IDEAS home Printed from https://ideas.repec.org/a/eee/reecon/v72y2018i1p147-168.html
   My bibliography  Save this article

The problem of the uninsured

Author

Listed:
  • Ehrlich, Isaac
  • Yin, Yong

Abstract

The problem of the uninsured cannot be fully understood without considering the role of non-market alternatives to ‘market insurance’ called ‘self-insurance’ and ‘self-protection’ (SISP), including the public ‘health care safety-net’ system. We tackle the problem by formulating a ‘full-insurance’ paradigm that accounts for all four interacting insurance measures. We apply two versions of the full-insurance model to estimate, via calibrated simulations, the impacts of SISP on the fraction of uninsured, health spending, and health levels, and to assess how the mandated Affordable Care Act might affect these outcomes in comparison with the CBO projections in 2010. The results indicate that policy analyses which overlook the role of the real price of market insurance relative to the shadow prices of SISP in determining the decision to insure can grossly distort the capacity of mandated reforms like the ACA to insure the uninsured, contain overall health care costs, and improve health and welfare outcomes.

Suggested Citation

  • Ehrlich, Isaac & Yin, Yong, 2018. "The problem of the uninsured," Research in Economics, Elsevier, vol. 72(1), pages 147-168.
    • Handle: RePEc:eee:reecon:v:72:y:2018:i:1:p:147-168
    DOI: 10.1016/j.rie.2017.05.001
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S1090944317300972
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.rie.2017.05.001?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Isaac Ehrlich & Yong Yin, 2013. "Equilibrium Health Spending and Population Aging in a Model of Endogenous Growth: Will the GDP Share of Health Spending Keep Rising?," Journal of Human Capital, University of Chicago Press, vol. 7(4), pages 411-447.
    2. Ehrlich, Isaac & Becker, Gary S, 1972. "Market Insurance, Self-Insurance, and Self-Protection," Journal of Political Economy, University of Chicago Press, vol. 80(4), pages 623-648, July-Aug..
    3. Howard Kunreuther & Adam Rose (ed.), 2004. "The Economics of Natural Hazards," Books, Edward Elgar Publishing, volume 0, number 2530.
    4. Manning, Willard G. & Marquis, M. Susan, 1996. "Health insurance: The tradeoff between risk pooling and moral hazard," Journal of Health Economics, Elsevier, vol. 15(5), pages 609-639, October.
    5. Yang-Ming Chang & Issac Ehrlich, 1985. "Insurance, Protection from Risk, and Risk-bearing," Canadian Journal of Economics, Canadian Economics Association, vol. 18(3), pages 574-586, August.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ellis, Randall P. & Manning, Willard G., 2007. "Optimal health insurance for prevention and treatment," Journal of Health Economics, Elsevier, vol. 26(6), pages 1128-1150, December.
    2. Nyman, John A., 1999. "The economics of moral hazard revisited," Journal of Health Economics, Elsevier, vol. 18(6), pages 811-824, December.
    3. Kowalski, Amanda E., 2015. "Estimating the tradeoff between risk protection and moral hazard with a nonlinear budget set model of health insurance," International Journal of Industrial Organization, Elsevier, vol. 43(C), pages 122-135.
    4. Dionne, Georges & Harrington, Scott, 2017. "Insurance and Insurance Markets," Working Papers 17-2, HEC Montreal, Canada Research Chair in Risk Management.
    5. Jihong Ding & Minglai Zhu, 2009. "A theoretical investigation of the reformed public health insurance in urban China," Frontiers of Economics in China, Springer;Higher Education Press, vol. 4(1), pages 1-29, March.
    6. Soderlund, Neil, 1998. "Possible objectives and resulting entitlements of essential health care packages," Health Policy, Elsevier, vol. 45(3), pages 195-208, September.
    7. Brianti, Marco & Magnani, Marco & Menegatti, Mario, 2018. "Optimal choice of prevention and cure under uncertainty on disease effect and cure effectiveness," Research in Economics, Elsevier, vol. 72(2), pages 327-342.
    8. Courbage, Christophe & Rey, Béatrice & Treich, Nicolas, 2013. "Prevention and precaution," IDEI Working Papers 805, Institut d'Économie Industrielle (IDEI), Toulouse.
    9. Archer, David W. & Shogren, Jason F., 1996. "Endogenous risk in weed control management," Agricultural Economics, Blackwell, vol. 14(2), pages 103-122, July.
    10. Sam Cole, 2010. "The regional portfolio of disruptions, protection, and disasters," The Annals of Regional Science, Springer;Western Regional Science Association, vol. 44(2), pages 251-272, April.
    11. Perronnin, Marc, 2013. "Effet de l'assurance complémentaire santé sur les consommations médicales, entre risque moral et amélioration de l'accès aux soins," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/13659 edited by Wittwer, Jérôme.
    12. Sidorenko, Alexandra, 2001. "Stochastic Model of Demand for Medical Care with Endogenous Labour Supply and Health Insurance," Departmental Working Papers 2001-08, The Australian National University, Arndt-Corden Department of Economics.
    13. Rong Fu & Haruko Noguchi, 2019. "Moral hazard under zero price policy: evidence from Japanese long-term care claims data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(6), pages 785-799, August.
    14. Yang-Ming Chang, 2008. "Risk Avoidance and Risk Taking under Uncertainty: A Graphical Analysis," The American Economist, Sage Publications, vol. 52(1), pages 73-85, March.
    15. Henri Loubergé, 1998. "Risk and Insurance Economics 25 Years After," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 23(4), pages 540-567, October.
    16. Çağatay Koç, 2005. "Health‐Specific Moral Hazard Effects," Southern Economic Journal, John Wiley & Sons, vol. 72(1), pages 98-118, July.
    17. Allen, W. David, 2013. "Self-protection against crime victimization: Theory and evidence from university campuses," International Review of Law and Economics, Elsevier, vol. 34(C), pages 21-33.
    18. Kai Hong & Peter A. Savelyev & Kegon T. K. Tan, 2020. "Understanding the Mechanisms Linking College Education with Longevity," Journal of Human Capital, University of Chicago Press, vol. 14(3), pages 371-400.
    19. Heyes, Anthony & Rickman, Neil & Tzavara, Dionisia, 2004. "Legal expenses insurance, risk aversion and litigation," International Review of Law and Economics, Elsevier, vol. 24(1), pages 107-119, March.
    20. Agarwal, Sumit & Satyanarain, Rengarajan & Sing, Tien Foo & Vollmer, Derek, 2016. "Effects of construction activities on residential electricity consumption: Evidence from Singapore's public housing estates," Energy Economics, Elsevier, vol. 55(C), pages 101-111.

    More about this item

    Keywords

    Health care; Health insurance; Market insurance; Self-protection; Medicaid; Medicare;
    All these keywords.

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I28 - Health, Education, and Welfare - - Education - - - Government Policy

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:reecon:v:72:y:2018:i:1:p:147-168. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/622941 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.