IDEAS home Printed from https://ideas.repec.org/a/spr/empeco/v68y2025i3d10.1007_s00181-024-02671-3.html
   My bibliography  Save this article

Household debt, self-insurance, and subjective medical expenses risk

Author

Listed:
  • Daniel Kaliski

    (Birkbeck, University of London)

Abstract

I examine the effect of medical expenses risk on debt. If individuals expect a medical expenses shock to be short-lived, it is rational to borrow to pay for medical bills and smooth consumption. By contrast, a persistent shock should decrease borrowing as loan repayments will be costly to make if future medical costs are also higher. I estimate changes to subjective forecasts of future medical expenses and debt in the months leading up to Medicare eligibility, as well as upper bounds for the effect of new information on debt for Medicare enrollees. The results indicate that there is a negligible negative effect on borrowing of lifetime medical expenses risk, but potentially a substantial positive effect of transitory medical expenses shocks, which partially accounts for the positive relationship between forecast medical expenses risk and debt in the data.

Suggested Citation

  • Daniel Kaliski, 2025. "Household debt, self-insurance, and subjective medical expenses risk," Empirical Economics, Springer, vol. 68(3), pages 1191-1231, March.
  • Handle: RePEc:spr:empeco:v:68:y:2025:i:3:d:10.1007_s00181-024-02671-3
    DOI: 10.1007/s00181-024-02671-3
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s00181-024-02671-3
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1007/s00181-024-02671-3?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 search for a different version of it.

    References listed on IDEAS

    as
    1. Olivier Armantier & Scott Nelson & Giorgio Topa & Wilbert van der Klaauw & Basit Zafar, 2016. "The Price Is Right: Updating Inflation Expectations in a Randomized Price Information Experiment," The Review of Economics and Statistics, MIT Press, vol. 98(3), pages 503-523, July.
    2. Silvia Helena Barcellos & Mireille Jacobson, 2015. "The Effects of Medicare on Medical Expenditure Risk and Financial Strain," American Economic Journal: Economic Policy, American Economic Association, vol. 7(4), pages 41-70, November.
    3. Michael L. Anderson & Carlos Dobkin & Tal Gross, 2014. "The Effect of Health Insurance on Emergency Department Visits: Evidence from an Age-Based Eligibility Threshold," The Review of Economics and Statistics, MIT Press, vol. 96(1), pages 189-195, March.
    4. David Autor & Andreas Kostøl & Magne Mogstad & Bradley Setzler, 2019. "Disability Benefits, Consumption Insurance, and Household Labor Supply," American Economic Review, American Economic Association, vol. 109(7), pages 2613-2654, July.
    5. Dimitris Christelis & Dimitris Georgarakos & Tullio Jappelli & Maarten van Rooij, 2020. "Consumption Uncertainty and Precautionary Saving," The Review of Economics and Statistics, MIT Press, vol. 102(1), pages 148-161, March.
    6. Sanna Nivakoski, 2020. "Wealth and the effect of subjective survival probability," Journal of Population Economics, Springer;European Society for Population Economics, vol. 33(2), pages 633-670, April.
    7. Antoine Bozio & Guy Laroque & Cormac O’Dea, 2017. "Discount rate heterogeneity among older households: a puzzle?," Journal of Population Economics, Springer;European Society for Population Economics, vol. 30(2), pages 647-680, April.
    8. Mariacristina De Nardi & Eric French & John B. Jones, 2010. "Why Do the Elderly Save? The Role of Medical Expenses," Journal of Political Economy, University of Chicago Press, vol. 118(1), pages 39-75, February.
    9. Libertad González, 2005. "Nonparametric bounds on the returns to language skills," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 20(6), pages 771-795.
    10. Nathaniel Hendren, 2017. "Knowledge of Future Job Loss and Implications for Unemployment Insurance," American Economic Review, American Economic Association, vol. 107(7), pages 1778-1823, July.
    11. Carlos Dobkin & Amy Finkelstein & Raymond Kluender & Matthew J. Notowidigdo, 2018. "The Economic Consequences of Hospital Admissions," American Economic Review, American Economic Association, vol. 108(2), pages 308-352, February.
    12. Wojciech Kopczuk & Joseph P. Lupton, 2007. "To Leave or Not to Leave: The Distribution of Bequest Motives," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 74(1), pages 207-235.
    13. Lusardi, Annamaria & Tufano, Peter, 2015. "Debt literacy, financial experiences, and overindebtedness," Journal of Pension Economics and Finance, Cambridge University Press, vol. 14(4), pages 332-368, October.
    14. Dimitris Christelis & Dimitris Georgarakos & Tullio Jappelli & Luigi Pistaferri & Maarten van Rooij, 2019. "Asymmetric Consumption Effects of Transitory Income Shocks," The Economic Journal, Royal Economic Society, vol. 129(622), pages 2322-2341.
    15. Gross, Tal & Notowidigdo, Matthew J., 2011. "Health insurance and the consumer bankruptcy decision: Evidence from expansions of Medicaid," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 767-778, August.
    16. Nathaniel Hendren, 2013. "Private Information and Insurance Rejections," Econometrica, Econometric Society, vol. 81(5), pages 1713-1762, September.
    17. Domenico Depalo, 2021. "True COVID-19 mortality rates from administrative data," Journal of Population Economics, Springer;European Society for Population Economics, vol. 34(1), pages 253-274, January.
    18. Glenn W. Harrison & Jia Min Ng, 2016. "Evaluating The Expected Welfare Gain From Insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 83(1), pages 91-120, January.
    19. Eric French & John Bailey Jones, 2011. "The Effects of Health Insurance and Self‐Insurance on Retirement Behavior," Econometrica, Econometric Society, vol. 79(3), pages 693-732, May.
    20. Guido W. Imbens & Charles F. Manski, 2004. "Confidence Intervals for Partially Identified Parameters," Econometrica, Econometric Society, vol. 72(6), pages 1845-1857, November.
    21. Atsushi Inoue & Lutz Kilian & Fatma Burcu Kiraz, 2009. "Do Actions Speak Louder Than Words? Household Expectations of Inflation Based on Micro Consumption Data," Journal of Money, Credit and Banking, Blackwell Publishing, vol. 41(7), pages 1331-1363, October.
    22. Liran Einav & Amy Finkelstein & Maria Polyakova, 2018. "Private Provision of Social Insurance: Drug-Specific Price Elasticities and Cost Sharing in Medicare Part D," American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 122-153, August.
    23. Richard Blundell & Luigi Pistaferri & Itay Saporta-Eksten, 2016. "Consumption Inequality and Family Labor Supply," American Economic Review, American Economic Association, vol. 106(2), pages 387-435, February.
    24. Monique De Haan, 2017. "The Effect of Additional Funds for Low‐ability Pupils: A Non‐parametric Bounds Analysis," Economic Journal, Royal Economic Society, vol. 127(599), pages 177-198, February.
    25. Gundersen, Craig & Kreider, Brent & Pepper, John, 2012. "The impact of the National School Lunch Program on child health: A nonparametric bounds analysis," Journal of Econometrics, Elsevier, vol. 166(1), pages 79-91.
    26. Meyer, Bruce D. & Mok, Wallace K.C., 2019. "Disability, earnings, income and consumption," Journal of Public Economics, Elsevier, vol. 171(C), pages 51-69.
    27. Arie Beresteanu & Francesca Molinari, 2008. "Asymptotic Properties for a Class of Partially Identified Models," Econometrica, Econometric Society, vol. 76(4), pages 763-814, July.
    28. Brent Kreider & John V. Pepper & Craig Gundersen & Dean Jolliffe, 2012. "Identifying the Effects of SNAP (Food Stamps) on Child Health Outcomes When Participation Is Endogenous and Misreported," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 107(499), pages 958-975, September.
    29. Mariacristina De Nardi & Eric French & John Bailey Jones, 2016. "Medicaid Insurance in Old Age," American Economic Review, American Economic Association, vol. 106(11), pages 3480-3520, November.
    30. Hanming Fang & Michael P. Keane & Dan Silverman, 2008. "Sources of Advantageous Selection: Evidence from the Medigap Insurance Market," Journal of Political Economy, University of Chicago Press, vol. 116(2), pages 303-350, April.
    31. Hugo Bentez-Silva & Debra S. Dwyer, 2005. "The Rationality of Retirement Expectations and the Role of New Information," The Review of Economics and Statistics, MIT Press, vol. 87(3), pages 587-592, August.
    32. Monique De Haan, 2017. "The Effect of Additional Funds for Low‐ability Pupils: A Non‐parametric Bounds Analysis," Economic Journal, Royal Economic Society, vol. 127(599), pages 177-198, February.
    33. Charles F. Manski & John V. Pepper, 2000. "Monotone Instrumental Variables, with an Application to the Returns to Schooling," Econometrica, Econometric Society, vol. 68(4), pages 997-1012, July.
    34. Basit Zafar, 2011. "How Do College Students Form Expectations?," Journal of Labor Economics, University of Chicago Press, vol. 29(2), pages 301-348.
    35. Liran Einav & Amy Finkelstein & Paul Schrimpf, 2015. "The Response of Drug Expenditure to Nonlinear Contract Design: Evidence from Medicare Part D," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 130(2), pages 841-899.
    36. Neale Mahoney, 2015. "Bankruptcy as Implicit Health Insurance," American Economic Review, American Economic Association, vol. 105(2), pages 710-746, February.
    37. Robert Kaestner & Cuping Schiman & G. Caleb Alexander, 2019. "Effects of Prescription Drug Insurance on Hospitalization and Mortality: Evidence from Medicare Part D," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 86(3), pages 595-628, September.
    38. Michael D. Grubb, 2015. "Consumer Inattention and Bill-Shock Regulation," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 82(1), pages 219-257.
    39. Deaton, Angus, 1992. "Understanding Consumption," OUP Catalogue, Oxford University Press, number 9780198288244, Decembrie.
    40. Mariacristina De Nardi & Eric French & John Bailey Jones, 2009. "Life Expectancy and Old Age Savings," American Economic Review, American Economic Association, vol. 99(2), pages 110-115, May.
    41. Pamela Giustinelli & Matthew D. Shapiro, 2024. "SeaTE: Subjective Ex Ante Treatment Effect of Health on Retirement," American Economic Journal: Applied Economics, American Economic Association, vol. 16(2), pages 278-317, April.
    42. Greg Kaplan & Giovanni L. Violante, 2014. "A Model of the Consumption Response to Fiscal Stimulus Payments," Econometrica, Econometric Society, vol. 82(4), pages 1199-1239, July.
    43. Kristin J. Kleinjans & Arthur Van Soest, 2014. "Rounding, Focal Point Answers And Nonresponse To Subjective Probability Questions," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 29(4), pages 567-585, June.
    44. Giustinelli, Pamela & Manski, Charles F. & Molinari, Francesca, 2022. "Tail and center rounding of probabilistic expectations in the Health and Retirement Study," Journal of Econometrics, Elsevier, vol. 231(1), pages 265-281.
    45. Michael D. Hurd, 2009. "Subjective Probabilities in Household Surveys," Annual Review of Economics, Annual Reviews, vol. 1(1), pages 543-564, May.
    46. Silvia Magri, 2007. "Italian households’ debt: the participation to the debt market and the size of the loan," Empirical Economics, Springer, vol. 33(3), pages 401-426, November.
    47. Kolsrud, Jonas & Landais, Camille & Spinnewijn, Johannes, 2020. "The value of registry data for consumption analysis: An application to health shocks," Journal of Public Economics, Elsevier, vol. 189(C).
    48. Kyle J. Caswell & John H. Goddeeris, 2020. "Does Medicare Reduce Medical Debt?," American Journal of Health Economics, University of Chicago Press, vol. 6(1), pages 72-103.
    49. Jan V. Hansen & Rasmus H. Jacobsen & Morten I. Lau, 2016. "Willingness To Pay For Insurance In Denmark," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 83(1), pages 49-76, January.
    50. Manski, Charles F. & Molinari, Francesca, 2010. "Rounding Probabilistic Expectations in Surveys," Journal of Business & Economic Statistics, American Statistical Association, vol. 28(2), pages 219-231.
    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. de Bresser, Jochem, 2019. "The Role of Heterogeneous Expectations in Life Cycle Models : Evaluating the Accuracy of Counterfactuals," Other publications TiSEM 25d04a47-1020-47eb-ba94-4, Tilburg University, School of Economics and Management.
    2. Molinari, Francesca, 2020. "Microeconometrics with partial identification," Handbook of Econometrics, in: Steven N. Durlauf & Lars Peter Hansen & James J. Heckman & Rosa L. Matzkin (ed.), Handbook of Econometrics, edition 1, volume 7, chapter 0, pages 355-486, Elsevier.
    3. de Bresser, Jochem, 2021. "Evaluating the Accuracy of Counterfactuals The Role of Heterogeneous Expectations in Life Cycle Models," Other publications TiSEM a7e2b4d8-fed0-4e86-926f-d, Tilburg University, School of Economics and Management.
    4. de Bresser, Jochem, 2019. "Measuring Subjective Survival Expectations : Do Response Scales Matter?," Other publications TiSEM 53bc2ec3-4126-4dfb-81f3-8, Tilburg University, School of Economics and Management.
    5. Tsunao Okumura & Emiko Usui, 2014. "Concave‐monotone treatment response and monotone treatment selection: With an application to the returns to schooling," Quantitative Economics, Econometric Society, vol. 5, pages 175-194, March.
    6. de Bresser, Jochem, 2021. "Evaluating the Accuracy of Counterfactuals The Role of Heterogeneous Expectations in Life Cycle Models," Discussion Paper 2021-034, Tilburg University, Center for Economic Research.
    7. Francesca Molinari, 2019. "Econometrics with Partial Identification," CeMMAP working papers CWP25/19, Centre for Microdata Methods and Practice, Institute for Fiscal Studies.
    8. Kárpáti, D.;, 2022. "Household Finance and Life-Cycle Economic Decisions under the Shadow of Cancer," Health, Econometrics and Data Group (HEDG) Working Papers 22/16, HEDG, c/o Department of Economics, University of York.
    9. Mariacristina De Nardi & Eric French & John Bailey Jones, 2016. "Medicaid Insurance in Old Age," American Economic Review, American Economic Association, vol. 106(11), pages 3480-3520, November.
    10. Ho, Kate & Rosen, Adam M., 2015. "Partial Identification in Applied Research: Benefits and Challenges," CEPR Discussion Papers 10883, C.E.P.R. Discussion Papers.
    11. Mariacristina De Nardi & Eric French & John Bailey Jones, 2016. "Savings After Retirement: A Survey," Annual Review of Economics, Annual Reviews, vol. 8(1), pages 177-204, October.
    12. Aizawa, T.;, 2019. "Reviewing the Existing Evidence of the Conditional Cash Transfer in India through the Partial Identification Approach," Health, Econometrics and Data Group (HEDG) Working Papers 19/24, HEDG, c/o Department of Economics, University of York.
    13. Wooyoung Kim & Koohyun Kwon & Soonwoo Kwon & Sokbae Lee, 2018. "The identification power of smoothness assumptions in models with counterfactual outcomes," Quantitative Economics, Econometric Society, vol. 9(2), pages 617-642, July.
    14. Arthur Seibold & Sebastian Seitz & Sebastian Siegloch, 2025. "Privatizing Disability Insurance," CRC TR 224 Discussion Paper Series crctr224_2025_640, University of Bonn and University of Mannheim, Germany.
    15. Charles F. Manski, 2018. "Survey Measurement of Probabilistic Macroeconomic Expectations: Progress and Promise," NBER Macroeconomics Annual, University of Chicago Press, vol. 32(1), pages 411-471.
    16. de Bresser, Jochem, 2019. "Measuring subjective survival expectations – Do response scales matter?," Journal of Economic Behavior & Organization, Elsevier, vol. 165(C), pages 136-156.
    17. Giorgio Brunello & Dimitris Christelis & Anna Sanz‐de‐Galdeano & Anastasia Terskaya, 2024. "Does college selectivity reduce obesity? A partial identification approach," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2306-2320, October.
    18. Pamela Giustinelli & Charles F. Manski, 2018. "Survey Measures Of Family Decision Processes For Econometric Analysis Of Schooling Decisions," Economic Inquiry, Western Economic Association International, vol. 56(1), pages 81-99, January.
    19. Brent Kreider & John V. Pepper & Manan Roy, 2016. "Identifying the Effects of WIC on Food Insecurity Among Infants and Children," Southern Economic Journal, John Wiley & Sons, vol. 82(4), pages 1106-1122, April.
    20. de Bresser, Jochem, 2016. "Test-Retest Reliability of Subjective Survival Expectations," Other publications TiSEM dfd6074d-31ae-4ecb-be25-6, Tilburg University, School of Economics and Management.

    More about this item

    Keywords

    Debt; Subjective expectations; Medical expenses; Insurance; Partial identification;
    All these keywords.

    JEL classification:

    • C14 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Semiparametric and Nonparametric Methods: General
    • D14 - Microeconomics - - Household Behavior - - - Household Saving; Personal Finance
    • D84 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Expectations; Speculations
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

    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:spr:empeco:v:68:y:2025:i:3:d:10.1007_s00181-024-02671-3. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    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.