TAILIEUCHUNG - HEALTH INSURANCE, COST EXPECTATIONS, AND ADVERSE JOB TURNOVER

This potential disparity in availability of private insurance between regions and crops is sometimes cited as a reason for government intervention (. GAO, 1980; Appel, Lord, and Harrington, 1999), but here again, crop insurance is not unique. Many risk management tools used by farmers are available only in certain regions. For example, cash forward contracting is widely available for corn and soybean producers in the Midwest, although the same is not necessarily true for producers in regions where basis risk is high. But there is little impetus for government intervention in those markets. While the conclusions drawn from the above studies would argue that the case for government intervention in crop insurance markets is weak. | HEALTH ECONOMICS Health Econ. 20 27-44 2011 Published online 26 January 2010 in Wiley Online Library . DOI HEALTH INSURANCE COST EXPECTATIONS AND ADVERSE JOB TURNOVER RANDALL P. ELLISa and CHING-TO ALBERT MAa b Department of Economics Boston University Boston MA USA b Universidad Carlos III de Madrid Madrid Spain SUMMARY Because less healthy employees value health insurance more than the healthy ones when health insurance is newly offered job turnover rates for healthier employees decline less than turnover rates for the less healthy. We call this adverse job turnover and it implies that a firm s expected health costs will increase when health insurance is first offered. Health insurance premiums may fail to adjust sufficiently fast because state regulations restrict annual premium changes or insurers are reluctant to change premiums rapidly. Even with premiums set at the long run expected costs some firms may be charged premiums higher than their current expected costs and choose not to offer insurance. High administrative costs at small firms exacerbate this dynamic selection problem. Using 1998-1999 MEDSTAT MarketScan and 1997 Employer Health Insurance Survey data we find that expected employee health expenditures at firms that offer insurance have lower within-firm and higher between-firm variance than at firms that do not. Turnover rates are systematically higher in industries in which firms are less likely to offer insurance. Simulations of the offer decision capturing between-firm health-cost heterogeneity and expected turnover rates match the observed pattern across firm sizes well. Copyright 2010 John Wiley Sons Ltd. Received 6 August 2007 Revised 29 September 2009 Accepted 13 October 2009 JEL classification D45 H40 KEY WORDS health insurance job turnover adverse selection 1. INTRODUCTION We study private employers decisions to offer health insurance to their employees. The US tax system favors employment-based .

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