_________________________________________________________________
E M P L O Y E E B E N E F I T S , C O M P E N S A T I O N
& P E N S I O N L A W
Vol. 4, No. 16: August 28, 2003
_________________________________________________________________
Publisher: LSN Employment, Labor, Compensation & Pension Journals
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and Social Science Research Network (SSRN)
Editor: PAMELA PERUN
Urban Institute
Mailto:pamela@planetnow.com
Copyright: SSEP, Inc. 2003. All rights reserved.
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Topic of This Issue:
Health Issues
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T A B L E of C O N T E N T S
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NEW and FORTHCOMING ARTICLES
"A Comparison of the USA Health Care Effort with other OECD
Countries"
Hacienda Publica Espanola, Vol. 161, No. 2, 2002, Instituto
de Estudios Fiscales, Copyright
EDUARD GRACIA
Deloitte - Strategy & Operations
JOAN GIL TRASFí
University of Barcelona
Department of Economic Theory
"National Health Spending up 8.7 Percent Between 2000-2001;
Spending for Health Care Will Continue to Grow"
EBRI Notes, Vol. 24, No. 6, June 2003
PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
"EBRI Research Highlights: Health Benefits"
EBRI Issue Brief, No. 257, May 2003
KENNETH J. MCDONNELL
Employee Benefit Research Institute (EBRI)
WORKING PAPERS
"What Do People Buy When They Don't Buy Health Insurance and What
Does that Say about Why They are Uninsured?"
HELEN LEVY
University of Chicago
Irving B. Harris Graduate School of Public Policy
Studies
National Bureau of Economic Research (NBER)
THOMAS C. DELEIRE
University of Chicago
Irving B. Harris Graduate School of Public Policy
Studies
Harvard University
John F. Kennedy School of Government
"Quality and Employers' Choice of Health Plan"
MICHAEL CHERNEW
University of Michigan at Ann Arbor
Department of Economics
National Bureau of Economic Research (NBER)
GAUTAM GOWRISANKARAN
Washington University, St. Louis
John M. Olin School of Business
National Bureau of Economic Research (NBER)
University of Minnesota - Twin Cities
Department of Economics
Harvard University
Federal Reserve Bank of San Francisco
CATHERINE G. MCLAUGHLIN
University of Michigan at Ann Arbor
Department of Health Management and Policy
TERESA GIBSON
University of Michigan at Ann Arbor
Department of Health Management and Policy
"Tax Credits and the Use of Medical Care"
MICHAEL SMART
University of Toronto
Department of Economics
CESifo (Center for Economic Studies and Ifo
Institute for Economic Research)
MARK STABILE
University of Toronto
Department of Economics
National Bureau of Economic Research (NBER)
"Who Gets Health Care?"
ROBERT W. FOGEL
University of Chicago
Graduate School of Business
National Bureau of Economic Research (NBER)
CHULHEE LEE
Seoul National University
School of Economics
"The Benefits Implications of Recent Trends in Flexible Staffing
Arrangements"
SUSAN N. HOUSEMAN
W.E. Upjohn Institute for Employment Research
S S R N I N F O R M A T I O N
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N E W and F O R T H C O M I N G Articles
_________________________________________________________________
"A Comparison of the USA Health Care Effort with other OECD
Countries"
Hacienda Publica Espanola, Vol. 161, No. 2, 2002, Instituto
de Estudios Fiscales, Copyright
BY: EDUARD GRACIA
Deloitte - Strategy & Operations
JOAN GIL TRASFí
University of Barcelona
Department of Economic Theory
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=410201
Other Electronic Document Delivery:
http://www.minhac.es/ief/Publicaciones/Revistas/Hacien
da%20Publica/161_comparison.pdf
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Contact: EDUARD GRACIA
Email: Mailto:egracia@dc.com
Postal: Deloitte - Strategy & Operations
Athene Place
66 Shoe Lane
London EC4A 3BQ, UNITED KINGDOM
Phone: (+44) 7879 430 370
Co-Auth: JOAN GIL TRASFí
Email: Mailto:jgil@eco.ub.es
Postal: University of Barcelona
Department of Economic Theory
Barcelona, SPAIN
ABSTRACT:
We use a sample of OECD countries in order to better understand
why the US health care expenditure as a percentage of its Gross
Domestic Product ("health care effort") is so far above any
other. To this end we employ a descriptive cross-country
methodology based partially on econometric estimations,
synthetic indicators and the Lerner's formula of market power,
that allows us to dismiss as explanatory variables all those
factors that were not differential across the sample. We advance
the exploratory hypothesis that the availability of a universal
public health coverage would increase the price elasticity of
demand and thus would reduce the control of prices by the
suppliers.
Keywords: US health care spending, cross-country health care
comparisons, price discipline
JEL Classification: H51, I18
______________________________
"National Health Spending up 8.7 Percent Between 2000-2001;
Spending for Health Care Will Continue to Grow"
EBRI Notes, Vol. 24, No. 6, June 2003
BY: PAUL FRONSTIN
Employee Benefit Research Institute (EBRI)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=425942
Other Electronic Document Delivery:
http://www.ebri.org
SSRN only offers technical support for papers
downloaded from the SSRN Electronic Paper Collection
location. When URLs wrap, you must copy and paste
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Contact: PAUL FRONSTIN
Email: Mailto:fronstin@ebri.org
Postal: Employee Benefit Research Institute (EBRI)
Suite 600
2121 K Street, NW
Washington, DC 20037-1896 UNITED STATES
Phone: 202-775-6352
Fax: 202-775-6312
Paper Requests:
Contact Alicia Willis at Mailto:publications@ebri.org, or 2121 K
St., NW, Suite 600, Washington, DC 20037-1896.
Phone:(202)572-7422, Fax:(202)775-6312. Full-Text downloads are
available from SSRN Online for $7.50.
ABSTRACT:
This paper discusses national health expenditures for the period
of 1970-2001.
Keywords: Health Care Costs
The PDF for the above title, published in the June 2003 issue
of EBRI Notes, also contains the fulltext of another June 2003
EBRI Notes article abstracted on SSRN: "Income of the Elderly
Population: 2001."
JEL Classification: H51, J32
______________________________
"EBRI Research Highlights: Health Benefits"
EBRI Issue Brief, No. 257, May 2003
BY: KENNETH J. MCDONNELL
Employee Benefit Research Institute (EBRI)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=413900
Other Electronic Document Delivery:
http://www.ebri.org
SSRN only offers technical support for papers
downloaded from the SSRN Electronic Paper Collection
location. When URLs wrap, you must copy and paste
them into your browser eliminating all spaces.
Contact: KENNETH J. MCDONNELL
Email: Mailto:MCDONNELL@EBRI.ORG
Postal: Employee Benefit Research Institute (EBRI)
Suite 600
2121 K Street, NW
Washington, DC 20037-1896 UNITED STATES
Phone: (202) 775-6342
Fax: (202) 775-6312
Paper Requests:
Contact Alicia Willis at Mailto:publications@ebri.org, or 2121 K
St., NW, Suite 600, Washington, DC 20037-1896.
Phone:(202)572-7422, Fax:(202)775-6312. Full-Text downloads are
available from SSRN Online for $7.50.
ABSTRACT:
This Employee Benefit Research Institute (EBRI) report
synthesizes highlights of recent EBRI research on health issues.
Health data in this document include: national health
expenditures, employment-based health benefits, the uninsured,
managed care, consumer-driven health benefits, Medicare and
retiree health benefits, public opinion, and small employers and
health benefits.
Keywords: Employment-based Benefits, Health Care Attitudes and
Opinions, Health Care Costs, Health Insurance Coverage,
Medicare, Retiree Health Benefits, Uninsured
JEL Classification: I1, J3
______________________________
W O R K I N G P A P E R Abstracts
_________________________________________________________________
"What Do People Buy When They Don't Buy Health Insurance and What
Does that Say about Why They are Uninsured?"
BY: HELEN LEVY
University of Chicago
Irving B. Harris Graduate School of Public Policy
Studies
National Bureau of Economic Research (NBER)
THOMAS C. DELEIRE
University of Chicago
Irving B. Harris Graduate School of Public Policy
Studies
Harvard University
John F. Kennedy School of Government
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=421787
Paper ID: NBER Working Paper No. W9826
Date: July 2003
Contact: HELEN LEVY
Email: Mailto:HLEVY@UCHICAGO.EDU
Postal: University of Chicago
Irving B. Harris Graduate School of Public
Policy Studies
1155 East 60th Street
Chicago, IL 60637 UNITED STATES
Co-Auth: THOMAS C. DELEIRE
Email: Mailto:T-DELEIRE@UCHICAGO.EDU
Postal: University of Chicago
Irving B. Harris Graduate School of Public
Policy Studies
1155 East 60th Street
Chicago, IL 60637 UNITED STATES
Paper Requests:
Full-Text downloads are available from SSRN Online for $5.
ABSTRACT:
Using data from the 1994 through 1998 Consumer Expenditure
Surveys, we compare household spending on 16 different goods
(food at home, food away from home, housing, transportation,
alcohol and tobacco, interest, furniture and appliances, home
maintenance, clothing, utilities, medical care, health
insurance, entertainment, personal care, education, and other)
for insured versus uninsured households, controlling for total
expenditures and demographic characteristics. The analysis shows
that the uninsured in the lowest quartile of the distribution of
total expenditures spend more on housing, food at home, alcohol
and tobacco, and education than do the insured. In contrast,
households in the top quartile of the distribution of total
expenditures spend more on transportation and furniture and
appliances than do comparable insured households. These results
are consistent with the idea that poor uninsured households face
higher housing prices than do poor insured households. Further
research is necessary to determine whether high housing prices
can help explain why some households do not have insurance.
JEL Classification: Z1
______________________________
"Quality and Employers' Choice of Health Plan"
BY: MICHAEL CHERNEW
University of Michigan at Ann Arbor
Department of Economics
National Bureau of Economic Research (NBER)
GAUTAM GOWRISANKARAN
Washington University, St. Louis
John M. Olin School of Business
National Bureau of Economic Research (NBER)
University of Minnesota - Twin Cities
Department of Economics
Harvard University
Federal Reserve Bank of San Francisco
CATHERINE G. MCLAUGHLIN
University of Michigan at Ann Arbor
Department of Health Management and Policy
TERESA GIBSON
University of Michigan at Ann Arbor
Department of Health Management and Policy
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=425583
Paper ID: NBER Working Paper No. W9847
Date: July 2003
Contact: MICHAEL CHERNEW
Email: Mailto:MCHERNEW@UMICH.EDU
Postal: University of Michigan at Ann Arbor
Department of Economics
611 Tappan Street
Ann Arbor, MI 48109-1220 UNITED STATES
Phone: 734-936-1193
Co-Auth: GAUTAM GOWRISANKARAN
Email: Mailto:gautam_gowrisankaran@nber.org
Postal: Washington University, St. Louis
John M. Olin School of Business
One Brookings Drive
Campus Box 1133
St. Louis, MO 63130-4899 UNITED STATES
Co-Auth: CATHERINE G. MCLAUGHLIN
Email: Mailto:cmcl@umich.edu
Postal: University of Michigan at Ann Arbor
Department of Health Management and Policy
109 Observatory
Ann Arbor, MI 48109-2029 UNITED STATES
Co-Auth: TERESA GIBSON
Email: Mailto:tgibson@umich.edu
Postal: University of Michigan at Ann Arbor
Department of Health Management and Policy
109 Observatory
Ann Arbor, MI 48109-2029 UNITED STATES
Paper Requests:
Full-Text downloads are available from SSRN Online for $5.
ABSTRACT:
We seek to understand the relationship between employer
decisions regarding which health plans firms choose to offer to
their employees and the performance of those plans. We measure
performance using data from the Health Plan Employer Data
Information Set (HEDIS) and the Consumer Assessment of Health
Plan Survey (CAHPS). We use a unique data set that lists the
Health Maintenance Organizations (HMOs) available to, and
offered by, large employers across markets in the year 2000, and
examine the relationship between plan offerings, performance
measures and other plan characteristics. We estimate two sets of
specifications that differ in whether they model plan choice as
a function of absolute plan performance or plan performance
relative to competitors. We find that employers are more likely
to offer plans with strong absolute and relative HEDIS and CAHPS
performance measures. Our results are consistent with the view
that large employers are responsive to the interests of their
employees.
JEL Classification: I11
______________________________
"Tax Credits and the Use of Medical Care"
BY: MICHAEL SMART
University of Toronto
Department of Economics
CESifo (Center for Economic Studies and Ifo
Institute for Economic Research)
MARK STABILE
University of Toronto
Department of Economics
National Bureau of Economic Research (NBER)
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=425591
Paper ID: NBER Working Paper No. W9855
Date: July 2003
Contact: MARK STABILE
Email: Mailto:mark.stabile@utoronto.ca
Postal: University of Toronto
Department of Economics
150 St. George Street
Toronto, Ontario M5S 3G7 CANADA
Phone: 416-978-4329
Fax: 416-978-6713
Co-Auth: MICHAEL SMART
Email: Mailto:MSMART@CHASS.UTORONTO.CA
Postal: University of Toronto
Department of Economics
Institute for Policy Analysis
150 St. George Street
Toronto, Ontario M5S 3G7 CANADA
Paper Requests:
Full-Text downloads are available from SSRN Online for $5.
ABSTRACT:
Several recent proposals have advocated using the income tax
system to collect user fees to help fund the health care system.
While there is a considerable amount of research investigating
both how individuals respond to tax incentives for employer
provided health insurance and on the effects of user fees
payable at the point of service on the use of health care
services, there is limited evidence on how individuals respond
to tax incentives when these are not realized until taxes are
paid. This paper uses existing exemptions in the Canadian tax
code that allow individuals to deduct the cost of health care or
health insurance from their taxable income in order to identify
the tax price elasticity of demand for health care when price
changes are realized at the end of the tax year. Our results
suggest that despite not realizing the tax benefit at the time
of purchase, individuals are quite responsive to changes in the
tax price of health care. Our elasticity estimates for a wide
range of health care products are well within the range of
traditional price elasticity estimates, including in particular
our estimates for prescription drugs. We also find some evidence
that suggests individuals trade off risk sharing through
traditional insurance companies with risk sharing through the
tax code. That is, as the tax price of health care decreases,
individuals spend more on health care, but spend less on health
insurance.
JEL Classification: I1, H2
______________________________
"Who Gets Health Care?"
BY: ROBERT W. FOGEL
University of Chicago
Graduate School of Business
National Bureau of Economic Research (NBER)
CHULHEE LEE
Seoul National University
School of Economics
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=428364
Paper ID: NBER Working Paper No. W9870
Date: July 2003
Contact: ROBERT W. FOGEL
Email: Mailto:rwf@cpe.uchicago.edu
Postal: University of Chicago
Graduate School of Business
Center for Population Economics
1101 East 58th Street
Chicago, IL 60637 UNITED STATES
Phone: 773-702-7709
Fax: 773-702-2901
Co-Auth: CHULHEE LEE
Email: Mailto:clee@prome.snu.ac.kr
Postal: Seoul National University
School of Economics
San 56-1, Silim-dong, Kwanak-ku
Seoul 151-742, KOREA
Paper Requests:
Full-Text downloads are available from SSRN Online for $5.
ABSTRACT:
Around the world, as in the United States, concern is growing
about who gets health care. Individuals from different
socioeconomic backgrounds face distressingly different prospects
of living a healthy life. Disparities in various measures of
health between the privileged and the deprived still remain
wide, despite the long-term tendency toward a healthier society.
Some investigators believe the shift in the health care system
in industrial countries from the principle of universal access
to a more market-oriented system may be one cause of the growing
disparities; rising income inequality is another potential
culprit. Policy makers worldwide speak of more efficiently
delivering 'essential' health care - but disagree on what counts
as essential and on the optimal mix of private and government
components of service. After reviewing the economic and
epidemiological literature on disparities in health and health
care systems, the question of how to define 'essential' health
care is considered. The paper concludes with a discussion of the
policy implications of the analysis.
JEL Classification: I1, I11
______________________________
"The Benefits Implications of Recent Trends in Flexible Staffing
Arrangements"
BY: SUSAN N. HOUSEMAN
W.E. Upjohn Institute for Employment Research
Document: Available from the SSRN Electronic Paper Collection:
http://papers.ssrn.com/paper.taf?abstract_id=369320
Paper ID: Upjohn Institute Staff Working Paper No. 02-88
Date: August 2001
Contact: SUSAN N. HOUSEMAN
Email: Mailto:houseman@we.upjohninst.org
Postal: W.E. Upjohn Institute for Employment Research
300 South Westnedge Avenue
Kalamazoo, MI 49007-4686 UNITED STATES
Phone: 616-343-5541
Fax: 616-343-3308
Paper Requests:
Contact Customer Service, W.E. Upjohn Institute for Employment
Research, Publications, 300 S. Westnedge Ave., Kalamazoo, MI
49007 USA. Mailto:publications@upjohninstitute.org Phone:
616-343-4330, Fax: 616-343-7310. Fee: $3.00, includes shipping
and handling.
ABSTRACT:
Workers in flexible staffing arrangements - including temporary
agency, direct-hire temporary, on-call, and contract workers -
are much less likely than regular, direct-hire employees to be
covered by laws mandating or regulating workplace benefits.
Workers in such arrangements, in turn, are much less likely to
receive pension, health insurance, and other benefits on the
job. This paper documents these differences in coverage by
benefits regulations and differences in benefits receipt. The
paper also reviews evidence on the incentives employers have to
use workers in these various flexible staffing arrangements.
Although reducing benefits costs is not the only reason
employers use flexible staffing arrangements, it is an important
factor motivating many employers to use them, and the level of
and growth in these arrangements would be lower in the absence
of this incentive.
Keywords: contingent work, part-time, benefits, healthcare,
pension, contract, Houseman, Upjohn, temporary