James H. Cardon

Asymmetric Information in Health Insurance: Evidence from the National Medical Expenditure Survey

Adverse selection is perceived to be a major source of market failure in insurance markets. There is little empirical evidence on the extent of the problem. We estimate a structural model of health insurance and health care choices using data on single individuals from the NMES. A robust prediction of adverse-selection models is that riskier types buy more coverage and, on average, end up using more care. We test for unobservables linking health insurance status and health care consumption. We find no evidence of informational asymmetries.

An examination of flexible spending accounts.

This paper develops a framework for analyzing flexible spending account (FSA) participation and usage. We explore patterns of FSA usage using data from a benefits firm for 1996 including an examination of types of FSA expenditures and their timing. We estimate some simple econometric models of the participation decision and also the decision of how much to put into an FSA. Several pieces of evidence suggest that much of an FSA election amount is based on foreknowledge of expenditures. We also find that participants tend to spend their election amount early, thus obtaining an interest-free loan.

Flexible Spending Accounts as Insurance

We model flexible spending accounts (FSAs) as a special type of insurance policy. We prove the following results given losses drawn from a continuous distribution: (1) the optimal election amount, F*, is increasing in the consumers level of risk aversion; (2) F* is increasing in the level of the maximum loss; If utility is decreasing in absolute risk aversion (DARA), then F* is (3) decreasing in income and (4) increasing in the marginal tax rate.

Strategic quality choice and charter schools

Abstract Proponents of Charter schools argue that competition will improve the educational outcomes of both Charter and public students. A model of quality choice has been used to examine this claim. With capacity constraints, there is an equilibrium in which the Charter school offers a higher quality which the public school will not match. Competition from Charter schools may therefore have only modest effects on public school quality, if any.

Flexible Spending Accounts and Adverse Selection

I model the interaction of flexible spending accounts (FSAs) and conventional insurance in a simple discrete loss setting with asymmetric information. I show that FSA availability can break a separating equilibrium, even when one would otherwise exist, because high-risk types might prefer the lower-coverage contract supplemented with FSA funds. In this case there may exist a Pareto-inferior separating equilibrium. It is also shown that FSA availability alters the optimal pooling contract. Employers can reduce coverage levels, raising expected utility for low-risk types, and can compensate high-risk types by offering supplemental FSA coverage. Thus, it is possible that FSAs strengthen pooling contracts.

Flexible spending accounts and the use-it-or-lose-it provision

Flexible spending accounts (FSAs) are a widely used arrangement that allow employees to pay for qualified out-of-pocket health expenses with pre-tax dollars. The original structure of FSAs included a significant forfeiture risk if households had unused funds in their accounts at the end of the year. In 2005, the US Treasury made an administrative ruling that offered a grace period for spending FSA funds after the end of the calendar year, thereby substantially reducing forfeiture risk. We use a unique panel data set to evaluate the effects of this rule change. We find that the change increased FSA participation rates by about 4 percentage points (17% increase from a 23.9% baseline). We also find that FSA election amounts increased by just over 3%, though this result is more fragile.