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The Liquidity Sensitivity of Healthcare Consumption: Evidence from Social Security Payments

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  • Tal Gross
  • Timothy Layton
  • Daniel Prinz

Abstract

Some consumers lack the cash needed to pay for medical care. As a result, they either delay care until they can pay for it or they forgo the care altogether. To test for such a possibility, we study the distribution of monthly Social Security checks among Medicare Part D enrollees. When Social Security checks are distributed, prescription fills increase by 6-12 percent. In that sense, drug consumption of low-income Medicare recipients is "liquidity sensitive." We then study recipients who transition onto a program that eliminates copayments. When those recipients do not face copayments, their drug consumption becomes less liquidity sensitive. That finding implies that, beyond risk protection, generous insurance also provides recipients with the ability to consume healthcare when they need it rather than when they have cash. Further, we find that recipients whose drug consumption is most liquidity sensitive exhibit price elasticities of demand that are twice the size of the average elasticity, suggesting that more-generous insurance causes recipients both to re-time prescription filling and also to start filling prescriptions that they otherwise would not fill. We present a stylized model that uses this finding to call into question the conventional interpretation of demand-response to price as solely inefficient moral hazard.

Suggested Citation

  • Tal Gross & Timothy Layton & Daniel Prinz, 2020. "The Liquidity Sensitivity of Healthcare Consumption: Evidence from Social Security Payments," NBER Working Papers 27977, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:27977
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    1. Nicholas S. Souleles & Jonathan A. Parker & David S. Johnson, 2006. "Household Expenditure and the Income Tax Rebates of 2001," American Economic Review, American Economic Association, vol. 96(5), pages 1589-1610, December.
    2. Vellekoop, Nathanael, 2018. "Explaining intra-monthly consumption patterns: The timing of income or the timing of consumption commitments?," SAFE Working Paper Series 237, Leibniz Institute for Financial Research SAFE.
    3. Keith Marzilli Ericson & Justin R. Sydnor, 2018. "Liquidity Constraints and the Value of Insurance," NBER Working Papers 24993, National Bureau of Economic Research, Inc.
    4. Jason Abaluck & Jonathan Gruber, 2011. "Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program," American Economic Review, American Economic Association, vol. 101(4), pages 1180-1210, June.
    5. 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.
    6. Aviva Aron-Dine & Liran Einav & Amy Finkelstein, 2013. "The RAND Health Insurance Experiment, Three Decades Later," Journal of Economic Perspectives, American Economic Association, vol. 27(1), pages 197-222, Winter.
    7. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    8. Beatty, Timothy K.M., 2016. "Food Price Variation over the SNAP Benefit Cycle," 2016 Annual Meeting, July 31-August 2, Boston, Massachusetts 236012, Agricultural and Applied Economics Association.
    9. Gelman, Michael & Kariv, Shachar & Shapiro, Matthew D. & Silverman, Dan & Tadelis, Steven, 2020. "How individuals respond to a liquidity shock: Evidence from the 2013 government shutdown," Journal of Public Economics, Elsevier, vol. 189(C).
    10. Bhashkar Mazumder & Sarah Miller, 2016. "The Effects of the Massachusetts Health Reform on Household Financial Distress," American Economic Journal: Economic Policy, American Economic Association, vol. 8(3), pages 284-313, August.
    11. Baugh, Brian & Ben-David, Itzhak & Park, Hoonsuk, 2013. "Disentangling Financial Constraints, Precautionary Savings, and Myopia: Household Behavior Surrounding Federal Tax Returns," Working Paper Series 2013-20, Ohio State University, Charles A. Dice Center for Research in Financial Economics.
    12. David B. Gross & Nicholas S. Souleles, 2002. "Do Liquidity Constraints and Interest Rates Matter for Consumer Behavior? Evidence from Credit Card Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 117(1), pages 149-185.
    13. Hansen, Gary D & Imrohoroglu, Ayse, 1992. "The Role of Unemployment Insurance in an Economy with Liquidity Constraints and Moral Hazard," Journal of Political Economy, University of Chicago Press, vol. 100(1), pages 118-142, February.
    14. David Card & Raj Chetty & Andrea Weber, 2007. "Cash-on-Hand and Competing Models of Intertemporal Behavior: New Evidence from the Labor Market," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(4), pages 1511-1560.
    15. Leandro S. Carvalho & Stephan Meier & Stephanie W. Wang, 2016. "Poverty and Economic Decision-Making: Evidence from Changes in Financial Resources at Payday," American Economic Review, American Economic Association, vol. 106(2), pages 260-284, February.
    16. Arna Olafsson & Michaela Pagel, 2018. "The Liquid Hand-to-Mouth: Evidence from Personal Finance Management Software," The Review of Financial Studies, Society for Financial Studies, vol. 31(11), pages 4398-4446.
    17. Alberto Abadie & Susan Athey & Guido W Imbens & Jeffrey M Wooldridge, 2023. "When Should You Adjust Standard Errors for Clustering?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 138(1), pages 1-35.
    18. Hitoshi Shigeoka, 2014. "The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection," American Economic Review, American Economic Association, vol. 104(7), pages 2152-2184, July.
    19. de Meza, David, 1983. "Health insurance and the demand for medical care," Journal of Health Economics, Elsevier, vol. 2(1), pages 47-54, March.
    20. Melvin Stephens Jr., 2003. ""3rd of tha Month": Do Social Security Recipients Smooth Consumption Between Checks?," American Economic Review, American Economic Association, vol. 93(1), pages 406-422, March.
    21. Jonathan D. Ketcham & Claudio Lucarelli & Eugenio J. Miravete & M. Christopher Roebuck, 2012. "Sinking, Swimming, or Learning to Swim in Medicare Part D," American Economic Review, American Economic Association, vol. 102(6), pages 2639-2673, October.
    22. Mário Centeno & Álvaro Novo, 2009. "Reemployment wages and UI liquidity effect: a regression discontinuity approach," Portuguese Economic Journal, Springer;Instituto Superior de Economia e Gestao, vol. 8(1), pages 45-52, April.
    23. Neale Mahoney, 2015. "Bankruptcy as Implicit Health Insurance," American Economic Review, American Economic Association, vol. 105(2), pages 710-746, February.
    24. Sara LaLumia, 2013. "The EITC, Tax Refunds, and Unemployment Spells," American Economic Journal: Economic Policy, American Economic Association, vol. 5(2), pages 188-221, May.
    25. Richard H. Thaler, 2008. "Mental Accounting and Consumer Choice," Marketing Science, INFORMS, vol. 27(1), pages 15-25, 01-02.
    26. Jonathan A. Parker, 1999. "The Reaction of Household Consumption to Predictable Changes in Social Security Taxes," American Economic Review, American Economic Association, vol. 89(4), pages 959-973, September.
    27. C. Fritz Foley, 2011. "Welfare Payments and Crime," The Review of Economics and Statistics, MIT Press, vol. 93(1), pages 97-112, February.
    28. Raj Chetty, 2008. "Moral Hazard versus Liquidity and Optimal Unemployment Insurance," Journal of Political Economy, University of Chicago Press, vol. 116(2), pages 173-234, April.
    29. Paul Goldsmith-Pinkham & Maxim L. Pinkovskiy & Jacob Wallace, 2020. "The Great Equalizer: Medicare and the Geography of Consumer Financial Strain," Staff Reports 911, Federal Reserve Bank of New York.
    30. Jonathan A. Parker & Nicholas S. Souleles & David S. Johnson & Robert McClelland, 2013. "Consumer Spending and the Economic Stimulus Payments of 2008," American Economic Review, American Economic Association, vol. 103(6), pages 2530-2553, October.
    31. Sonia Jaffe & Anup Malani, 2017. "The Welfare Implications of Health Insurance," Working Papers 2017-045, Human Capital and Economic Opportunity Working Group.
    32. Hu, Luojia & Kaestner, Robert & Mazumder, Bhashkar & Miller, Sarah & Wong, Ashley, 2018. "The effect of the affordable care act Medicaid expansions on financial wellbeing," Journal of Public Economics, Elsevier, vol. 163(C), pages 99-112.
    33. Greg Kaplan & Giovanni L. Violante, 2014. "A Model of the Consumption Response to Fiscal Stimulus Payments," Econometrica, Econometric Society, vol. 82(4), pages 1199-1239, July.
    34. Maria Polyakova, 2016. "Regulation of Insurance with Adverse Selection and Switching Costs: Evidence from Medicare Part D," American Economic Journal: Applied Economics, American Economic Association, vol. 8(3), pages 165-195, July.
    35. Zeckhauser, Richard, 1970. "Medical insurance: A case study of the tradeoff between risk spreading and appropriate incentives," Journal of Economic Theory, Elsevier, vol. 2(1), pages 10-26, March.
    36. Marianne Bertrand & Adair Morse, 2009. "What Do High-Interest Borrowers Do with Their Tax Rebate?," American Economic Review, American Economic Association, vol. 99(2), pages 418-423, May.
    37. Tal Gross & Matthew J. Notowidigdo & Jialan Wang, 2020. "The Marginal Propensity to Consume over the Business Cycle," American Economic Journal: Macroeconomics, American Economic Association, vol. 12(2), pages 351-384, April.
    38. Scott Ross Baker & Contantine Yannelis, 2017. "Income Changes and Consumption: Evidence from the 2013 Federal Government Shutdown," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 23, pages 99-124, January.
    39. Raj Chetty, 2008. "Moral Hazard versus Liquidity and Optimal Unemployment Insurance," Journal of Political Economy, University of Chicago Press, vol. 116(2), pages 173-234, April.
    40. Liran Einav & Amy Finkelstein & Maria Polyakova, 2018. "Private Provision of Social Insurance: Drug-Specific Price Elasticities and Cost Sharing in Medicare Part D," American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 122-153, August.
    41. Gruber, Jonathan, 1997. "The Consumption Smoothing Benefits of Unemployment Insurance," American Economic Review, American Economic Association, vol. 87(1), pages 192-205, March.
    42. Shapiro, Jesse M., 2005. "Is there a daily discount rate? Evidence from the food stamp nutrition cycle," Journal of Public Economics, Elsevier, vol. 89(2-3), pages 303-325, February.
    43. Katherine Baicker & Sendhil Mullainathan & Joshua Schwartzstein, 2015. "Behavioral Hazard in Health Insurance," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 130(4), pages 1623-1667.
    44. Jacob Goldin & Tatiana Homonoff & Katherine Meckel, 2022. "Issuance and Incidence: SNAP Benefit Cycles and Grocery Prices," American Economic Journal: Economic Policy, American Economic Association, vol. 14(1), pages 152-178, February.
    45. Tal Gross & Jeremy Tobacman, 2014. "Dangerous Liquidity and the Demand for Health Care: Evidence from the 2008 Stimulus Payments," Journal of Human Resources, University of Wisconsin Press, vol. 49(2), pages 424-445.
    46. Raj Chetty, 2008. "Moral Hazard vs. Liquidity and Optimal Unemployment Insurance," NBER Working Papers 13967, National Bureau of Economic Research, Inc.
    47. Sumit Agarwal & Wenlan Qian, 2014. "Consumption and Debt Response to Unanticipated Income Shocks: Evidence from a Natural Experiment in Singapore," American Economic Review, American Economic Association, vol. 104(12), pages 4205-4230, December.
    48. Amy Finkelstein & Nathaniel Hendren & Mark Shepard, 2019. "Subsidizing Health Insurance for Low-Income Adults: Evidence from Massachusetts," American Economic Review, American Economic Association, vol. 109(4), pages 1530-1567, April.
    49. Benjamin R. Handel, 2013. "Adverse Selection and Inertia in Health Insurance Markets: When Nudging Hurts," American Economic Review, American Economic Association, vol. 103(7), pages 2643-2682, December.
    50. Paul Goldsmith-Pinkham & Maxim Pinkovskiy & Jacob Wallace, 2020. "Medicare and the Geography of Financial Health," Working Papers 2020-004, Human Capital and Economic Opportunity Working Group.
    51. Nicholas S. Souleles, 1999. "The Response of Household Consumption to Income Tax Refunds," American Economic Review, American Economic Association, vol. 89(4), pages 947-958, September.
    52. Nyman, John A., 1999. "The value of health insurance: the access motive," Journal of Health Economics, Elsevier, vol. 18(2), pages 141-152, April.
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    2. Liu, Hong & Ma, Jinqiu & Zhao, Liqiu, 2023. "Public long-term care insurance and consumption of elderly households: Evidence from China," Journal of Health Economics, Elsevier, vol. 90(C).
    3. Yoko Ibuka & Junya Hamaaki, 2024. "Income Receipt, Economic Activities, and Health: Evidence from Ambulance Transport Patterns," Working Papers 202401, University of Hawaii at Manoa, Department of Economics.
    4. Daniel Kaliski, 2023. "Identifying the impact of health insurance on subgroups with changing rates of diagnosis," Health Economics, John Wiley & Sons, Ltd., vol. 32(9), pages 2098-2112, September.
    5. Victor Hernandez Martinez & Kaixin Liu, 2022. "The Value of Unemployment Insurance: Liquidity vs. Insurance Value," Working Papers 22-16, Federal Reserve Bank of Cleveland.
    6. Yang, Feng-An & Chang, Hung-Hao, 2023. "Impact of a pension program on healthcare utilization among older farmers: Empirical evidence from health claims data," World Development, Elsevier, vol. 169(C).
    7. Nianzhai Ma & Weizeng Sun & Zhen Wang, 2022. "Host Identity and Consumption Behavior: Evidence from Rural–Urban Migrants in China," Sustainability, MDPI, vol. 14(19), pages 1-25, September.
    8. Timothy K. M. Beatty & Joakim A. Weill, 2024. "Social Security and High-Frequency Labor Supply: Evidence from Uber Drivers," Finance and Economics Discussion Series 2024-079, Board of Governors of the Federal Reserve System (U.S.).
    9. Thomson, Sarah & Cylus, Jonathan & Al Tayara, Lynn & Martínez, Marcos Gallardo & García-Ramírez, Jorge Alejandro & Gregori, María Serrano & Cerezo-Cerezo, José & Karanikolos, Marina & Evetovits, Tamás, 2024. "Monitoring progress towards universal health coverage in Europe: a descriptive analysis of financial protection in 40 countries," LSE Research Online Documents on Economics 122773, London School of Economics and Political Science, LSE Library.
    10. Carlos Alberto Belchior & Yara Gomes, 2022. "Liquidity constraints, cash transfers and the demand for health care in the Covid‐19 pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 31(11), pages 2369-2380, November.
    11. Guettabi, Mouhcine & Witman, Allison, 2023. "Universal cash transfers and prescription utilization: Evidence from the Alaska permanent fund dividend," Journal of Health Economics, Elsevier, vol. 90(C).
    12. Aurélien Baillon & Owen O'Donnell & Stella Quimbo & Kim van Wilgenburg, 2022. "Do time preferences explain low health insurance take‐up?," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(4), pages 951-983, December.
    13. Amitabh Chandra & Evan Flack & Ziad Obermeyer, 2021. "The Health Costs of Cost-Sharing," NBER Working Papers 28439, National Bureau of Economic Research, Inc.

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    More about this item

    JEL classification:

    • G5 - Financial Economics - - Household Finance
    • H0 - Public Economics - - General
    • I1 - Health, Education, and Welfare - - Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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