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1. Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services

   https://doi.org/10.1177/2381468318760298  

   Smith, Kyle T.; Monti, Denise; Mir, Nageen; Peters, Ellen; Tipirneni, Renuka; Politi, Mary C. (January 2018, MDM Policy & Practice)

   null (Ed.)

   Background: Despite recently expanded access to health insurance, consumers still face barriers to using their coverage to obtain needed health care. Objective: To examine the characteristics of those who delay or avoid health care due to costs. Methods: Participants were recruited via Amazon MTurk and completed a survey assessing demographic characteristics, financial toxicity, health care minimizer-maximizer tendencies, health insurance knowledge, numeracy, delaying/avoiding any care, and delaying/avoiding six common health care services (three preventive and three nonpreventive services). Validated measures were used when available. Delay/avoidance behaviors were categorized into delaying/avoiding any care, preventive care, and nonpreventive care. Logistic regression models examined 1) financial toxicity, 2) minimizer-maximizer tendencies, 3) numeracy, 4) health insurance knowledge, and 5) knowledge of preventive care coverage separately on three forms of delay/avoidance behaviors, controlling for chronic conditions, insurance status, and/or income where appropriate. Results: Of 518 respondents, 470 did not fail attention-check questions and were used in analyses. Forty-five percent of respondents reported delaying/avoiding care due to cost. Multivariable analyses found that financial toxicity was related to delaying/avoiding any care (odds ratio [OR] = 0.884, P < 0.001), preventive care (OR = 0.906, P < 0.001), and nonpreventive care (OR = 0.901, P < 0.001). A tendency to minimize seeking health care (OR = 0.734, P < 0.001) and lower subjective numeracy (OR = 0.794, P = 0.023) were related to delaying/avoiding any care. General health insurance knowledge (OR = 0.989, P = 0.023) and knowledge of preventive care coverage (OR = 0.422, P < 0.001) were related to delaying/avoiding preventive care. Conclusions: Many people delay or avoid health care due to costs, even when insured. Results suggest that there may be different reasons individuals delay or avoid preventive and nonpreventive care. Findings may inform interventions to educate consumers and support discussions about health care costs to facilitate appropriate health care utilization. 

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2. A copula model for marked point process with a terminal event: An application in dynamic prediction of insurance claims

   https://doi.org/10.1214/24-AOAS1902  

   Yang, Lu; Shi, Peng; Huang, Shimeng (December 2024, The Annals of Applied Statistics)

   Accurate prediction of an insurer’s outstanding liabilities is crucial for maintaining the financial health of the insurance sector. We aim to develop a statistical model for insurers to dynamically forecast unpaid losses by leveraging the granular transaction data on individual claims. The liability cash flow from a single insurance claim is determined by an event process that describes the recurrences of payments, a payment process that generates a sequence of payment amounts, and a settlement process that terminates both the event and payment processes. More importantly, the three components are dependent on one another, which enables the dynamic prediction of an insurer’s outstanding liability. We introduce a copula-based point process framework to model the recurrent events of payment transactions from an insurance claim, where the longitudinal payment amounts and the time-to-settlement outcome are formulated as the marks and the terminal event of the counting process, respectively. The dependencies among the three components are characterized using the method of pair copula constructions. We further develop a stagewise strategy for parameter estimation and illustrate its desirable properties with numerical experiments. In the application we consider a portfolio of property insurance claims for building and contents coverage obtained from a commercial property insurance provider, where we find intriguing dependence patterns among the three components. The superior dynamic prediction performance of the proposed joint model enhances the insurer’s decision-making in claims reserving and risk financing operations. 

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3. Optimal Contract Design for End-of-Life Care Payments

   https://doi.org/10.1109/CDC56724.2024.10886745  

   Jiang, Muyan; Chen, Ying; Chen, Xin; Lavaei, Javad; Aswani, Anil (December 2024, IEEE)

   A large fraction of total healthcare expenditure occurs due to end-of-life (EOL) care, which means it is important to study the problem of more carefully incentivizing necessary versus unnecessary EOL care because this has the potential to reduce overall healthcare spending. This paper introduces a principal-agent model that integrates a mixed payment system of fee-for-service and pay-for-performance in order to analyze whether it is possible to better align healthcare provider incentives with patient outcomes and cost-efficiency in EOL care. The primary contributions are to derive optimal contracts for EOL care payments using a principal-agent framework under three separate models for the healthcare provider, where each model considers a different level of risk tolerance for the provider. We derive these optimal contracts by converting the underlying principal-agent models from a bilevel optimization problem into a single-level optimization problem that can be analytically solved. Our results are demonstrated using a simulation where an optimal contract is used to price intracranial pressure monitoring for traumatic brain injuries. 

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4. Job Displacement Insurance and (the Lack of) Consumption-Smoothing

   https://doi.org/10.1257/aer.20190388  

   Gerard, François; Naritomi, Joana (March 2021, American Economic Review)

   null (Ed.)

   We study the spending profile of workers who experience both a positive transitory income shock (lump-sum severance pay) and a negative permanent income shock (layoff). Using de-identified expenditure and employment data from Brazil, we show that workers increase spending at layoff by 35 percent despite experiencing a 14 percent long-term loss. We find high sensitivity of spending to cash-on-hand across consumption categories and for several sources of variation, including predictable income drops. A model with present-biased workers can rationalize our findings, and highlights the importance of the timing of benefit disbursement for the consumption-smoothing gains of job displacement insurance policies. (JEL D12, G51, J65, J63, O12) 

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5. Consumption Insurance against Wage Risk: Family Labor Supply and Optimal Progressive Income Taxation

   https://doi.org/10.1257/mac.20180125  

   Wu, Chunzan; Krueger, Dirk (January 2021, American Economic Journal: Macroeconomics)

   null (Ed.)

   We show that a calibrated life cycle two-earner household model with endogenous labor supply can rationalize the extent of consumption insurance against shocks to male and female wages, as estimated empirically by Blundell, Pistaferri, and Saporta-Eksten (2016) in US data. In the model, 35 percent of male and 18 percent of female permanent wage shocks pass through to consumption, compared to the empirical estimates of 32 percent and 19 percent. Most of the consumption insurance against permanent male wage shocks is provided through the presence and labor supply response of the female earner. Abstracting from this private intrahousehold income insurance mechanism strongly biases upward the welfare losses from idiosyncratic wage risk as well as the desired extent of public insurance through progressive income taxation. Relative to the standard one-earner life cycle model, the optimal degree of tax progressivity is significantly lower and the welfare gains from implementing the optimal system are cut roughly in half. (JEL D15, H21, H24, J16, J22, J31) 

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