Patrick Hullegie

The Effect of Private Health Insurance on Medical Care Utilization and Self-Assessed Health in Germany

In Germany, employees are generally obliged to participate in the public health insurance system, where coverage is universal, co-payments and deductibles are moderate, and premia are based on income. However, they may buy private insurance instead if their income exceeds the compulsory insurance threshold. Here, premia are based on age and health, individuals may choose to what extent they are covered, and deductibles and co-payments are common. In this paper, we estimate the effect of private insurance coverage on the number of doctor visits, the number of nights spent in a hospital and self-assessed health. Variation in income around the compulsory insurance threshold provides a natural experiment that we exploit to control for selection into private insurance. We document that income is measured with error and suggest an approach to take this into account. We find negative effects of private insurance coverage on the number of doctor visits, no effects on the number of nights spent in a hospital, and positive effects on health.

Is there empirical evidence for decreasing returns to scale in a health capital model

We estimate a health investment equation, derived from a health capital model that is an extension of the well-known Grossman model. Of particular interest is whether the health production function has constant returns to scale, as in the standard Grossman model, or decreasing returns to scale, as in the Ehrlich-Chuma model and extensions thereof. The model with decreasing returns to scale has a number of theoretically and empirically desirable characteristics that the constant returns model does not have. Although our empirical equation does not point-identify the decreasing returns to scale curvature parameter, it does allow us to test for constant versus decreasing returns to scale. The results are suggestive of decreasing returns and in line with prior estimates from the literature. But when we attempt to control for the endogeneity of health by using instrumental variables, the results become inconclusive. This brings into question the robustness of prior estimates in this literature.

Empirical Evidence for Decreasing Returns to Scale in a Health Capital Model

We estimate a health investment equation, derived from a health capital model that is an extension of the well-known Grossman model. Of particular interest is whether the health production function has constant returns to scale, as in the standard Grossman model, or decreasing returns to scale, as in the Ehrlich-Chuma model and extensions thereof. The model with decreasing returns to scale has a number of theoretically and empirically desirable characteristics that the constant returns model does not have. Although our empirical equation does not point-identify the decreasing returns to scale curvature parameter, it does allow us to test for constant versus decreasing returns to scale. The results are suggestive of decreasing returns and in line with prior estimates from the literature. But when we attempt to control for the endogeneity of health by using instrumental variables, the results become inconclusive. This brings into question the robustness of prior estimates in this literature.

Employee Health and Employer Incentives

In the past two decades the OECD has regularly voiced concern about the labor market exclusion of people with disabilities and about the cost of disability insurance programs. This paper examines whether the fundamental disability insurance reforms that were implemented in the Netherlands have helped or hindered employment opportunities of workers with health problems or disability. An important component of the Dutch reforms was to enhance employer incentives, which was done by making them responsible for paying sickness benefits and by strengthening their sickness monitoring obligations. These employer incentives may stimulate preventive and reintegration activities by firms, thereby improving the employment opportunities of disabled workers. However, the reforms also impose substantial costs on employers when an employee gets sick and may therefore reduce employment opportunities of disabled workers. We use data from the Dutch Labor Force Survey and rich administrative data from hospital admission records, social security records, and the municipality registers containing demographic information to examine whether the disability reforms have in fact improved the economic situation for the disabled. On balance, we conclude that the DI reforms implemented by the Dutch government have mainly protected those who already have a job, and may have inadvertently reduced the hiring opportunities of people with a disability.

The Determinants of the Long-Run Equity Risk Premium

One of the anomalies in finance is the equity risk premium in relation to normal risk attitude of financial agents. We address the role of the equity market in a Ramsey-type model of long-run growth. The main claim of the paper is to show that, if even in the long run equity and debt are imperfect substitutes, we can determine the long-run determinants of the equity risk premium. The first argument to assume heterogeneity between equity and debt is that equity (and not debt) holds voting power, which might increase the role of the consumer as owner of the firm in improving long-run productivity. But holding equity might lead to disutility, since the right to vote might be nonattractive to carry. A second alleged difference between equity and debt is that debt should be more sensitive to inflation than equity. We discuss the role of voting power and burden and the impact of inflation in a growth model. We test the empirical implications of the model using data for 30 countries using data over the years 1981-2001.

How disability insurance reforms change the consequences of health shocks on income and employment

This paper examines whether Dutch disability insurance reforms have helped or hindered employment opportunities of workers that are facing unanticipated shocks to their health. An important component of the reforms was to make employers responsible for paying sickness benefits and to strengthen their sickness monitoring obligations. This may stimulate preventive and reintegration activities by firms. Using administrative data on hospitalizations, we conclude that both financial incentives and monitoring obligations have substantially lowered DI receipt and increased the employment of workers after a health shock.