universal coverage with supply side reform the impact on medical expenditure risk and utilization in thailand abstract we estimate the impact on out of pocket oop medical expenditure of a major reform in thailand that greatly extended health insurance coverage to achieve universality while implementing supply side measures intended to deliver cost effective care from an increased but modest public health budget difference in differences comparison of groups to whom coverage was extended or deepened with those whose coverage did not change indicates that the reform reduced oop expenditure by 28 on average and by 42 at the 95th percentile of the conditional distribution simulations suggest that exposure to medical expenditure risk was reduced by three fifths on average generating a social welfare gain equivalent to 80 200 of the approximate deadweight loss from financing the reform estimated effects on health care access suggest that the policy managed to reduce households medical expenses while also raising their utilization of both inpatient and ambulatory care

similarities and convergence in g 7 cycles this paper examines the properties of g 7 cycles using a multicountry bayesian panel var model with time variations unit specific dynamics and cross country interdependences we demonstrate the presence of a significant world cycle and show that country specific indicators play a much smaller role we detect di erences across business cycle phases but apart from an increase in synchronicity in the late 1990s find little evidence of major structural changes we also find no evidence of the existence of an euro area specific cycle or of its emergence in the 1990s

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

u s and canadian industrial production indices as coupled oscillators abstract this paper uses ozaki s 1985 variable amplitude coefficient model to explore the impact of different types of dynamical linkages coupling between the indices of industrial production for the u s and canada empirical analysis reveals that for each country the requisite lag structure extends for up to six years and that the coupling linkages are functions of lagged changes in growth rates incorporating these linkages leads to an increased degree of oscillation in the equilibrium paths a marginal improvement in stability and somewhat greater synchronization between the two series the out of sample forecasts for each series are improved by the coupling

financial risk protection from social health insurance this paper estimates the impact of social health insurance on financial risk by utilizing data from a natural experiment created by the phased roll out of a social health insurance program for the poor in india we estimate the distributional impact of insurance on of out of pocket costs and incorporate these results with a stylized expected utility model to compute associated welfare effects we adjust the standard model accounting for conditions of developing countries by incorporating consumption floors informal borrowing and asset selling which allow us to separate the value of financial risk reduction from consumption smoothing and asset protection results show that insurance reduces out of pocket costs particularly in higher quantiles of the distribution we find reductions in the frequency and amount of money borrowed for health reasons finally we find that the value of financial risk reduction outweighs total per household costs of the insurance program by two to five times

on price competition with complementary goods we consider a duopoly industry with two separate firms each selling an indivisible product the joint consumption of these goods has a specific value for the consumers which exceeds the mere addition of utilities when products are consumed in isolation the higher this excess the larger the complementarity between the goods we analyse price equilibria in this market as related to the degree of complementarity existing between the two products

on the distribution and dynamics of health care costs using data from the health and retirement survey and the assets and health dynamics of the oldest old survey we estimate the stochastic process that determines both the distribution and dynamics of health care costs we find that the data generating process for log health costs is well represented as the sum of a white noise process and a highly persistent ar 1 process we also find that the innovations to this process can be modelled with a normal distribution that has been adjusted to capture the risk of catastrophic health care costs simulating this model we find that in any given year 0 1 of households receive a health cost shock with a present value of at least 125 000 copyright 2004 john wiley sons ltd

what mean impacts miss distributional effects of welfare reform experiments labor supply theory predicts systematic heterogeneity in the impact of recent welfare reforms on earnings transfers and income yet most welfare reform research focuses on mean impacts we investigate the importance of heterogeneity using random assignment data from connecticut s jobs first waiver which features key elements of post 1996 welfare programs estimated quantile treatment effects exhibit the substantial heterogeneity predicted by labor supply theory thus mean impacts miss a great deal looking separately at samples of dropouts and other women does not improve the performance of mean impacts we conclude that welfare reform s effects are likely both more varied and more extensive than has been recognized

quality coordination and complementary products this article models the choice of price and quality where products are complementary and components can be provided by either one or two monopolists the firms have to choose price and quality simultaneously but can coordinate in the latter dimension we consider two specifications for the quality of the composite good bottleneck and additive set ups in both cases a single monopolist may produce lower quality as compared to dual ownership if the latter is modelled as a single stage quality and price setting game when separate markets for components of the composite good are added to the model we provide an example where dual ownership leading to higher quality also yields higher consumer surplus but not total welfare than a single monopolist

moral hazard in health insurance what we know and how we know it we describe research on the impact of health insurance on healthcare spending moral hazard and use this context to illustrate the value of and important complementarities between different empirical approaches one common approach is to emphasize a credible research design we review results from two randomized experiments as well as some quasi experimental studies this work has produced compelling evidence that moral hazard in health insurance exists that is individuals on average consume less healthcare when they are required to pay more for it out of pocket as well as qualitative evidence about its nature these studies alone however provide little guidance for forecasting healthcare spending under contracts not directly observed in the data therefore a second and complementary approach is to develop an economic model that can be used out of sample we note that modeling choices can be consequential different economic models may fit the reduced form but deliver different counterfactual predictions an additional role of the more descriptive analyses is therefore to provide guidance regarding model choice

the incidence of medicare abstract the medicare program transfers nearly 300 billion annually from taxpayers to beneficiaries this paper considers the incidence of such transfers in the context of a life cycle model with uncertainty about future health care expenditures we find the distributional consequences of the medicare program are roughly neutral in dollar terms households living in high income neighborhoods pay more in taxes but they also receive more in benefits these dollar flows however ignore the insurance value of the medicare system given the incomplete insurance coverage of lower income elderly households prior to the medicare program the money metric benefits to lower income groups exceed the dollar flows suggesting that medicare redistributes more than a simple accounting exercise would suggest

can targeted transfers improve birth outcomes evidence from the introduction of the wic program abstract the goal of federal food and nutrition programs in the united states is to improve the nutritional well being and health of low income families a large body of literature evaluates the extent to which the supplemental program for women infants and children wic has accomplished this goal but most studies have been based on research designs that compare program participants to non participants if selection into these programs is non random then such comparisons will lead to biased estimates of the program s true effects in this study we use the rollout of the wic program across counties to estimate the impact of the program on infant health we find that the implementation of wic led to an increase in average birth weight and a decrease in the fraction of births that are classified as low birth weight we find no evidence that these estimates are driven by changes in fertility or selection into live births our preferred estimates suggest that wic initiation raised average birth weight by 2 g or by 7 g among infants born to mothers with low education levels these translate into estimated birth weight increases among participating mothers of approximately 18 to 29 g estimated treatments on the treated impacts among infants born to participating mothers with low education are of similar magnitude

the effect of patient cost sharing on utilization health and risk protection abstract this paper exploits a sharp reduction in patient cost sharing at age 70 in japan using a regression discontinuity design to examine its effect on utilization health and financial risk arising from out of pocket expenditures due to the national policy cost sharing is 60 80 percent lower at age 70 than at age 69 i find that both outpatient and inpatient care are price sensitive among the elderly while i find little impact on mortality and other health outcomes the results show that reduced cost sharing is associated with lower out of pocket expenditures especially at the right tail of the distribution jel g22 i11 i12 i13 i18 j14

life cycle responses to health insurance status this paper studies the lifetime effects of exogenous changes in health insurance coverage e g medicare ppaca termination of employer provided plans on the dynamic optimal allocation consumption leisure health expenditures status health and wealth and welfare we solve simulate and structurally estimate a parsimonious life cycle model with endogenous exposure to morbidity and mortality risks and exogenous health insurance by varying coverage we identify the marginal effects of insurance when young and or when old on allocations statuses and welfare our results highlight positive effects of insurance on health wealth and welfare as well as mid life substitution away from healthy leisure in favor of more health expenses caused by peaking wages and accelerating health issues

should income transfers be targeted or universal insights from public pension influences on elderly mortality in canada 1921 1966 we investigate the impact of canada s means tested and universal public pension programs on the mortality rates of age groups eligible for pension benefits for the period 1921 1966 we find that only the universal program significantly reduced pension eligible age group mortality rates the implied social value of the mortality risk reduction from this program is one tenth of the value per statistical life associated with contemporary government policy meaning that canadians did not need to place a high value on the life of a senior to justify the higher cost of the universal program jel classification i3 j1 on analyse l impact des regimes de rentes universels et de ceux qui impliquent une enquete sur la situation de fortune sur les taux de mortalite des groupes d ge eligibles aux prestations de retraite pour la periode 1921 1966 on decouvre que seulement les regimes universels reduisent de maniere significative les taux de mortalite des groupes d ge eligibles la valeur sociale implicite de la reduction du risque de mortalite attribuable a un tel regime est egale a un dixieme de la valeur de la vie statistique associee aux politiques contemporaines des gouvernements voila qui signifie que les canadiens n ont pas a attribuer une grande valeur a la vie d un aine pour justifier le cout plus eleve du programme universel

trade integration and business cycle convergence is the relation robust across time and space in this paper we investigate the relationship between trade intensity and the business cycle correlation using a panel data set taken from 24 countries over the period 1959 2003 most previous studies did not account for the possibility that the business cycle correlation may be influenced by unobservable country pair specific effects our estimates using both fixed and random effects methodologies suggest that trade intensity and the business cycle correlation are positively related to one another however detailed investigation shows that this relationship exists mainly for the european countries

measuring world business cycles using kalman filtering and dynamic factor analysis the authors decompose aggregate output consumption and investment for the g7 countries into factors that are 1 common across all countries and aggregates 2 common across aggregates within a country and 3 specific to each individual aggregate in quarterly data for the period 1970 through 1993 fluctuations in all aggregates contain world and country specific common components that are both statistically significant and quantitatively important the authors find that the world and country specific common components play different roles in different business cycle episodes for each of the seven countries and that either may be dominant during a particular episode copyright 1997 by economics department of the university of pennsylvania and the osaka university institute of social and economic research association

an investigation of regime shifts in uk commercial property returns a time series analysis the random walk hypothesis vis a vis asset price suggests that prices traded in a market cannot be predicted based on historical information employing unsecuritized uk commercial property returns we analyse this hypothesis by investigating regime shifts or multiple changes in persistence in the series our results uncover regime shifts in both the aggregate and sector specific data specifically the shifts are less frequent in the industrial sector compared to the office retail and aggregate returns data we highlight some implications for academics practitioners and regulators

estimating the tradeoff between risk protection and moral hazard with a nonlinear budget set model of health insurance insurance induces a tradeoff between the welfare gains from risk protection and the welfare losses from moral hazard empirical work traditionally estimates each side of the tradeoff separately potentially yielding mutually inconsistent results i develop a nonlinear budget set model of health insurance that allows for both simultaneously nonlinearities in the budget set arise from deductibles coinsurance rates and stoplosses that alter moral hazard as well as risk protection i illustrate the properties of my model by estimating it using data on employer sponsored health insurance from a large firm

the insurance value of medical innovation abstract economists think of medical innovation as a valuable but risky good producing health benefits but increasing financial risk for consumers and healthcare payers this perspective overlooks how innovation can lower physical risks borne by healthy patients facing the prospect of future disease we present an alternative framework that accounts for all these sources of value and links them to the value of healthcare insurance we show that any innovation worth buying reduces overall risk and generates positive insurance value on its own we conduct a stylized numerical exercise to assess the potential empirical significance of our insights our calculations suggest that conventional methods meaningfully understate the value of historical health gains and disproportionately undervalue treatments for the most severe illnesses where physical risk to consumers is the costliest these calculations also suggest that the value of physical insurance from new technologies may exceed the financial spending risk that they pose

on the sources of business cycles in the g 7 abstract this paper examines sources of cyclical movements in output inflation and the term structure of interest rates in the g 7 it employs a novel identification approach which uses the sign of the theoretical cross correlation function in response to shocks to catalog orthogonal disturbances we find that demand shocks are the dominant source of output and inflation fluctuations in several of the g 7 countries the proportion of term structure variability explained by different structural sources does not depend on the horizon apart from the us and canada structural shocks are nearly uncorrelated across countries

competition and integration among complements and network market structure this article analyzes the competition and integration among complementary products that can be combined to create composite goods or systems the model generalizes the cournot duopoly complements model to the case in which there are multiple brands of compatible components it analyzes equilibrium prices for a variety of organizational and market structures that differ in their degree of competition and integration the model applies to a variety of product networks including automatic teller machines real estate multiple listing services and airlines crs as well as to nonnetwork markets of compatible components such as computer cpus and peripherals hardware and software and long distance and local telephone services copyright 1992 by blackwell publishing ltd

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

estimating health demand for an aging population a flexible and robust bayesian joint model in this paper we analyse two frequently used measures of the demand for health care namely hospital visits and out of pocket health care expenditure which have been analysed separately in the existing literature given that these two measures of healthcare demand are highly likely to be closely correlated we propose a framework to jointly model hospital visits and out of pocket medical expenditure furthermore the joint framework allows for the presence of non linear effects of covariates using splines to capture the effects of aging on healthcare demand sample heterogeneity is modelled robustly with the random effects following dirichlet process priors with explicit cross part correlation the findings of our empirical analysis of the u s health and retirement survey indicate that the demand for healthcare varies with age and gender and exhibits significant cross part correlation that provides a rich understanding of how aging affects health care demand which is of particular policy relevance in the context of an aging population

the emergence of regional business cycle in africa a reality or myth a bayesian dynamic factor model analysis this paper examines the evolution and the underlying forces of the business cycle co movements among seven african a 7 countries over the period 1970 2016 these countries accounted for over 60 of regional gdp have abundant natural resources access to the global capital market and widely viewed as potential drivers of regional or african business cycle we model the national business cycle using real output consumption and investment we employ a dynamic factor model to decompose fluctuations in these macro variables into a regional country specific and idiosyncratic components using bayesian methods we also analyse the relative importance of some notable drivers of business cycle fluctuations found in the literature we find that the idiosyncratic component is dominating cyclical fluctuations in the a 7 countries while country specific and regional factors play a negligible role suggesting the inexistence of a common regional cycle despite deepening intra african trade among the driving variables the terms of trade shocks exert greater influence on the a 7 business cycle while exchange rate movements and changes in money supply explain sizeable fluctuations in consumption and investment in most of the a 7 countries shocks associated with changes in relative domestic oil prices monetary and fiscal policies cause large output fluctuations

informality and the expansion of social protection programs evidence from mexico many countries are moving from employer based to universal health coverage which can generate crowd out in mexico seguro popular provides public health coverage to the uninsured using the gradual roll out of the system at the municipality level we estimate that seguro popular had no effect on informality in the overall population informality did increase by 1 7 for less educated workers but the wage gains for workers who switch between the formal and the informal sector were not significantly affected this suggests that marginal workers do not choose between formal and informal jobs on the basis of health insurance coverage

interconnections between eurozone and us booms and busts using a bayesian panel markov switching var model summary the proposed panel markov switching var model accommodates changes in low and high data frequencies and incorporates endogenous time varying transition matrices of country specific markov chains allowing for interconnections an efficient multi move sampling algorithm draws time varying markov switching chains using industrial production growth and credit spread data several important data features are obtained three regimes appear with slow growth becoming persistent in the eurozone turning point analysis indicates the usa leading the eurozone cycle amplification effects influence recession probabilities for eurozone countries a credit shock results in temporary negative industrial production growth in germany spain and the usa core and peripheral countries exist in the eurozone copyright 2016 john wiley sons ltd

global output growth and volatility spillovers this article examines discernable patterns of real gross domestic product gdp growth co movements across 29 countries using consistent time series data 1912 2008 of these countries only 12 are found to form three statistically significant groupings i e g6 six organization for economic co operation and development oecd european countries g4 four anglo saxon countries and g2 two major asian countries one may then conclude that inter alia geographical proximity cultural ties and the level of socio economic and financial ties among countries determine the global systematic co movements of growth rates our results indicate that any recession in the us initially engulfs other anglo saxon countries as well as g6 and g2 countries before exerting its adverse knock on effects to the rest of the world a multivariate generalized autoregressive conditional heteroscedasticity mgarch model is also used to examine the transmission of gdp growth across these three groups and their corresponding vol

the risk and duration of catastrophic health care expenditures the authors measure the time series property of catastrophic medical costs facing the elderly using information on medical deductions from a panel of tax returns during the period of analysis 1968 73 taxpayers could deduct medical expenses above 3 percent of income they correct for the resulting censoring bias using multivariate tobit estimated with a variant of the smoothed simulated maximum likelihood method the estimated coefficients imply a 1 00 increase in out of pocket medical spending is associated with 2 65 in future out of pocket spending copyright 1994 by mit press

international business cycles world region and country specific factors the paper investigates the common dynamic properties of business cycle fluctuations across countries regions and the world we employ a bayesian dynamic latent factor model to estimate common components in macroeconomic aggregates output consumption and investment in a 60 country sample covering seven regions of the world the results indicate that a common world factor is an important source of volatility for aggregates in most countries providing evidence for a world business cycle we find that region specific factors play only a minor role in explaining fluctuations in economic activity we also document similarities and differences across regions countries and aggregates jel f41 e32 c11 c32

stock market volatility and international business cycle dynamics evidence from oecd economies abstract how does a surprise movement in stock market volatility affect our forecasts of future output across countries this paper studies the time series and cross sectional responses of output to variation in stock market volatility across 27 countries over 40 years controlling for a number of country specific characteristics high levels of stock market volatility are detrimental to future output growth not only after financial crises as previously emphasized in the literature but also in non crisis periods output growth and interest rates react negatively to a random shock to volatility and revert to their means quickly thereafter moreover these results are robust after controlling for economic policy uncertainty the level of financial development and the direction of the market

catastrophic medical expenditure risk we propose a measure of household exposure to particularly onerous medical expenses the measure can be decomposed into the probability that medical expenditure exceeds a threshold the loss due to predictably low consumption of other goods if it does and the further loss arising from the volatility of medical expenses above the threshold depending on the choice of threshold the measure is consistent with a model of reference dependent utility with loss aversion unlike the risk premium the measure is only sensitive to particularly high expenses and can identify households that expect to incur such expenses and would benefit from subsidised but not actuarially fair insurance an empirical illustration using data from seven asian countries demonstrates the importance of taking account of informal insurance and reveals clear differences in catastrophic medical expenditure risk across and within countries in general risk is higher among poorer rural and chronically ill populations

losing public health insurance tenncare reform and personal financial distress abstract a primary goal of health insurance is smoothing the financial risk associated with health shocks we estimate the effect of exposure to health insurance reform on individual level financial well being utilizing a plausibly exogenous shock to health insurance status resulting from a sudden disenrollment from tennessee s medicaid program in 2005 we find that the reform resulted in a 2 78 point decline in credit risk score for an individual in the median county in tennessee this study is the first examining the impact of losing any form of public assistance on personal financial well being and our results inform ongoing discussions around medicaid reform

health insurance and the labor supply decisions of older workers evidence from a u s department of veterans affairs expansion this paper exploits a major mid 1990s expansion in the u s department of veterans affairs health care system to provide evidence on the labor market effects of expanding health insurance availability using data from the current population survey we employ a difference in differences strategy to compare the labor market behavior of older veterans and non veterans before and after the va health benefits expansion to test the impact of public health insurance on labor supply we find that older workers are significantly more likely to decrease work both on the extensive and intensive margins after receiving access to non employer based insurance workers with some college education or a college degree are more likely to transition into self employment a result consistent with job lock effects however less educated workers are more likely to leave self employment a result suggesting that the positive income effect from receiving public insurance dominates the job lock effect for these workers some relatively disadvantaged sub populations may also increase their labor supply after gaining greater access to public insurance consistent with complementary positive health effects of health care access or decreased work disincentives for these groups we conclude that this reform has affected employment and retirement decisions and suggest that future moves toward universal coverage or expansions of medicare are likely to have significant labor market effects

the impact of health insurance on stockholding a regression discontinuity approach economic theory predicts that a reduction in background risk should induce financial risk taking particularly for individuals with low stock market participation costs hence health insurance coverage could affect financial risk taking by offsetting health related background risk we use a regression discontinuity design to examine whether medicare eligibility at age 65 increases stockholding in the us and find that it does so for those with college education but not for their less educated counterparts who face higher stock market participation costs our results are unlikely due to the reduction of medical expenses associated with medicare coverage because the latter does not affect bondholding

the credit consequences of unpaid medical bills abstract this paper quantifies the costs of leaving medical bills unpaid and what these costs imply for the value of health insurance to beneficiaries we argue that a large fraction of unpaid medical bills is sent to third party collections and reported to credit bureaus with detrimental effects on patients credit outcomes combining a large panel of credit records with data on credit offers we find that the aca medicaid expansion reduced newly reported medical collections by 5 89 billion and led to better terms of credit we find that the financial benefits of medicaid at least double when including this indirect credit channel

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

health insurance and the consumer bankruptcy decision evidence from expansions of medicaid abstract anecdotal evidence and several observational studies suggest that out of pocket medical costs are pivotal in a large fraction of consumer bankruptcy decisions in this paper we assess the contribution of medical costs to household bankruptcy risk by exploiting plausibly exogenous variation in publicly provided health insurance using cross state variation in medicaid expansions from 1992 to 2004 we find that a 10 percentage point increase in medicaid eligibility reduces personal bankruptcies by 8 with no evidence that business bankruptcies are similarly affected we interpret our findings with a model in which health insurance imperfectly substitutes for other forms of financial protection and we use the model to present simple calibration results which illustrate how our reduced form parameter estimate affects the optimal level of health insurance benefits we conclude with calculations which suggest that out of pocket medical costs are pivotal in roughly 26 of personal bankruptcies among low income households

common and country specific fluctuations in productivity investment and the current account abstract dynamic factor analysis and kalman filtering are used to construct a measure of common economic activity for the g7 countries we find that the common fluctuations are strongly associated with movements in us investment common fluctuations have substantial impact on fluctuations in both productivity and investment in these countries but very little impact on the current account country specific investment fluctuations have a significant negative impact on the current account while country specific productivity movements have little independent effect these findings are shown to be generally consistent with the predictions of a multi country dynamic model calibrated to the empirical decomposition of productivity shocks

the oregon health insurance experiment evidence from the first year in 2008 a group of uninsured low income adults in oregon was selected by lottery to be given the chance to apply for medicaid this lottery provides an opportunity to gauge the effects of expanding access to public health insurance on the health care use financial strain and health of low income adults using a randomized controlled design in the year after random assignment the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected we find that in this first year the treatment group had substantively and statistically significantly higher health care utilization including primary and preventive care as well as hospitalizations lower out of pocket medical expenditures and medical debt including fewer bills sent to collection and better self reported physical and mental health than the control group

are correlations of stock returns justified by subsequent changes in national outputs abstract in an integrated world capital market the same pricing kernel is applicable to all securities we apply this idea to the stock returns of different countries we investigate the underlying determinants of cross country stock return correlations first we determine for a given measured degree of commonality of country outputs what should be the degree of correlation of national stock returns we propose a framework that contains a statistical model for output and an intertemporal financial market model for stock returns we then attempt to match the correlations generated by the model with measured correlations our results show that under the hypothesis of market segmentation the model correlations are much smaller than observed correlations however assuming world markets are integrated our model correlations can be matched with observed correlations

determinants of business cycle comovement a robust analysis abstract this paper investigates the determinants of business cycle comovement between countries our dataset includes over 100 countries both developed and developing we search for variables that are robust in explaining comovement using the approach of leamer amer econom rev 73 1983 31 variables considered are i bilateral trade between countries ii total trade in each country iii sectoral structure iv similarity in export and import baskets v factor endowments and vi gravity variables we find that bilateral trade is robust however two variables that the literature has argued are important for business cycles industrial structure and currency unions are found not to be robust

a unified welfare analysis of government policies we conduct a comparative welfare analysis of 133 historical policy changes over the past half century in the united states focusing on policies in social insurance education and job training taxes and cash transfers and in kind transfers for each policy we use existing causal estimates to calculate both the benefit that each policy provides its recipients measured as their willingness to pay and the policy s net cost inclusive of long term impacts on the government s budget we divide the willingness to pay by the net cost to the government to form each policy s marginal value of public funds or its mvpf comparing mvpfs across policies provides a unified method of assessing their impact on social welfare our results suggest that direct investments in low income children s health and education have historically had the highest mvpfs on average exceeding 5 many such policies have paid for themselves as governments recouped the cost of their initial expenditures through additional taxes collected and reduced transfers we find large mvpfs for education and health policies amongst children of all ages rather than observing diminishing marginal returns throughout childhood we find smaller mvpfs for policies targeting adults generally between 0 5 and 2 expenditures on adults have exceeded this mvpf range in particular if they induced large spillovers on children we relate our estimates to existing theories of optimal government policy and we discuss how the mvpf provides lessons for the design of future research

medicaid insurance in old age the old age provisions of the medicaid program were designed to insure retirees against medical expenses we estimate a structural model of savings and medical spending and use it to compute the distribution of lifetime medicaid transfers and medicaid valuations across currently single retirees compensating variation calculations indicate that current retirees value medicaid insurance at more than its actuarial cost but that most would value an expansion of the current medicaid program at less than its cost these findings suggest that for current single retirees the medicaid program may be of the approximately right size

long run impacts of childhood access to the safety net a growing economics literature establishes a causal link between in utero shocks and health and human capital in adulthood most studies rely on extreme negative shocks such as famine and pandemics we are the first to examine the impact of a positive and policy driven change in economic resources available in utero and during childhood in particular we focus on the introduction of a key element of the u s safety net the food stamp program which was rolled out across counties in the u s between 1961 and 1975 we use the panel study of income dynamics to assemble unique data linking family background and county of residence in early childhood to adult health and economic outcomes the identification comes from variation across counties and over birth cohorts in availability of the food stamp program our findings indicate that the food stamp program has effects decades after initial exposure specifically access to food stamps in childhood leads to a significant reduction in the incidence of metabolic syndrome obesity high blood pressure and diabetes and for women an increase in economic self sufficiency overall our results suggest substantial internal and external benefits of the safety net that have not previously been quantified

health cost risk a potential solution to the annuity puzzle we find that health cost risk lowers optimal annuity demand at retirement if medical expenses can be sizeable early in retirement full annuitisation at retirement is no longer optimal because agents do not have enough time to build a liquid wealth buffer furthermore large deviations from optimal annuitisation levels lead to small utility differences our results suggest that health cost risk can explain a large proportion of empirically observed annuity choices finally allowing additional annuitisation after retirement results in welfare gains of at most 2 5 when facing health cost risk and negligible gains without this risk

when and how us dollar shortages evolved into the full crisis evidence from the cross currency swap market abstract this paper investigates when and how the us dollar shortages evolved into the full crisis in the cross currency swap market between major european currencies and the us dollar during the turmoil of 2007 2009 using the dynamic factor model with regime switching coefficients of each swap price with respect to the latent common factor the 1 year market entered the high crisis regime soon after the onset of the subprime problem in august 2007 the 10 year market entered that regime following the collapse of bear sterns in mid march 2008 financial credit spreads have significant predictive power for switches between high and low regimes

the aggregate effects of health insurance evidence from the introduction of medicare this paper investigates the effects of market wide changes in health insurance by examining the single largest change in health insurance coverage in american history the introduction of medicare in 1965 i estimate that the impact of medicare on hospital spending is over six times larger than what the evidence from individual level changes in health insurance would have predicted this disproportionately larger effect may arise if market wide changes in demand alter the incentives of hospitals to incur the fixed costs of entering the market or of adopting new practice styles i present some evidence of these types of effects a back of the envelope calculation based on the estimated impact of medicare suggests that the overall spread of health insurance between 1950 and 1990 may be able to explain about half of the increase in real per capita health spending over this time period

sovereign credit spreads abstract the paper develops a structural credit risk model to study sovereign credit risk and the dynamics of sovereign credit spreads the model features endogenous default and recovery rates that both depend on the interaction between domestic output fluctuations and global macroeconomic conditions we show that sovereigns choose to default at higher levels of economic output once global macroeconomic conditions are bad this yields to default rates and credit spreads that are substantially higher compared to normal times we derive closed form expressions for sovereign debt values and default times and focus on the dynamics of sovereign credit spreads as opposed to standard theories of sovereign debt this paper s structural model generates much richer default patterns and non linearities through regime shifts in the global macroeconomic environment moreover changes in the global environment reveal the interconnectedness of the financial system

pricing decisions for complementary products with firms different market powers abstract this article reports the results of a study that explores the pricing problems with regard to two complementary products in a supply chain with two manufacturers and one common retailer the authors establish five pricing models under decentralized decision cases including the ms bertrand ms stackelberg rs bertrand rs stackelberg and ng models with consideration of different market power structures among channel members by applying a game theoretical approach corresponding analytic solutions are obtained then by comparing the maximum profits and optimal pricing decisions obtained in different decision cases interesting and valuable managerial insights are established

what did medicare do the initial impact of medicare on mortality and out of pocket medical spending abstract we study the impact of the introduction of one of the major pillars of the social insurance system in the united states the introduction of medicare in 1965 our results suggest that in its first 10 years the establishment of universal health insurance for the elderly had no discernible impact on elderly mortality however we find a substantial reduction in the elderly s exposure to out of pocket medical expenditure risk specifically we estimate that the introduction of medicare was associated with a 40 decline in out of pocket spending for the top quartile of the out of pocket spending distribution a stylized expected utility framework suggests that the welfare gains from such reductions in risk exposure alone may be sufficient to cover almost two fifths of the costs of medicare these findings underscore the importance of considering the direct insurance benefits from public health insurance programs in addition to any indirect benefits from an effect on health

the effect of medicare part d on pharmaceutical prices and utilization prescription drug expenditures represent the most rapidly growing component of health care spending increasing from 5 percent of health care spending in 1980 to more than 10 percent by 2005 centers for medicare and medicaid services cms 2007a further almost 60 percent of all prescriptions in the united states are filled for beneficiaries of medicare medicaid and other government programs rapid innovation in new pharmaceuticals has contributed substantially to quality of life and longevity in the us frank lichtenberg 1996 these facts combined indicate that government procurement schemes are critical both in determining government expenditure on pharmaceuticals and in stimulating innovation of new treatments in this paper we show that the institutions and mechanisms used by the government to pur chase prescription drugs can strongly affect market outcomes by institutions we have in mind large buyer groups structured incentives for patients to consume certain products and the devel opment and use of formularies a formulary is a mechanism that allows a buyer to identify a therapeutically similar treatment as a viable substitute for a patented treatment and to create price competition due to the ability to substitute away from the more expensive product when bargaining with the seller of a patented product the ability to shift demand to a substitute drug is a powerful negotiating tool our paper provides evidence for what we consider a surprising outcome in the case of the new prescription drug program for medicare enrollees moving consumers from cash paying status to membership in an insured group lowers optimal prices for branded prescription drugs below what they otherwise would be this is surprising because the standard effect of insurance is to create inelastic demand and therefore elicit higher prices from a seller with market power duggan and scott morton 2006 however the insurers that we study bundle insurance with a formulary and other mechanisms to create elastic demand an individual consumer typically does not know which drugs are acceptable therapeutic substitutes the consumer s physician typi cally has poor knowledge of prices especially negotiated prices and any one consumer is too small a share of demand to negotiate with a pharmaceutical company a prescription drug plan can potentially surmount all three hurdles our evidence leads us to conclude that the formulary and other mechanisms perform the spe cial role of allowing buyers to move market share among drugs with patent protection thereby raising cross price elasticities and lowering purchase prices or reducing price increases for branded drugs this result contrasts with the common intuition that an uninsured consumer

the interaction of public and private insurance medicaid and the long term care insurance market a long tradition in public finance examines how public programs can crowd out private activ ity in areas as diverse as education savings and insurance among others these studies typi cally focus on aggregate economic implications particularly for government expenditures and national savings in this paper we demonstrate that crowd out can also have an important effect on individual welfare specifically we show that the provision of even very incomplete public insurance can crowd out more comprehensive private policies by imposing a large implicit tax on private insurance benefits thus potentially increasing overall risk exposure for individuals we examine the interaction of public and private insurance for one of the largest uninsured financial risks facing the elderly in the united states long term care expenditures at 135 bil lion in 2004 long term care expenditures represented over 8 5 percent of total health expendi tures or all ages or roughly 1 2 percent of gdp moreover real long term care expenditures are projected to triple over the next 35 years due to rising medical costs and the aging of the baby boomers only 10 percent of the elderly however have any private long term care insurance and one third of expenditures are paid for out of pocket congressional budget office cbo 1999 cbo 2004 brown and finkelstein 2007 one potential explanation for the small size of the private market is that the public insurance provided by medicaid may crowd out demand for private insurance medicaid was designed to provide long term care insurance for the poor elderly mark v pauly 1989 1990 has established the qualitative result that as an incomplete but publicly funded source of long term care insur ance medicaid has the potential to reduce substantially demand for private long term care insur ance even among the nonpoor our work builds on this insight by quantifying the magnitude of medicaid s crowd out effect and the incomplete nature of medicaid coverage we also illustrate the mechanism behind medicaid s crowd out effect and are therefore able to assess the likely impact of alternative policies on private insurance demand we develop a utility based model of a 65 year old risk averse individual who chooses an opti mal intertemporal consumption path in the presence of uncertainty about long term care expen ditures we calibrate the model using data on the distribution of long term care expenditure risk common state medicaid rules and the prices and coverage of typical private long term care insurance policies

new evidence on the money s worth of individual annuities this paper presents new information on the expected present discounted value of payouts on individual life annuities the annuity we examine is the single premium immediate life annuity an insurance product that pays out a nominal level sum as long as the covered person lives in exchange for an initial lump sum premium this annuity offers protection against the risk of someone outliving his saving given uncertainty about longevity for reasonable estimates of behavioral parameters we calculate that individual annuities are currently priced so that retirees without bequest motives should find these policies of substantial value in configuring their portfolios to smooth retirement consumption we also find that the expected present discounted value of payouts relative to the initial cost of the annuity has increased over the last decade these findings bear on the policy debate regarding the role of individual choice and self reliance in retirement planning this abstract was borrowed from another version of this item

the effect of health insurance on home payment delinquency evidence from aca marketplace subsidies abstract we use administrative tax data and survey responses to quantify the effect of subsidized health insurance on rent and mortgage delinquency we employ a regression discontinuity rd design exploiting the income threshold for receiving marketplace subsidies in states that did not expand medicaid under the affordable care act among households targeted by the policy eligibility for subsidies is associated with a roughly 25 decline in the delinquency rate and reduced exposure to out of pocket medical expenditure risk iv treatment effects are significant indicating that the decline in the delinquency rate is related to participation in health insurance we show that under plausible assumptions the social benefits implied by our rd estimates in terms of fewer evictions and foreclosures 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

europe and central asia s great post communist social health insurance experiment aggregate impacts on health sector outcomes abstract the post communist transition to social health insurance in many of the central and eastern european and central asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax financed health systems this paper employs regression based generalizations of the difference in differences method on panel data from 28 countries for the period 1990 2004 we find that controlling for any concurrent provider payment reforms adoption of social health insurance increased national health spending and hospital activity rates but did not lead to better health outcomes

does medicare benefit the poor abstract measuring the progressivity of age targeted government programs is difficult because no single data set measures income and benefit use throughout life previous research using zip code as a proxy for lifetime income has found that medicare benefits flow primarily to the most economically advantaged groups and that the financial returns to medicare are often higher for the rich than the poor however our analysis produces the starkly opposed result that medicare is an extraordinarily progressive public program in dollar terms or welfare terms these new results owe themselves to our measurement of socioeconomic status as an individual s education rather than the geographically aggregated measures of income used by previous research we argue that individual education has important practical and conceptual advantages over geographically aggregated measures of income our results suggest the crucial importance of accurate poverty measurement in evaluating the progressivity of complex government programs like medicare or social security

international demand and liquidity shocks in a svar model of the australian economy a structural vector autoregressive model of the australian economy that allows for international shocks from the usa japan as well as world commodity prices is specified and estimated for the period 1979 1999 a block exogenous structure linking the three countries is imposed the international linkages are modelled using a factor structure to circumvent problems from estimating large scale dynamic models the factors are estimated recursively using a kalman filter and are found to represent aggregate demand and liquidity shocks for the usa and japan respectively the key empirical result is the usa shocks are the dominant source of international shocks on the australian economy with the japanese economy having a dampening effect on the usa shocks the empirical results also show that australian monetary policy responds to domestic conditions rather than international monetary policy

sources and propagation of international output cycles common shocks or transmission abstract this paper studies the generation and transmission of international cycles in a multi country model with production and consumption interdependencies two sources of disturbance are considered and three channels of propagation are compared technology disturbances which are mildly correlated across countries are more successful than government expenditure disturbances in reproducing actual data the presence of a common component to the shocks and of production interdependencies appear to be crucial in quantitatively matching the properties of the data

work incentives and the food stamp program abstract labor supply theory makes strong predictions about how the introduction or expansion of a social welfare program impacts work effort although there is a large literature on the work incentive effects of afdc and the eitc relatively little is known about the work incentive effects of the food stamp program and none of the existing literature is based on quasi experimental methods we use the cross county introduction of the program in the 1960s and 1970s to estimate the impact of the program on the extensive and intensive margins of labor supply earnings and family cash income consistent with theory we find reductions in employment and hours worked when food stamps are introduced the reductions are concentrated among families headed by single woman

identifying the common component of international economic fluctuations a new approach in this paper we develop an aggregation procedure using time varying weights for constructing the common component of international economic fluctuations the methodology for deriving time varying weights is based on some stylised features of the data documented in the paper the model allows for a unified treatment of cyclical and seasonal fluctuations and also accommodates the dynamic propagation of shocks across countries we find evidence for a world business cycle as well as evidence for a distinct european common component we also find some evidence that macroeconomic fluctuations have become more closely linked across industrial economies in the period after 1973 the world economy has become more closely integrated in recent years due to increasing trade and financial flows across countries this has spurred interest in the question of how the ongoing phenomenon of globalisation has affected the transmission and propagation of business cycle fluctuations across national borders an important question in this context is whether a substantial fraction of economic fluctuations are country specific or if there exists a world business cycle which might be defined as fluctuations that are common across all countries more generally the comovement of macroeconomic aggregates across different countries has become a topic of increasing interest in both academic and policy circles these issues have implications in a number of dimensions an empirical analysis of the relative importance of country specific versus common international fluctuations is of relevance for determining the structure of certain classes of international business cycle models from a policy perspective strong comovement of output across countries at business cycle frequencies implies that external trade would be unlikely to play a significant role in dampening fluctuations domestic policies aimed at affecting the real exchange rate and thereby attempting to boost net exports in the short run would then tend to have limited impact the degree of synchronisation of business cycles across countries also has important implications for short run international policy coordination and for assessing the feasibility of monetary unions therefore identifying and analysing the common component of international economic fluctuations is relevant from a number of different perspectives

the impact of nearly universal insurance coverage on health care utilization evidence from medicare the onset of medicare eligibility at age 65 leads to sharp changes in the health insurance coverage of the u s population these changes lead to increases in the use of medical services with a pattern of gains across socioeconomic groups that varies by type of service while routine doctor visits increase more for groups that previously lacked insurance hospital admissions for relatively expensive procedures like bypass surgery and joint replacement increase more for previously insured groups that are more likely to have supplementary coverage after 65 reflecting the relative generosity of their combined insurance package under medicare