government old age support and labor supply evidence from the old age assistance program many major government programs transfer resources to older people and implicitly or explicitly tax their labor in this paper we shed new light on the labor supply and welfare effects of such programs by investigating the old age assistance program oaa a means tested and state administered pension program created by the social security act of 1935 using newly available census data on the entire us population in 1940 we exploit the large differences in oaa programs across states to estimate the labor supply effects of oaa our estimates imply that oaa reduced the labor force participation rate among men aged 65 74 by 5 8 percentage points nearly half of its 1930 40 decline however both reduced form evidence and an estimated structural model of labor supply imply that the welfare cost to recipients of the high tax rates implicit in oaa s earnings test were small the evidence also suggests that social security could account for at least half of the large decline in late life work from 1940 to 1960

public insurance expansions and the health of immigrant and native children abstract the costs of public insurance expansions are ordinarily justified by the claim that increased eligibility causes gains in insurance coverage which translate into improved health care and health this paper studies dramatic changes in public health insurance eligibility for immigrant and native children from 1998 to 2009 and finds that children s nativity status is crucial to understanding the impacts of recent eligibility expansions i document a significantly higher degree of take up and less crowding out of private insurance among first and second generation immigrant children than among children of u s natives eligibility expansions increased immigrant children s use of preventive and ambulatory care and decreased emergency care in hospitals while estimated effects for children of natives are negligible my results also suggest improvements in some health measures that would be expected to respond to preventive and ambulatory care

does medical malpractice law improve health care quality we assess the potential for medical liability forces to deter medical errors and improve health care treatment quality identifying liability s influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians using hospital discharge records from the national hospital discharge survey and clinically validated quality metrics inspired by the agency for health care research and quality we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards we do not find evidence however suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care similarly we do not find evidence of deterioration in health care quality following remedy focused liability reforms such as caps on non economic damages awards

effects of universal health insurance on health care utilization and supply side responses evidence from japan abstract we investigate the effects of a massive expansion in health insurance coverage on health care utilization and supply side responses by focusing on universal health insurance introduced in japan in 1961 there are two major findings first health care utilization measured in terms of admissions inpatient days and outpatient visits to hospitals increased significantly second we also find a supply response but the size of the supply response differs across service types while the number of beds increases effects on the number of medical institutions physicians and nurses are either negligible or inconclusive our results suggest that countries planning a large expansion in health insurance coverage would need to generate sufficient financial resources to cover the surge in health care expenditures both in the short and long run our results also indicate that any slowdown in the supply side response may constrain the ability of the health care system to meet increased demand

the effect of safety net programs on food insecurity we investigate to what extent major safety net program benefits affect food insecurity in families we impute program eligibility and benefits in each state for 2001 2009 accounting for cross program eligibility rules we use simulated eligibility and benefits for a nationally representative sample as instruments for imputed eligibility and potential benefits among nonimmigrant low income single parent families 1 000 in potential cash or food benefits reduces the incidence of food insecurity by 1 1 percentage points on a base of 33 percent cash and food both reduce food insecurity the results highlight the importance of jointly considering a full range of safety net programs

structural adjustment and the construction sector abstract this paper adds a construction sector to a dynamic dependent economy model equipped with consumer tradeables and non tradeables sectors the model is used to study the response of the production structure relative prices and the trade balance to a favorable terms of trade shock under the benchmark assumptions of perfect intersectoral factor mobility a perfect international capital market and no adjustment costs for realistic relative capital intensities the model predicts a boom in the construction and consumer non tradeables sectors a contraction of the tradeables sector and no relative price changes the implications of relaxing those benchmark assumptions are discussed separately

the family as the health producer when spouses are nash bargainers the grossman model is extended to a situation in which the family is regarded as the producer of individual health and spouses are nash bargainers the model has implications for the interaction between family structure income and the stocks of health capital and the bargaining strength of different family members the main insight is that the possibility of divorce affects the distribution of health capital between family members we analyse inter alia the impact on the distribution of health particularly regarding child health of changes in family policies related to the dissolution of the family

hips and hearts the variation in incentive effects of insurance across hospital procedures the separate identification of effects due to incentives selection and preference heterogeneity in insurance markets is the topic of much debate in this paper we investigate the presence and variation in moral hazard across health care procedures the key motivating hypothesis is the expectation of larger causal effects in the case of more discretionary procedures the empirical approach relies on an extremely rich and extensive dataset constructed by linking survey data to administrative data for hospital medical records using this approach we are able to provide credible evidence of large moral hazard effects but for elective surgeries only

transfers in cash and in kind theory meets the data we review theoretical explanations for in kind transfers in light of the limited empirical evidence after reviewing the traditional paternalistic arguments we consider explanations based on imperfect information and self targeting we then discuss the large literature on in kind programs as a way of improving the efficiency of the tax system and a range of other possible explanations including the samaritan s dilemma pecuniary effects credit constraints asymmetric information amongst agents and political economy considerations our reading of the evidence suggests that paternalism and interdependent preferences are leading overall explanations for the existence of in kind transfer programs but that some of the other arguments may apply to specific cases political economy considerations must also be part of the story

the effect of medicaid expansions for low income children on medicaid participation and private insurance coverage evidence from the sipp abstract we examine medicaid enrollment and private coverage loss following expansions of medicaid eligibility we attempt to replicate cutler and gruber s q j econ 111 1996 391 results using the survey of income and program participation sipp and find smaller rates of take up and little evidence of crowding out we find that some of the difference in results can be attributed to different samples and recall periods in the data sets used extending the previous literature we find that take up is slightly increased if a child s siblings are eligible and with time spent eligible focusing on children whose eligibility status changes during the sample we estimate smaller take up effects we find little evidence of crowding out in any of our extensions

censored quantile instrumental variable estimates of the price elasticity of expenditure on medical care efforts to control medical care costs depend critically on how individuals respond to prices i estimate the price elasticity of expenditure on medical care using a censored quantile instrumental variable cqiv estimator cqiv allows estimates to vary across the conditional expenditure distribution relaxes traditional censored model assumptions and addresses endogeneity with an instrumental variable my instrumental variable strategy uses a family member s injury to induce variation in an individual s own price across the conditional deciles of the expenditure distribution i find elasticities that vary from 0 76 to 1 49 which are an order of magnitude larger than previous estimates

the price effects of cash versus in kind transfers this article examines the effect of cash versus in kind transfers on local prices both types of transfers increase the demand for normal goods in kind transfers also increase supply in recipient communities which could lead to lower prices than under cash transfers we test and confirm this prediction using a programme in mexico that randomly assigned villages to receive boxes of food trucked into the village equivalently valued cash transfers or no transfers we find that prices are significantly lower under in kind transfers compared to cash transfers relative to the control group in kind transfers cause a 4 fall in prices while cash transfers cause a positive but negligible increase in prices in the more economically developed villages in the sample households purchasing power is only modestly affected by these price effects in the less developed villages the price effects are much larger in magnitude which we show is due to these villages being less tied to the outside economy and having less competition among local suppliers

the rise of the states u s fiscal decentralization in the postwar period article i nfo article history one of the most dramatic changes in the fiscal federalism landscape during the postwar period has been the rapid growth in state budgets which almost tripled as a share of gdp and doubled as a share of government spending between 1952 and 2006 we argue that the greater role of states cannot be easily explained by changes in tiebout forces of fiscal competition such as mobility and voting patterns and are not accounted for by demographic or income trends rather we demonstrate that much of the growth in state budgets has been driven by changes in intergovernmental interactions restricted federal grants to states have increased and federal policy and legal constraints have also mandated or heavily incentivized state own source spending particularly in the areas of education health and public welfare these outside pressures moderate the forces of fiscal competition and must be taken into account when assessing the implications of observed revenue and spending patterns

voting technology political responsiveness and infant health evidence from brazil this paper studies the introduction of electronic voting technology in brazilian elections estimates exploiting a regression discontinuity design indicate that electronic voting reduced residual error ridden and uncounted votes and promoted a large de facto enfranchisement of mainly less educated citizens estimates exploiting the unique pattern of the technology s phase in across states over time suggest that as predicted by political economy models it shifted government spending toward health care which is particularly beneficial to the poor positive effects on both the utilization of health services prenatal visits and newborn health low weight births are also found for less educated mothers but not for the more educated

unemployment insurance recall expectations and unemployment outcomes this paper empirically examines the importance of explicitly accounting for the layoff rehire process in the analysis of unemployment outcomes in the united states we find that the spells of individuals who initially expect to be recalled account for much more of the unemployment of unemployment insurance ui recipients than do spells actually ending in recall our results indicate that the recall and new job escape rates from unemployment have quite different time patterns and are often affected in opposite ways by explanatory variables we also find that the probability of leaving unemployment both through recalls and new job finding increases greatly around the time that ui benefits lapse over the past fifteen years many studies have empirically analyzed the determinants of individual unemployment spell durations in the united states much of this literature has used a job search framework in which the unemployed are viewed as permanently displaced workers who are unattached to jobs the possibility of recall to a former job a process not requiring search has been omitted from explicit consideration in the majority of these studies 2 an explicit treatment of the layoff rehire process is necessary for a proper understanding of the determinants of unemployment durations and of the impacts of unemployment policies in the united states for at least three reasons first temporary layoffs in which workers are often rehired by their original employers are a quantitatively quite important feature of the u s labor market 3 second expectations concerning the likelihood of recall are likely to affect the responses of employers and unemployed workers to labor market interventions such as reemployment bonuses and subsidies

economic status and health in childhood the origins of the gradient the well known positive association between health and income in adulthood has antecedents in childhood not only is children s health positively related to household income but the relationship between household income and children s health becomes more pronounced as children age part of the relationship can be explained by the arrival and impact of chronic conditions children from lower income households with chronic conditions have worse health than do those from higher income households the adverse health effects of lower income accumulate over children s lives part of the intergenerational transmission of socioeconomic status may work through the impact of parents income on children s health

health insurance and retirement of married couples summary most health insurance in the usa is provided by employers until eligibility for public health insurance medicare begins at age 65 retiring before 65 exposes workers who lack retiree health insurance coverage to the risk of catastrophic medical expenditure we solve and estimate a dynamic model of the employment behavior of older married couples that includes risky medical expenditure and health insurance parameter estimates imply that the risk reducing feature of health insurance can account for about half of the observed association between retiree health insurance and employment for married men but can account for only one tenth of the much larger observed association for married women policy simulations imply very small effects on employment of changing the age of eligibility for medicare from 65 to 67 copyright 2006 john wiley sons ltd

moral hazard in health insurance do dynamic incentives matter using data from employer provided health insurance and medicare part d we investigate whether healthcare utilization responds to the dynamic incentives created by the nonlinear nature of health insurance contracts we exploit the fact that because annual coverage usually resets every january individuals who join a plan later in the year face the same initial spot price of healthcare but a higher expected end of year future price we find a statistically significant response of initial utilization to the future price rejecting the null that individuals respond only to the spot price we discuss implications for analysis of moral hazard in health insurance

the value of medicaid interpreting results from the oregon health insurance experiment we develop frameworks for welfare analysis of medicaid and apply them to the oregon health insurance experiment across different approaches we estimate low income uninsured adults willingness to

government decision making and the incidence of federal mandates abstract this paper analyzes the effects of federally mandated program changes on state spending and revenues incorporating and evaluating the predictive value of several common theories of the state decision making process using several sources of exogenous increases in public medical spending i estimate that the entire state portion of the burden of mandated spending is borne by decreases in other public welfare spending while federal mandates may influence the composition of benefits at the state level it is much more difficult for them to change the total level of state transfers comparison of state reactions to different shocks suggests that these reductions are due in part to the substitutability of programs in the voter utility function but also in part to the stickiness of spending within budget categories states with greater racial differences between recipients and voters and states with less generous neighbors reduce other public welfare spending by even more alleviating the burden the medical expansions imposed on their taxpayers mandates may thus serve only to increase inequality across states

effective policy for reducing poverty and inequality the earned income tax credit and the distribution of income we examine the effect of the eitc on the poverty and income of single mothers with children using a quasi experimental approach that leverages variation in generosity due to policy expansions across tax years and family sizes we find that the income increasing effects of the eitc are concentrated between 75 and 150 percent of income to poverty with little effect at the lowest income levels and at levels of 250 percent of poverty and higher we use these results to show that by failing to capture the indirect effects of the credit on earnings static calculations of the antipoverty effects of the eitc may be underestimated by almost 50 percent abstract from author

assessing health reform in colombia from theory to practice in 1993 colombia implemented an ambitious health reform its key component was a radical transformation of the manner in which health care provision particularly care that was directed toward lower income individuals was financed we first describe the institutional aspects of the reform and discuss the difficulties that transferring funding from supply to demand side channels entailed we emphasize that while the reform substantially increased health insurance coverage progress was slower than forecast and entailed a substantial increase in expenditure the second part of the paper evaluates the impact of the subsidized regime that the reform introduced to benefit the low income population we explore the subsidized regime s effect on health outcomes measured through self reports on health status and on the number of days in which individuals were unable to perform regular activities the use of medical services household consumption of nonhealth goods and labor force participation

public insurance and private savings who is affected and by how much this paper employs a recently developed instrumental quantile regression method to investigate the effect of medicaid on household savings across different wealth groups it finds that the disincentive effect of medicaid on household savings is heavily concentrated in the middle net worth households in contrast the effects on the bottom and top net worth households are quite small and insignificant these heterogeneous incentive effects are partly explained by medicaid asset tests our findings hold regardless of whether affluence is measured in terms of wealth or income they suggest that despite generating substantial crowd out for the mean household medicaid expansions are unlikely to discourage the savings of the poorest households copyright 2008 john wiley sons ltd

public insurance and child hospitalizations access and efficiency effects abstract the 1983 1996 period saw enormous expansions in access to public health insurance for low income children we explore the impact of these expansions on child hospitalizations while greater access to inpatient care may increase hospital utilization improved efficiency of care for children who are also newly eligible for primary care could lower hospitalization rates we use a large sample of child discharges from the national hospital discharge survey nhds to assess the net impact of medicaid expansions on hospitalizations during this period we find that total hospitalizations increased significantly with each 10 percentage point rise in eligibility leading to an 8 4 increase in hospitalizations thus the access effect strongly outweighs any efficiency effect produced by expanded coverage however we find some support for an efficiency effect the increase in hospitalizations for unavoidable conditions is much larger than that for avoidable conditions that are most sensitive to outpatient care indeed the increase in avoidable hospitalizations is less than half that of unavoidable hospitalizations and it is not statistically significant we also find that expanded medicaid eligibility reduced the average length of stay but increased the utilization of inpatient procedures so that the net impact on total costs per stay is ambiguous

reexamining the consumption smoothing benefits of unemployment insurance abstract the great recession spurred renewed interest in the moral hazard effects of the unemployment insurance ui program however little research has focused on determining its benefits this paper examines the consumption smoothing benefit of the ui program over the last 40 years finding strong evidence of heterogeneity in this effect over time in particular the effects of ui are smaller in the 1990s compared with the 1970s the 1990s were unique because of the long period of low unemployment rates as well as relatively low ui program generosity thus we test whether the consumption smoothing effects vary by the state unemployment rate and average program generosity we find suggestive evidence that the effects are larger when the state unemployment rate and average generosity are high together these two dimensions can explain around 30 46 of the differential effect that we find in the 1990s

estimating heterogeneous takeup and crowd out responses to existing medicaid income limits and their nonmarginal expansions we use a switching probit model and the income limit based structure of medicaid eligibility for children to estimate treatment effects of nonmarginal medicaid expansions on medicaid takeup private insurance coverage and crowd out as well as crowd out for those eligible for medicaid under rules already in place many of these estimates are not found in existing work on public insurance and cannot be calculated with the linear probability model used by previous work in this literature we provide an estimation approach that is straightforward to implement yet yields precise treatment effects

does medicare save lives health insurance characteristics shift at age 65 as most people become eligible for medicare we measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends the age profiles of admissions and comorbidities for these patients are smooth at age 65 suggesting that the severity of illness is similar on either side of the medicare threshold in contrast the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities implying that patients over 65 receive more services we estimate a nearly 1 percentage point drop in 7 day mortality for patients at age 65 equivalent to a 20 reduction in deaths for this severely ill patient group the mortality gap persists for at least 9 months after admission

incentives for the identification and treatment of children with disabilities the supplemental security income program abstract this paper examines how supplemental security income ssi benefit availability and generosity affect the probability that families identify health problems in their children and move onto the ssi rolls first i observe that a liberalization of ssi eligibility in 1990 was followed by a substantial re evaluation of the health status of low income children by their parents then i find that increases in ssi benefits raise the likelihood that a family identifies a chronic impairment in their child my results indicate that cash assistance targeted on children with disabilities promotes the detection and treatment of medical problems in low income children

compensating differentials and income taxes are the wages of dangerous jobs more responsive to tax changes than the wages of safe jobs income taxes distort the relationship between wages and nontaxable amenities when the marginal tax rate increases amenities become more valuable as the compensating differential for low amenity jobs is taxed away while there is evidence that the provision of amenities responds to taxes the literature has ignored the consequences for job characteristics which cannot fully adjust this paper compares the wage response of dangerous jobs to the wage response of safe jobs when tax rates increase we should see the pretax compensating differential for on the job risk increase empirically i find large differences in the wage response of jobs based on their riskiness

health insurance and mortality experimental evidence from taxpayer outreach we evaluate a randomized pilot study in which the irs sent informational letters to 3 9 million taxpayers who paid a tax penalty for lacking health insurance coverage under the affordable care act drawing on administrative data we study the effect of the intervention on taxpayers subsequent health insurance enrollment and mortality we find the intervention led to increased coverage in the two years following treatment and that this additional coverage reduced mortality among middle aged adults over the same time period our results provide the first experimental evidence that health insurance reduces mortality

incentivizing better quality of care the role of medicaid and competition in the nursing home industry this paper develops a model of the nursing home industry to investigate the quality effects of policies that either raise regulated reimbursement rates or increase local competition using data from pennsylvania i estimate the parameters of the model the findings indicate that nursing homes increase the quality of care measured by the number of skilled nurses per resident by 8 7 following a universal 10 increase in medicaid reimbursement rates in contrast i find that pro competitive policies lead to only small increases in skilled nurse staffing ratios suggesting that medicaid increases are more cost effective in raising the quality of care

disability insurance rejection rates and the labor supply of older workers abstract we investigate the effects of trying to mitigate moral hazard in the disability insurance di program by raising the stringency of the screening process for applicants we do so by studying a dramatic increase in rejection rates for the di program in the late 1970s which varied substantially across the us states we find that each 10 rise in denial rates led to a statistically significant 2 8 fall in labor force non participation among 45 64 year old males we also find that the denial rate increases effectively targeted their incentive effects to more able individuals according to an anthropometric measure of disability

the impact of medicaid insurance coverage on dental service use abstract the new comprehensive health reform beginning in 2014 will require medicaid to expand all elements of coverage to individuals with incomes up to 133 percent of the federal poverty line with millions more individuals gaining eligibility for adult medicaid dental benefits generating an unbiased estimate of the elasticity of demand for dental services is critical the causal relationship between access to adult medicaid dental benefits and usage of dental services for low income adults is estimated using difference in differences estimation procedures to exploit the state level variation in adult medicaid dental benefits results suggest that adult medicaid dental benefits increase the probability of a dental visit within 12 months by 16 4 22 percent a variety of robustness checks are invoked to confirm the finding

vocational training programs and youth labor market outcomes evidence from nepal abstract lack of skills is arguably one of the most important determinants of high levels of unemployment and poverty in response policymakers often initiate vocational training programs in effort to enhance skill formation among the youth using a regression discontinuity design we examine a large youth training intervention in nepal we find twelve months after the start of the training program that the intervention generated an increase in non farm employment of 10 percentage points itt estimates and up to 31 percentage points for program compliers late estimates we also detect sizeable gains in monthly earnings women who start self employment activities inside their homes largely drive these impacts we argue that low baseline educational levels and non farm employment levels and nepal s social and cultural norms towards women drive our large program impacts our results suggest that the program enables otherwise underemployed women to earn an income while staying at home close to household errands and in line with the socio cultural norms that prevent them from taking up employment outside the house

the impact of health care reform on hospital and preventive care evidence from massachusetts in april 2006 massachusetts passed legislation aimed at achieving near universal health insurance coverage the key features of this legislation were a model for national health reform passed in march 2010 the reform gives us a novel opportunity to examine the impact of expansion to near universal coverage state wide among hospital discharges in massachusetts we find that the reform decreased uninsurance by 36 relative to its initial level and to other states reform affected utilization by decreasing length of stay the number of inpatient admissions originating from the emergency room and preventable admissions at the same time hospital cost growth did not increase

socio economic status and child health does public health insurance narrow the drawing on evidence from the u s this paper examines the effects of public health insurance on children recent expansions of american public health insurance programs to previously ineligible children have created a great deal of variation that can be used to identify their effects results indicate that providing public insurance to poor children narrows socio economic gaps in utilization and health among children however inefficiencies and inequities in the allocation of health care remain which suggests that universality and outreach programs are also important components of the public health systems common in europe

long term impacts of childhood medicaid expansions on outcomes in adulthood we use administrative data from the internal revenue service to examine long term impacts of childhood medicaid eligibility expansions on outcomes in adulthood at each age from 19 to 28 greater medicaid eligibility increases college enrolment and decreases fertility especially through age 21 starting at age 23 females have higher contemporaneous wage income although male increases are imprecise together both genders have lower mortality these adults collect less from the earned income tax credit and pay more in taxes cumulatively from ages 19 to 28 at a 3 discount rate the federal government recoups 58 cents of each dollar of its investment in childhood medicaid

the equilibrium impact of unemployment insurance on unemployment evidence from a non linear policy rule abstract we estimate the macro effect of an increase in the generosity of unemployment insurance ui on unemployment in sweden using regional data the national ui benefit formula features a benefit ceiling and a statutory replacement rate and does not take regional wage differentials into account changes in the national rules are useful for identification since a change in the benefit ceiling for example has a greater impact on ui generosity in a high wage region than in a low wage region because a greater fraction of the workforce will be affected by the benefit ceiling in the high wage region we implement this identification strategy using data for the swedish municipalities over the time period 1992 2014 our estimates suggest that the macro elasticity of an increase in ui on unemployment is around 3 this is twice as large as the corresponding micro elasticity which we estimate to 1 4 1 5 using data from the same time period

child cash benefits and family expenditures evidence from the national child benefit income may improve child outcomes through two mechanisms as a direct input into health and education or indirectly by reducing household financial stress we exploit policy induced changes in refundable tax benefit income in canada to study these two potential mechanisms our findings suggest that additional income may improve outcomes through both mechanisms some benefit income is spent on direct education inputs while some is spent on everyday items likely to improve the general conditions children face additionally some families reduce spending on risky behaviour items spending responses to benefit generosity appear to vary by income and by child age prestations pour enfants en especes et depenses des familles ce que revele la prestation nationale pour enfants le revenu permet d ameliorer le developpement d un enfant gr ce a deux mecanismes en contribuant directement a l education et a la sante et en reduisant indirectement les difficultes financieres au sein du foyer afin d etudier ces deux mecanismes nous nous appuyons sur les modifications politiques apportees au credit d impot remboursable de type prestation fiscale pour revenu de travail au canada nos resultats suggerent que par l entremise de ces deux mecanismes la situation peut s ameliorer gr ce a un revenu additionnel une partie de ces prestations est depensee directement pour l education tandis qu une autre est utilisee pour les biens quotidiens susceptibles d ameliorer les conditions de vie generales de l enfant de plus certaines familles reduisent les depenses d articles pouvant induire des comportements a risque les types de depenses lies aux prestations sociales semblent varier en fonction des revenus et de l ge des enfants

the effects of access to health insurance evidence from a regression discontinuity design in peru in many countries large parts of the population do not have access to health insurance peru has made an effort to change this in the early 2000s the institutional setup gives rise to the rare opportunity to study the effects of health insurance coverage exploiting a sharp regression discontinuity design we find large effects on utilization that are most pronounced for the provision of curative care individuals seeing a doctor leads to increased awareness about health problems and generates a potentially desirable form of supplier induced demand they decide to pay themselves for services that are in short supply

recall expectations and duration dependence using novel administrative data from austria we investigate the nature of temporary layoffs and recalls we find that on average jobs ending in temporary layoffs lasted shorter but paid higher wages the majority of temporarily laid off workers return to their previous employer but also one fifth of those permanently laid off are recalled compared to job switchers recalls have shorter unemployment spells and do not experience wage losses negative duration dependence of unemployment only appears once recall exits are excluded for temporary and permanent layoffs however for temporary layoffs the aggregate pattern masks significant heterogeneity by pre unemployment tenure additional survey evidence suggests a lower average search level for temporary layoffs

recall and unemployment abstract we document in the survey of income and program participation covering the period 1990 2013 that a surprisingly large share of workers return to their previous employer after a jobless spe

health insurance subsidies and deductible choice evidence from regional variation in subsidy schemes the extent to which premium subsidies can influence health insurance choices is an open question in this paper we explore the regional variation in subsidy schemes in switzerland designed as either in kind or cash transfers to study their impact on the choice of health insurance deductibles using health survey data and a difference in differences methodology we find that in kind transfers increase the likelihood of choosing a low deductible plan by approximately 4 percentage points or 7 our results indicate that the response to in kind transfers is strongest among women middle aged and unmarried individuals which we explain by differences in risk taking behavior health status financial constraints health insurance and financial literacy we discuss our results in the light of potential extra marginal effects on the demand for health care services which are however not supported by our data

public health insurance and medical treatment the equalizing impact of the medicaid expansions abstract we investigate the impact of expanding public health insurance on the medical treatment received by women at childbirth using vital statistics data on every birth in the us over the 1987 1992 period the effects of insurance status on treatment are identified using the tremendous variation in eligibility for public insurance coverage under the medicaid program over this period among low education mothers who were largely uninsured before being made eligible for medicaid eligibility for this program was associated with significant increases in the use of a variety of obstetric procedures among women with more education however there is a countervailing effect on procedure use most of these women had private insurance before becoming medicaid eligible and some may have been crowded out onto the public program moving from insurance which reimburses medical care more generously to insurance with much less generous reimbursement this movement was accompanied by reductions in procedure use thus on net the medicaid expansions had an equalizing effect increasing the treatment intensity of the previously uninsured while lowering it among the previously insured

the integration of child tax credits and welfare evidence from the national child benefit program abstract in 1998 the canadian government introduced a new child tax credit the innovation in the program was its integration with social assistance welfare some provinces agreed to subtract the new federally paid benefits from provincially paid social assistance partially lowering the welfare wall other provinces did not integrate benefits providing a quasi experimental framework for estimation we find large changes in social assistance take up and employment in provinces that provided the labour market incentives to do so in our sample the integration of benefits can account for between 19 and 27 of the decline in social assistance receipt between 1997 and 2000

do wages compensate for anticipated working time restrictions evidence from seasonal employment in austria this article investigates the existence of compensating wage differentials across seasonal and long term jobs that arise due to anticipated working time restrictions using longitudinal information from the austrian administrative records we derive a definition of seasonality based on observed regularities in employment patterns as wages change across seasonal and long term jobs for the same individual over time we can control for individual specific effects and use variation in the starting month of seasonal jobs as an exogenous predictor of anticipated unemployment we find that employers pay on average a positive wage differential of about 11 for seasonal jobs

the effect of child health insurance access on schooling evidence from public insurance expansions although a sizable literature analyzes the effects of public health insurance programs on short run health outcomes little prior work has examined their long term effects we examine the effects of public insurance expansions among children in the 1980s and 1990s on their future educational attainment we find that expanding health insurance coverage for low income children increases the rate of high school and college completion these estimates are robust to only using federal medicaid expansions and mostly are due to expansions that occur when the children are not newborns our results indicate that the long run benefits of public health insurance are substantial

the war on poverty s experiment in public medicine community health centers and the mortality of older americans this paper uses the rollout of the first community health centers chcs to study the longer term health effects of increasing access to primary care within ten years chcs are associated with a reduction in age adjusted mortality rates of 2 percent among those 50 and older the implied 7 to 13 percent decrease in one year mortality risk among beneficiaries amounts to 20 to 40 percent of the 1966 poor non poor mortality gap for this age group large effects for those 65 and older suggest that increased access to primary care has longer term benefits even for populations with near universal health insurance jel h75 i12 i13 i18 i32 i38 j14

the family as producer of health an extended grossman model deriving a model where each family member is the producer of his own and other family members health shows that the family will not try to equalise marginal benefits and marginal costs of health capital for each family member they will rather invest in health until the rate of marginal consumption benefits equals the rate of marginal net effective costs of health capital the level of compensation in the social insurance system the effective price of care health related information and transfer payments will all affect the production possibility set and therefore the optimal level and distribution of family health

reference dependent job search evidence from hungary we propose a model of job search with reference dependent preferences with loss aversion relative to recent income the reference point in this model newly unemployed individuals search hard since consumption is below their reference point over time though they get used to lower income and thus reduce their search effort in anticipation of a benefit cut their search effort rises again then declines once they get accustomed to the lower postcut benefit level the model fits the typical pattern of exit from unemployment even with no unobserved heterogeneity to distinguish between this and other models we use a unique reform in the unemployment insurance ui benefit path in 2005 hungary switched from a single step ui system to a two step system with overall generosity unchanged the system generated increased hazard rates in anticipation of and especially following benefit cuts in ways the standard model has a hard time explaining we estimate a model with optimal consumption endogenous search effort and unobserved heterogeneity the reference dependent model fits the hazard rates substantially better than plausible versions of the standard model including habit formation our estimates indicate a slow adjusting reference point and substantial impatience likely reflecting present bias jel codes d03 j64 j65

will extending medicaid to two parent families encourage marriage several welfare programs in the united states restrict eligibility to single parent families this paper asks whether eliminating this restriction for medicaid encourages marriage i identify medicaid s effect through a series of health insurance reforms that were passed in the 1980s and 1990s targeting young children these reforms were associated with an increase in the probability of marriage of 1 7 percentage points while the expansions offered some incentives to become married they also created other incentives to become divorced known as the independence effect after controlling for the outflows from marriage due to the independence effect the estimated effect increases by 10 percent

health insurance coverage and the macroeconomy this paper investigates the relationship between the macroeconomy and health insurance coverage for non elderly americans we find that for men state unemployment rate is positively correlated with the probability of health insurance coverage in general and through an employer in particular and that these correlations are only partly explained by changes in employment status in contrast the insurance coverage of women and children appears to be insulated from fluctuations in the unemployment rate by public health insurance programs like medicaid and state children s health insurance program schip we estimate that 984 000 americans nearly all of whom were adult men lost health insurance due to macroeconomic conditions alone during the 2001 recession

efficiency of health care delivery systems effects of health insurance coverage health insurance expansions may increase the demand for care creating incentives for health systems to increase input consumption the possibility remains that added capacity and personnel will have little effect on health outcomes decreasing the technical efficiency of health care delivery systems we estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1 3 percentage points translating into approximately 50 billion dollars in additional health expenditures this finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur

health insurance eligibility utilization of medical care and child health two economists applied data from the current population survey and the national health interview survey and state level data on child mortality to a simulation model of utilization of medical care that varies only with the states legislative environment to examine the utilization of medical care and health effects of medicaid eligibility on low income children the models took into consideration the recent expansions of medicaid to low income children 38 of those ineligible for medicaid in 1984 who became eligible due to changes during 1984 1992 were uninsured between 1984 and 1992 expansions of the medicaid program increased the proportion of children eligible for medicaid almost two fold 16 1 vs 31 2 yet coverage rates were always lower than eligibility rates 13 2 vs 16 1 in 1984 and 20 3 vs 31 2 in 1992 and the increase in coverage rates was only about 50 of the increase in eligibility rates during 1984 1992 the probability that a child was eligible for medicaid increased the probability of health insurance coverage by 29 77 when the model considered bias in variables e g a recession in a state the take up rate was only 22 73 nevertheless medicaid markedly increased use of medical care for example eligibility for medicaid increased the likelihood of making a visit to a physicians office in the last two weeks by about 50 it also increased the probability of a child visiting the hospital suggesting inefficiency in the way that providers deliver care to medicaid enrollees medicaid eligibility had a significant effect on reducing child mortality the 15 1 percentage point increase in eligibility during 1984 1992 reduced child mortality by 4 5 when the researchers examined parent assessed subjective health measures medicaid eligibility had no effect on child health medicaid eligibility reduced race and education based disparities in the number of visits and racial differences in mortality yet it may actually intensify current disparities in health care delivery site

u s states the medicaid program and tax smoothing this paper tests the tax smoothing theory by focusing on its implication that a change in permanent government spending should result in an equal sized change in the tax rate the effect of medicaid a state administered federal and state funded medical insurance program for the poor on state tax rates is investigated the medicaid program provides a natural experiment for this test as states are required to cover certain groups in order to receive federal matching money additionally during the 1980s a series of federal mandates greatly increased state medicaid expenditures two stage least squares is used on a panel of u s states 1978 1994 to test whether changes in permanent state medicaid expenditures resulted in equal sized tax rate changes tax smoothing as a positive theory of state government behavior is rejected additionally it is found that this rejection cannot be attributed to the stringency of balanced budget rules