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The Interaction of Partial Public Insurance Programs and Residual Private Insurance Markets: Evidence from the U.S. Medicare Program

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Author Info
Amy Finkelstein
Abstract

A ubiquitous form of government intervention in insurance markets is to provide compulsory, but partial, public insurance coverage and to allow voluntary purchases of supplementary insurance on the private market. Yet we know little about the effects of such programs on total insurance coverage and on welfare. A primary concern is that the compulsory public insurance program - designed to counter the effects of adverse selection in the private insurance market - may in fact exacerbate adverse selection pressures in the residual private insurance market. Theoretically, however, these programs may either improve or impair the functioning of the residual private insurance market. To examine this question empirically, I investigate the effect of the U.S. Medicare program - which provides partial public health insurance to individuals aged 65 and over - on the private insurance market for prescription drugs, a benefit not provided by the public program. The results suggest that Medicare does not have substantial spillover effects on residual private insurance markets. In particular, there is no evidence that Medicare is associated with increased adverse selection problems in the residual private health insurance market.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 9031.

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Date of creation: Jun 2002
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Handle: RePEc:nbr:nberwo:9031

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Find related papers by JEL classification:
I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods

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  3. Walliser, Jan, 2000. " Adverse Selection in the Annuities Market and the Impact of Privatizing Social Security," Scandinavian Journal of Economics, Blackwell Publishing, vol. 102(3), pages 373-93, June. [Downloadable!] (restricted)
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  7. Pauly, Mark V, 1986. "Taxation, Health Insurance, and Market Failure in the Medical Economy," Journal of Economic Literature, American Economic Association, vol. 24(2), pages 629-75, June. [Downloadable!] (restricted)
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  16. Cutler, David M & Gruber, Jonathan, 1996. "Does Public Insurance Crowd Out Private Insurance?," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 391-430, May. [Downloadable!] (restricted)
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  17. Amy Finkelstein, 2002. "When Can Partial Public Insurance Produce Pareto Improvements?," NBER Working Papers 9035, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  18. Blomqvist, Ake & Johansson, Per-Olov, 1996. "Economic Efficiency and Mixed Public/Private Insurance," Working Paper Series in Economics and Finance 110, Stockholm School of Economics.
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  19. Selden, Thomas M., 1993. "Should the government provide catastrophic insurance?," Journal of Public Economics, Elsevier, vol. 51(2), pages 241-247, June. [Downloadable!] (restricted)
  20. Sherry Glied & Mark Stabile, 1997. "Avoiding Health Insurance Crowd-Out: Evidence from the Medicare as Secondary Payer Legislation," NBER Working Papers 6277, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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