella(No affiliation)

摘要：We analyze how intergenerational mobility and inequality would change relative to the status quo if dynasties had access to optimal insurance against low ability of future generations. Based on a dynamic, dynastic Mirrleesian model, we find that insurance against intergenerational ability risk increases in the social optimum relative to the status quo. This implies less intergenerational mobility in terms of welfare but no quantitatively significant change in earnings mobility. Earnings mobility is thus similar across economies with different incentives and welfare, illustrating that changes in earnings mobility cannot be interpreted readily in welfare terms without further analysis.

我们分析了如果家族能够获得针对后代能力低下的最优保险，代际流动性和不平等相对于现状将如何变化。基于动态的家族Mirrleesian模型，我们发现相对于现状，针对代际能力风险的保险在社会最优状态中增加。这意味着在福利方面代际流动性更低，但收入流动性方面没有数量上的显著变化。因此，在具有不同激励措施和福利的经济体中，收入流动性是相似的，这表明如果不进一步分析，收入流动性的变化就无法轻易地用福利变化来解释。

原文链接：

https://www.sciencedirect.com/science/article/pii/S0047272722000251

Sebastian Fleitas（鲁汶大学）, Gautam Gowrisankaran（哥伦比亚大学）, Anthony Lo Sasso（德保罗大学）