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Working Papers

2018May
Keane Mike

Michael Keane, Jonathan Ketcham, Nicolai Kuminoff and Timothy Neal

Abstract: We propose new methods to model choice behavior and conduct welfare analysis in complex environments where it is untenable to assume that choices fully reveal preferences. In particular, we investigate how Medicare beneficiaries choose prescription drug plans (PDPs) under the Medicare Part D program. Our approach is novel in that we estimate a multinomial logit model for PDP choice that allows for heterogeneity in both preferences and the behavioral choice process. We find the data can be well characterized by a mixture of three behavioral types: The “rational” type constructs expected out-of-pocket costs E(OOP) rationally, and, ceteris paribus, seeks to minimize premiums plus E(OOP) as theory suggests. The second type constructs expected out-of-pocket (OOP) costs rationally, but puts too much weight on premiums relative to E(OOP) in choosing plans. A third type, who we label “confused,” places weight on irrelevant financial aspects of drug plans, implying they fail to construct E(OOP) rationally. A consumer is more likely to be the “confused” type if they suffer from Alzheimer’s disease and/or depression. We use the model to quantify the monetary and welfare losses that arise from suboptimal decision making for the population, for the behavioral types, and for people with cognitive limitations. We also evaluate policies to simplify the choice set to reduce these losses.

 

2018Feb
Aged care analysis

Yajing Xu, Michael Sherris and Jonathan Ziveyi

The pricing of longevity-linked securities depends not only on the stochastic uncertainty of the underlying risk factors, but also the attitude of investors towards those factors. In this research, we investigate how to estimate the market risk premium of longevity risk using investable retirement indexes, incorporating uncertain real interest rates using an affine dynamic Nelson-Siegel model. 

2018Feb
Elena Capatina

Elena Capatina, Michael Keane and Shiko Maruyama

In the US healthcare system, patients of different socio-economic status (SES) often receive disparate treatment for similar conditions. Prior work documents this phenomenon for particular treatments/conditions, but we take a system-wide view and examine socioeconomic disparities in spending for all medical conditions at the 3-digit ICD-9 level. We also compare SES spending gradients for those covered by private vs. public insurance (Medicare). Using data on adult respondents from the Medical Expenditure Panel Survey 2000-14, we estimate multivariate regressions for individual medical spending (total and out of pocket) controlling for medical conditions, demographics, health, and insurance, separately by sex, education, and age. Within age-sex categories, we assess how spending on each condition varies with education (a proxy for SES). In the predominantly privately insured population aged 24-64, system spending for several of the most socially costly conditions is strongly increasing in education (e.g., breast cancer for women and chest symptoms for men). These disparities are not explained by differences in health, insurance status, or ability-to-pay, suggesting they arise due to discrimination. However, we find no positive SES gradients for individuals over 64 covered by the public Medicare program, suggesting that Medicare plays an important role in improving equity.

2018Jan
Pensioners enjoying a stroll

Shang Wu, Hazel Bateman, Ralph Stevens and Susan Thorp

We investigate whether a life care annuity - the integration of a life annuity with long-term care insurance (LTCI) - can enhance insurance participation to mitigate the economic puzzle of under- insurance in the longevity insurance and LTCI markets. Using an online choice experiment, we elicit individuals' preferences for consumption in different health conditions and their demand for a life care annuity and its health-contingent income feature. 

2018Jan
Michael Sherris

Michael Sherris, Yajing Xu and Jonathan Ziveyi.

Multi-country risk management of longevity risk provides new opportunities to hedge mortality and interest rate risks in guaranteed lifetime income streams. This requires consideration of both interest rate and mortality risks in multiple countries. For this purpose, we develop value-based longevity indexes for multiple cohorts in two different countries that take into account the major sources of risks impacting life insurance portfolios, mortality and interest rates. To construct the indexes we propose a cohort-based affine model for multi-country mortality and use an arbitrage-free multi-country Nelson-Siegel model for the dynamics of interest rates. Index based longevity hedging strategies have the advantages of efficiency, liquidity and lower cost but introduce basis risk. Graphical risk metrics are a way to effectively capture the relationship between an insurer’s portfolio and hedging strategies. We illustrate the effectiveness of using a value–based index for longevity risk management between two countries using graphical basis risk metrics. To show the impact of both interest rate and mortality risk we use Australia and UK as domestic and foreign countries, and, to show the impact of mortality only, we use the male populations of the Netherlands and France with common interest rates and basis risk arising only from differences in mortality risks.

2018Jan
Data graphs

Michael Sherris, Yajing Xu and Jonathan Ziveyi

Multi-country risk management of longevity risk provides new opportunities to hedge mortality and interest rate risks in guaranteed lifetime income streams. This requires consideration of both interest rate and mortality risks in multiple countries. For this purpose, we develop value-based longevity indexes for multiple cohorts in two different countries that take into account the major sources of risks impacting life insurance portfolios, mortality and interest rates.

2018Jan
Keane Mike

Michael P Keane and Ramna Thakur

India has a high level of out-of-pocket (OOP) health care spending, and lacks well developed health insurance markets. As a result, official measures of poverty and inequality that treat medical spending symmetrically with consumption goods can be misleading. We argue that OOP medical costs should be treated as necessary expenses for the treatment of illness, not as part of consumption. Adopting this perspective, we construct poverty and inequality measures for India that account for impoverishment induced by OOP medical costs. For 2011/12 we estimate that 4.1% of the population, or 50 million people, are in a state of “hidden poverty” due to medical expenses. Furthermore, while poverty in India fell substantially from 1999/00 to 2011/12, the fraction of the remaining poverty that is due to medical costs has risen substantially. Economic growth appears less “pro-poor” if one accounts for OOP medical costs, especially since 2004/05, and especially in rural areas.

2017Dec
Cepar - Retirement Decisions

Susan Thorp, Hazel Bateman, Isabella Dobrescu, Ben R. Newell, and Andreas Ortmann

Simplified disclosures can make comparisons between complex financial products easier, and increase consumer expertise. We use incentivized experiments to investigate whether and to what extent simpler information on fees and investment returns assists retirement plan members to make competent choices.

 

2017Dec
Woman offering aged care support

Jennifer Alonso-García, Hazel Bateman, Johan Bonekamp, and Ralph Stevens

Implied endorsement is considered, together with inertia, as an explanation for the stickiness of defaults. This paper explores whether implied endorsement can serve as an explanation for the stickiness of defaults in the retirement decumulation phase.