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The Risk and Duration of Catastrophic Health Care Expenditures

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Author Info
Daniel Feenberg
Jonathan Skinner

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Abstract

Catastrophic medical expenses are an important economic risk facing the elderly. Little is known about the persistence of such out-of-pocket medical costs. We measure the time-series property of medical costs 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. We correct for the resulting censoring bias using multivariate Tobit estimated with a variant of the smoothed simulated maximum likelihood (SSML) method. The data suggest that the burden of out-of-pocket medical expenses is substantially larger for lower income families. Furthermore, the estimated coefficients suggest substantial time-persistence in out-of-pocket medical care costs; a $1 increase in out-of-pocket medical spending is predicted to increase future spending by an additional $2.80. These results may shed light both on the social value of catastrophic health insurance as well on aggregate saving behavior.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 4147.

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Date of creation: Aug 1992
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Publication status: published as The Review of Economics and Statistics, 76(4), Nov. 1994, pp. 633-647
Handle: RePEc:nbr:nberwo:4147

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  1. Venti, Steven F. & Wise, David A., 1991. "Aging and the income value of housing wealth," Journal of Public Economics, Elsevier, vol. 44(3), pages 371-397, April. [Downloadable!] (restricted)
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  1. William Crown & Ernst Berndt & Onur Baser & Stan Finkelstein & Whitney Witt & Jonathan Maguire & Kenan Haver, 2004. "Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?," Forum for Health Economics & Policy, Berkeley Electronic Press, vol. 7(1), pages 1053-1053. [Downloadable!] (restricted)
  2. Siikamäki, Juha & Layton, David, 2005. "Incentive Payment Programs for Environmental Protection: A Framework for Eliciting and Estimating Landowners' Willingness to Participate," Discussion Papers dp-05-57, Resources For the Future. [Downloadable!]
  3. Mariacristina De Nardi & Eric French & John Bailey Jones, 2006. "Differential Mortality, Uncertain Medical Expenses, and the Saving of Elderly Singles," NBER Working Papers 12554, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  4. Fang Yang, 2006. "Consumption along the life cycle: how different is housing?," Working Papers 635, Federal Reserve Bank of Minneapolis. [Downloadable!]
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  5. Eric French & John Bailey Jones, 2002. "On the distribution and dynamics of health costs," Working Paper Series WP-02-21, Federal Reserve Bank of Chicago. [Downloadable!]
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  6. David F. Layton & Klaus Moeltner, 2000. "A Censored Random Coefficients Model for Pooled Survey Data with Application to the Estimation of Power Outage Costs," Econometric Society World Congress 2000 Contributed Papers 0912, Econometric Society. [Downloadable!]
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  7. William H. Crown & Ernst R. Berndt & Onur Baser & Stan N. Finkelstein & Whitney P. Witt, 2003. "Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?," NBER Working Papers 10062, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  8. Olesya Baker & Phil Doctor & Eric French, 2007. "Asset rundown after retirement: the importance of rate of return shocks," Economic Perspectives, Federal Reserve Bank of Chicago, issue Q II, pages 48-65. [Downloadable!]
  9. Eric French & John Bailey Jones, 2001. "The effects of health insurance and self-insurance on retirement behavior," Working Paper Series WP-01-19, Federal Reserve Bank of Chicago. [Downloadable!]
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  10. Carlos Arias & THOMAS L. COX, 1998. "Estimation of a U.S. Dairy Sector Model by Maximum Simulated Likelihood," Wisconsin-Madison Agricultural and Applied Economics Staff Papers 417, Wisconsin-Madison Agricultural and Applied Economics Department. [Downloadable!]
  11. Ed Westerhout & Kees Folmer, 2007. "Co-payment systems in health care: between moral hazard and risk reduction," CPB Discussion Papers 78, CPB Netherlands Bureau for Economic Policy Analysis. [Downloadable!]
  12. Carlos Arias & THOMAS L. COX, 1999. "Maximum Simulated Likelihood: A Brief Introduction for Practitioners," Wisconsin-Madison Agricultural and Applied Economics Staff Papers 421, Wisconsin-Madison Agricultural and Applied Economics Department. [Downloadable!]
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