Doctoral Dissertation Research in Economics: The Impact of Medicare on Bankruptcy

经济学博士论文研究：医疗保险对破产的影响

• 批准号: 1324468
• 负责人: Mary Hansen
• 金额: $ 2.31万
• 依托单位: American University
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1324468&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Economics; Impact

Medicare aimed to improve access to medical care and to reduce out-of-pocket costs for individuals over the age of 65, many of whom had low income, high medical expenses, and no health insurance. On July 1, 1966, all 19 million Americans aged 65 years and older became eligible for Medicare. Within a year after the rapid implementation of Medicare, the personal bankruptcy rate began a gradual decline that lasted until 1974. The objective of this project is to determine the extent to which the implementation of Medicare contributed to the decline in the bankruptcy rate by reducing medical debt. To augment publicly available aggregate data, this dissertation will use newly collected data from original bankruptcy court case files from the 1960s and 1970s.Because out-of-pocket medical expenses have risen more than 73% since 1996, medical debt and medical bankruptcy have become important areas of research. Medical debt has been shown to be one of the leading reasons that individuals file for personal bankruptcy; however, estimates of the fraction of bankruptcies that are due to medical debt range from 17% to 62.1%. The estimates are imprecise in part because today much medical debt is subsumed in credit card debt. Because credit cards were not widely used in the 1960s, the new data from court case files will allow a more accurate view of the medical debt of petitioners for bankruptcy.Bankruptcy can be considered a form of insurance. It transfers risk of loss from the debtors to the creditors in exchange for higher interest rates. Though it is occasionally noted that both bankruptcy and Medicare are forms of insurance that protect people from loss due to medical debt, no study has looked at the impact one has on the other. Understanding how health insurance can affect bankruptcy is critical to designing a package of policies that reduces economic vulnerability. Specifically, this project examines how the implementation of the first public health insurance program in the United States decreased medical debt under bankruptcy by examining three different aspects of bankruptcy:- State bankruptcy rates,- medical debt among petitioners for bankruptcy, and- the demographic characteristics of petitioners.The results will show whether Medicare effectively reduced the burden of medical debt on those over 65. Moreover, the results will increase understanding of the mechanisms through which public health insurance can affect medical debt among the population of people who file for bankruptcy. Therefore, it will inform future work on how health insurance more generally affects medical debt.Understanding how health insurance can affect medical debt under bankruptcy is critical to the analysis of the benefits of public health insurance and to designing policy that may lower personal bankruptcy rates. Understanding how the implementation of Medicare affected medical debt is critical to designing policy such that individuals do not have to declare bankruptcy as a result of illness or injury. In order to make informed decisions about the future of the Medicare program, policy makers need to understand Medicare's past benefits, including whom it helped.

Medicare旨在改善获得医疗服务的机会，并降低65岁以上个人的自付费用，其中许多人的收入低，医疗费用高，没有健康保险。 1966年7月1日，所有65岁及65岁以上的美国人都有资格获得Medicare。在迅速实施Medicare的一年之内，个人破产率开始逐步下降，一直持续到1974年。该项目的目的是确定Medicare的实施程度在多大程度上导致破产率下降，通过降低医疗债务。为了增加公开可用的总数据，本文将使用1960年代和1970年原始破产法院案件档案中的新数据。由于自1996年以来，自付费用的医疗费用已上涨了73％以上，医疗债务和医疗破产已成为重要的研究领域。医疗债务已被证明是个人申请个人破产的主要原因之一；但是，由于医疗债务造成的破产比例的估计是17％至62.1％。这些估计是不精确的，部分原因是今天，许多医疗债务都包含在信用卡债务中。由于信用卡在1960年代没有被广泛使用，因此法院案件文件的新数据将允许更准确地看待请愿人对破产的医疗债务。BankRuppty可以被视为一种保险形式。它会将损失的风险从债务人转移到债权人中，以换取更高的利率。尽管偶尔指出，破产和医疗保险都是保护人们免受医疗债务损失的保险形式，但没有研究对另一种影响。了解健康保险如何影响破产对于设计减少经济脆弱性的一揽子政策至关重要。具体而言，该项目研究了美国第一个公共卫生保险计划的实施是如何通过检查破产的三个不同方面来减少破产的医疗债务： - 国家破产率， - 请愿人中的医疗债务对破产的人口统计学特征，以及 - 请愿人的人口统计学特征，结果将显示出对公共债务的降低，这将降低医疗保险的责任，这将通过65的医疗保险降低医疗债务，这将降低医疗保险，从而降低了65岁的医疗债务，该公司的债务能够造成65的责任，而这一债务的负担会造成更大的责任。在申请破产的人群中。因此，它将为未来的工作提供有关健康保险通常如何影响医疗债务的工作。理解健康保险如何影响破产的医疗债务对于分析公共卫生保险的福利和设计可能降低个人破产率的保单至关重要。了解医疗保险影响医疗债务的实施对于设计政策至关重要，以使个人不必因疾病或伤害而宣布破产。为了就Medicare计划的未来做出明智的决定，决策者需要了解Medicare的过去收益，包括它的帮助。