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risk neutral A person who is risk neutral is indifferent between
a certain income and an uncertain income with the same
expected value.
risk loving An individual who is risk loving prefers a risky
income to a certain income, even if the expected value of the
uncertain income is less than that of the certain income.
People differ in their willingness to bear risk. Some are risk averse,
some risk loving and some risk neutral.
Demand for Health Insurance
What is insurance?
The incidence of illness seems to be random and so,
health care expenses are uncertain. Since health care
expenses are unpredictable, they can be financially
catastrophic for the households.
Insurance reduces the variability of incomes (or
losses) of those insured by pooling a large number of
people and operating on the principle of the law of
large numbers.
Consumers actually purchase a pooling
arrangement when they buy a policy from an
insurance company. Pooling arrangements
help mitigate some of the risk associated with
potential losses.
Suppose, two individuals, Joe and Lee face
the same distribution of losses. Both of them
face a 20% prob. of losing $20 and an 80%
prob. of losing nothing. So, the expected
value of this distribution of losses:
0.2*$20+0.8*$0=$4.
Joe can expect to lose $4. We are more concerned
about the variability of the expected loss.
Variance=0.2($20-$4), S.D.=$8
Both the expected loss of $4 and its s.d. can be
thought of as measures of risk.
Lets now show how Joe and Lee might mutually
gain from entering into an pooling arrangement.
Entering into a pooling arrangement essentially
replaces each persons individual loss distribution
with the average loss distribution of the group.
16
Why People demand for health insurance?
The conventional theory or standard gamble
model, assumes that people purchase health
insurance to avoid or transfer risk. In this case,
insurance serves as a pooling arrangement to
replace the high risk or variability of individual
losses with the reduced risk or variability
associated with aggregated losses.
Logic
The consumer pays insurer a premium to
cover medical expenses in coming year
For any one consumer, the premium will be higher
or lower than medical expenses
But the insurer can pool or spread risk among
many insurees so that
The sum of premiums will exceed the sum of
medical expenses
Characterizing Risk Aversion
Recall the consumer maximizes utility, with
prices and income given
Utility = U (health, other goods)
health = h (medical care)
Insurance doesnt guarantee health, but
provides $ to purchase health care
We assumed diminishing marginal utility of
health and other goods
In addition, lets assume diminishing
marginal utility of income
Utility
Income
Assume that we can assign a numerical
utility value to each income level
Also, assume that a healthy individual
earns $40,000 per year, but only $20,000
when ill
$20,000
$40,000
70
90
Income Utility
Sick
Healthy
Utility
Income $20,000 $40,000
90
70
Utility when
healthy
Utility when sick
A
B
Individual doesnt know whether she will
be sick or healthy
But she has a subjective probability of
each event
She has an expected value of her utility in the
coming year
Define: P
0
= prob. of being healthy
P
1
= prob. of being sick
P
0
+ P
1
= 1
An individuals subjective probability of
illness (P
1
) will depend on her health stock,
age, lifestyle, etc.
Then without insurance, the individuals
expected utility for next year is:
E(U) = P
0
U($40,000) + P
1
U($20,000)
= P
0
90 + P
1
70
For any given values of P
0
and P
1
, E(U) will
be a point on the chord between A and B
Utility
Income $20,000 $40,000
70
90
A
B
Assume the consumer sets P
1
=.20
Then if she does not purchase insurance:
E(U) = .8090 + .2070 = 86
E(Y) = .8040,000 + .2020,000 = $36,000
Without insurance, the consumer has an
expected loss of $4,000
Utility
Income $20,000 $40,000
90
70
A
B
$36,000
C
86
The consumers expected utility for next
year without insurance = 86 utils
Suppose that 86 utils also represents
utility from a certain income of $35,000
Then the consumer could pay an insurer
$5,000 to insure against the probability of
getting sick next year
Paying $5,000 to insurer leaves consumer with
86 utils, which equals E(U) without insurance
Utility
Income $20,000 $40,000
90
70
A
B
$36,000
C
86
$35,000
D
At most, the consumer is willing to pay
$5,000 in insurance premiums to cover
$4,000 in expected medical benefits
$1,000 loading fee price of insurance
Covers
profits
administrative expenses
taxes
Determinants of Health Insurance
Demand
1 Price of insurance
In the previous example, the consumer will
forego health insurance if the premium is
greater than $5,000
2 Degree of Risk Aversion
Greater risk aversion increases the demand for
health insurance
Utility
Income $40,000 $20,000
A
B
If there is no risk aversion, utility = expected utility, and
there is no demand for insurance
3 Income
Larger income losses due to illness will
increase the demand for health insurance
4 Probability of ILLNESS
Consumers demand less insurance for events
most likely to occur (e.g. dental visits)
Consumers demand less insurance for events
least likely to occur
Consumers more likely to insure against
random events
Estimates of Price & Income Elasticities
for Demand for Health Ins.
Price elasticities b/w -.03 and -.54
At the individual level
Enrollment or premium expenditure
Elastic or Inelastic demand?
Income elasticities b/w 0.01 and 0.13
Estimates of Price & Income Elasticities
for Demand for Health Ins.
What about when employees are choosing
between the menu of plans offered by their
employer?
Range of choices is more limited
Price elasticites are found to range between -2
and -8.4, depending on age, job tenure, medical
risk category
Dowd and Feldman 1994, Strombom et al. 2002
Assumptions underlying the theoretical model
of health insurance demand
Consumers bear the full cost of their own
health insurance
Insurance companies can appropriately
price policies
Individuals can afford health
insurance/health care
The above 3 assumptions do not always hold
in the real world
The majority of Americans have employer-
provided health insurance
Employer-paid health insurance is exempt
from federal, state, and Social Security taxes
Employee will prefer to purchase insurance
through work, rather than on his own
Example: Insurance and take-home pay
when income is $1,000 per week and
income tax rate is 28%
Employee Purchased
$1,000
28% tax <280>
after tax 720
insurance <50>
net pay 670
Employer Purchased
$1,000
insurance <50>
subtotal 950
28% tax <266>
net pay 684
Employer Health Insurance Coverage of
U.S. Population (percent)
58
59
60
61
62
63
64
65
Total Employment Based
1995
1998
2000
2002
2005
Consequences for costs
Too many services were covered by
insurance
Coverage of more small claims increased
administrative costs
Employers offering more than 1 plan often fully
subsidized the more expensive plans
Insurance Terminology
Coinsurance: A cost-sharing requirement
under a health insurance policy that provides
that the insured will assume a portion or a
percentage of the costs of covered services.
Co-payment: A cost sharing arrangement in
which the insured pays a flat amount for a
specified for a specified service. It does not
vary with the cost of service, unlike the
coinsurance that is based on some percentage
of cost.
Deductibles: Amounts required to be paid
by the insured under a health insurance
contract, before benefits become payable.
In a sense, the insurance does not apply
until the consumer pays the deductible.