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Anticipated benefit termination and health care consumption responses: Evidence from a quasi-experiment

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  • Liu, Jiacheng
  • Wang, Yaojing
  • Yao, Yi

Abstract

This study is among the first attempts to explore the behavioral responses of anticipated preferential treatment retraction from low-income individuals in the context of health insurance. Utilizing a unique quasi-experimental setting in China, we capture health care demand responses to anticipated benefit termination using a difference-in-differences design. We find a significant increase in individuals’ inpatient health care consumption in anticipation of losing generous insurance benefits. We further investigate the increased consumption and the results suggest that it is largely associated with providing necessary treatments. Additionally, we do not find evidence of supplier-induced demand. In terms of heterogeneity, we find that individuals with chronic disease history, more education, and higher income tend to be more responsive in increasing their health care consumption. While policy evaluations usually focus on the effects upon implementation, our findings shed light on the end-of-benefit responses, and the importance of providing education sessions and liquidity support on individuals’ dynamic decision-making, these findings are meaningful in fully evaluating the impact of insurance contractions.

Suggested Citation

  • Liu, Jiacheng & Wang, Yaojing & Yao, Yi, 2024. "Anticipated benefit termination and health care consumption responses: Evidence from a quasi-experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 227(C).
  • Handle: RePEc:eee:jeborg:v:227:y:2024:i:c:s0167268124003482
    DOI: 10.1016/j.jebo.2024.106734
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    1. Schweri, Juerg & Hartog, Joop, 2014. "Do wage expectations influence the decision to enroll in nursing college?," VfS Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100542, Verein für Socialpolitik / German Economic Association.
    2. John Coglianese & Lucas W. Davis & Lutz Kilian & James H. Stock, 2017. "Anticipation, Tax Avoidance, and the Price Elasticity of Gasoline Demand," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 32(1), pages 1-15, January.
    3. Harris-Fry, Helen & Saville, Naomi M. & Paudel, Puskar & Manandhar, Dharma S. & Cortina-Borja, Mario & Skordis, Jolene, 2022. "Relative power: Explaining the effects of food and cash transfers on allocative behaviour in rural Nepalese households," Journal of Development Economics, Elsevier, vol. 154(C).
    4. Diriwaechter, Patric & Shvartsman, Elena, 2018. "The anticipation and adaptation effects of intra- and interpersonal wage changes on job satisfaction," Journal of Economic Behavior & Organization, Elsevier, vol. 146(C), pages 116-140.
    5. Celidoni, Martina & Costa-Font, Joan & Salmasi, Luca, 2022. "Too Healthy to Fall Sick? Longevity Expectations and Protective Health Behaviours during the First Wave of COVID-19," Journal of Economic Behavior & Organization, Elsevier, vol. 202(C), pages 733-745.
    6. Zarek C. Brot-Goldberg & Amitabh Chandra & Benjamin R. Handel & Jonathan T. Kolstad, 2017. "What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 132(3), pages 1261-1318.
    7. Brune, Lasse & Karlan, Dean & Kurdi, Sikandra & Udry, Christopher, 2022. "Social protection amidst social upheaval: Examining the impact of a multi-faceted program for ultra-poor households in Yemen," Journal of Development Economics, Elsevier, vol. 155(C).
    8. Dominic Coey & Bradley J. Larsen & Brennan C. Platt, 2020. "Discounts and Deadlines in Consumer Search," American Economic Review, American Economic Association, vol. 110(12), pages 3748-3785, December.
    9. Torun, Huzeyfe, 2019. "Ex-ante labor market effects of compulsory military service," Journal of Comparative Economics, Elsevier, vol. 47(1), pages 90-110.
    10. Simonsen, Marianne & Skipper, Lars & Skipper, Niels & Christensen, Anne Illemann, 2021. "Spot price biases in non-linear health insurance contracts," Journal of Public Economics, Elsevier, vol. 203(C).
    11. Raj Chetty & John N. Friedman & Emmanuel Saez, 2013. "Using Differences in Knowledge across Neighborhoods to Uncover the Impacts of the EITC on Earnings," American Economic Review, American Economic Association, vol. 103(7), pages 2683-2721, December.
    12. Guan, Hongyu & Yang, Tianli & Zhang, Yunyun & Shi, Yaojiang, 2023. "Time's ticking! Effects of deadline on the utilization of health services: Evidence from a cluster-randomized controlled trial," Social Science & Medicine, Elsevier, vol. 338(C).
    13. Scott R. Baker & Lorenz Kueng & Leslie McGranahan & Brian T. Melzer, 2019. "Do Household Finances Constrain Unconventional Fiscal Policy?," Tax Policy and the Economy, University of Chicago Press, vol. 33(1), pages 1-32.
    14. Scott R. Baker & Stephanie Johnson & Lorenz Kueng, 2021. "Shopping for Lower Sales Tax Rates," American Economic Journal: Macroeconomics, American Economic Association, vol. 13(3), pages 209-250, July.
    15. Christina M Dalton & Gautam Gowrisankaran & Robert J Town, 2020. "Salience, Myopia, and Complex Dynamic Incentives: Evidence from Medicare Part D," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 87(2), pages 822-869.
    16. Tal Gross & Timothy J. Layton & Daniel Prinz, 2022. "The Liquidity Sensitivity of Healthcare Consumption: Evidence from Social Security Payments," American Economic Review: Insights, American Economic Association, vol. 4(2), pages 175-190, June.
    17. Jonathan D. Ketcham & Kosali Simon, 2008. "Medicare Part D's Effects on Elderly Drug Costs and Utilization," NBER Working Papers 14326, National Bureau of Economic Research, Inc.
    18. Matthew Blackwell & Stefano Iacus & Gary King & Giuseppe Porro, 2009. "cem: Coarsened exact matching in Stata," Stata Journal, StataCorp LP, vol. 9(4), pages 524-546, December.
    19. Heejung Bang & James M. Robins, 2005. "Doubly Robust Estimation in Missing Data and Causal Inference Models," Biometrics, The International Biometric Society, vol. 61(4), pages 962-973, December.
    20. Klonner, Stefan & Oldiges, Christian, 2022. "The welfare effects of India’s rural employment guarantee," Journal of Development Economics, Elsevier, vol. 157(C).
    21. Lei An & Yu Qin & Jing Wu & Wei You, 2024. "The Local Labor Market Effect of Relaxing Internal Migration Restrictions: Evidence from China," Journal of Labor Economics, University of Chicago Press, vol. 42(1), pages 161-200.
    22. Judith Chevalier & Austan Goolsbee, 2009. "Are Durable Goods Consumers Forward-Looking? Evidence from College Textbooks," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(4), pages 1853-1884.
    23. Alpert, Abby, 2016. "The anticipatory effects of Medicare Part D on drug utilization," Journal of Health Economics, Elsevier, vol. 49(C), pages 28-45.
    24. Eliana La Ferrara & Alberto Chong & Suzanne Duryea, 2012. "Soap Operas and Fertility: Evidence from Brazil," American Economic Journal: Applied Economics, American Economic Association, vol. 4(4), pages 1-31, October.
    25. Klein, Tobias J. & Salm, Martin & Upadhyay, Suraj, 2022. "The response to dynamic incentives in insurance contracts with a deductible: Evidence from a differences-in-regression-discontinuities design," Journal of Public Economics, Elsevier, vol. 210(C).
    26. Raj Chetty & Adam Looney & Kory Kroft, 2009. "Salience and Taxation: Theory and Evidence," American Economic Review, American Economic Association, vol. 99(4), pages 1145-1177, September.
    27. Saurabh Bhargava & Dayanand Manoli, 2015. "Psychological Frictions and the Incomplete Take-Up of Social Benefits: Evidence from an IRS Field Experiment," American Economic Review, American Economic Association, vol. 105(11), pages 3489-3529, November.
    28. Helmut Farbmacher & Peter Ihle & Ingrid Schubert & Joachim Winter & Amelie Wuppermann, 2017. "Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1234-1248, October.
    29. Raj Chetty & Emmanuel Saez & Laszlo Sandor, 2014. "What Policies Increase Prosocial Behavior? An Experiment with Referees at the Journal of Public Economics," Journal of Economic Perspectives, American Economic Association, vol. 28(3), pages 169-188, Summer.
    30. Thomas Allen & Eleonora Fichera & Matt Sutton, 2016. "Can Payers Use Prices to Improve Quality? Evidence from English Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 25(1), pages 56-70, January.
    31. Berg, Erlend, 2013. "Are poor people credit-constrained or myopic? Evidence from a South African panel," Journal of Development Economics, Elsevier, vol. 101(C), pages 195-205.
    32. Roth, Alvin E & Murnighan, J Keith & Schoumaker, Francoise, 1988. "The Deadline Effect in Bargaining: Some Experimental Evidence," American Economic Review, American Economic Association, vol. 78(4), pages 806-823, September.
    33. Liran Einav & Amy Finkelstein, 2018. "Moral Hazard in Health Insurance: What We Know and How We Know It," Journal of the European Economic Association, European Economic Association, vol. 16(4), pages 957-982.
    34. Meinhofer, Angélica & Witman, Allison E., 2018. "The role of health insurance on treatment for opioid use disorders: Evidence from the Affordable Care Act Medicaid expansion," Journal of Health Economics, Elsevier, vol. 60(C), pages 177-197.
    35. Abaluck, Jason & Gruber, Jonathan & Swanson, Ashley, 2018. "Prescription drug use under Medicare Part D: A linear model of nonlinear budget sets," Journal of Public Economics, Elsevier, vol. 164(C), pages 106-138.
    36. Laajaj, Rachid & Moya, Andrés & Sánchez, Fabio, 2022. "Equality of opportunity and human capital accumulation: Motivational effect of a nationwide scholarship in Colombia," Journal of Development Economics, Elsevier, vol. 154(C).
    37. Argys, Laura M. & Friedson, Andrew I. & Pitts, M. Melinda & Tello-Trillo, D. Sebastian, 2020. "Losing public health insurance: TennCare reform and personal financial distress," Journal of Public Economics, Elsevier, vol. 187(C).
    38. Maclean, Johanna Catherine & Tello-Trillo, Sebastian & Webber, Douglas, 2023. "Losing insurance and psychiatric hospitalizations," Journal of Economic Behavior & Organization, Elsevier, vol. 205(C), pages 508-527.
    39. Zhang, Li & Xie, Lunyu & Zheng, Xinye, 2023. "Across a few prohibitive miles: The impact of the Anti-Poverty Relocation Program in China," Journal of Development Economics, Elsevier, vol. 160(C).
    40. Aviva Aron-Dine & Liran Einav & Amy Finkelstein & Mark Cullen, 2015. "Moral Hazard in Health Insurance: Do Dynamic Incentives Matter?," The Review of Economics and Statistics, MIT Press, vol. 97(4), pages 725-741, October.
    41. Makofske, Matthew Philip, 2021. "Spoiled food and spoiled surprises: Inspection anticipation and regulatory compliance," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 348-365.
    42. Douglas L. Miller, 2023. "An Introductory Guide to Event Study Models," Journal of Economic Perspectives, American Economic Association, vol. 37(2), pages 203-230, Spring.
    43. Mona Balesh Abadi & Kevin Devereux & Farah Omran, 2023. "Correcting for transitory effects in RCTs: Evidence from the RAND Health Insurance Experiment," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 56(1), pages 288-305, February.
    44. Aggarwal, Shilpa, 2018. "Do rural roads create pathways out of poverty? Evidence from India," Journal of Development Economics, Elsevier, vol. 133(C), pages 375-395.
    45. Liran Einav & Amy Finkelstein & Paul Schrimpf, 2015. "The Response of Drug Expenditure to Nonlinear Contract Design: Evidence from Medicare Part D," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 130(2), pages 841-899.
    46. Johansson, Naimi & de New, Sonja C. & Kunz, Johannes S. & Petrie, Dennis & Svensson, Mikael, 2023. "Reductions in out-of-pocket prices and forward-looking moral hazard in health care demand," Journal of Health Economics, Elsevier, vol. 87(C).
    47. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    48. Malani, Anup & Reif, Julian, 2015. "Interpreting pre-trends as anticipation: Impact on estimated treatment effects from tort reform," Journal of Public Economics, Elsevier, vol. 124(C), pages 1-17.
    49. Pui Hing Chau & Moses Wong & Jean Woo, 2014. "Ischemic Heart Disease Hospitalization among Older People in a Subtropical City — Hong Kong: Does Winter Have a Greater Impact than Summer?," IJERPH, MDPI, vol. 11(4), pages 1-14, April.
    50. Lin, Haizhen & Sacks, Daniel W., 2019. "Intertemporal substitution in health care demand: Evidence from the RAND Health Insurance Experiment," Journal of Public Economics, Elsevier, vol. 175(C), pages 29-43.
    51. Daniel Sebastian Tello‐Trillo, 2021. "Effects of losing public health insurance on preventative care, health, and emergency department use: Evidence from the TennCare disenrollment," Southern Economic Journal, John Wiley & Sons, vol. 88(1), pages 322-366, July.
    52. Li, Pei & Lu, Yi & Wang, Jin, 2016. "Does flattening government improve economic performance? Evidence from China," Journal of Development Economics, Elsevier, vol. 123(C), pages 18-37.
    53. Schweri, Juerg & Hartog, Joop, 2017. "Do wage expectations predict college enrollment? Evidence from healthcare," Journal of Economic Behavior & Organization, Elsevier, vol. 141(C), pages 135-150.
    54. Bellés Obrero, Cristina & Rice, Caoimhe T. & Vall Castello, Judit, 2023. "Hit Where It Hurts: Healthcare Access and Intimate Partner Violence," IZA Discussion Papers 15994, Institute of Labor Economics (IZA).
    55. Limwattananon, Supon & Neelsen, Sven & O'Donnell, Owen & Prakongsai, Phusit & Tangcharoensathien, Viroj & van Doorslaer, Eddy & Vongmongkol, Vuthiphan, 2015. "Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand," Journal of Public Economics, Elsevier, vol. 121(C), pages 79-94.
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    More about this item

    Keywords

    Quasi-experiment; Anticipation effect; Health behavior; Health insurance;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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