Health Care Financing over the Life Cycle:A Quantitative Macroeconomic Analysis o

描述（由申请人提供）：美国医疗保健系统的两个主要问题是低医疗保险覆盖率和高医疗保健成本，这威胁到美国家庭和政府的偿付能力。许多经济学家和政策制定者呼吁进行全面改革。然而，目前的卫生经济学研究主要依赖于微观经济和计量经济模型，在提供适合分析卫生保健改革的宏观经济后果的框架方面存在不足。我们提出了一种使用宏观经济建模技术来解决这些问题的新方法。我们的研究议程：我们将健康资本的Grossman模型（Grossman (1972a)）整合到一个大规模随机生命周期宏观经济模型中。我们的目标是为卫生保健和健康保险的需求开发具有微观基础的定量宏观经济模型。为了使我们的模型更有说服力，我们使用医疗支出小组调查（MEPS）提供了广泛的数据分析，并证明我们的模型能够在整个生命周期中产生现实的医疗支出模式和保险占比。此外，该模型考虑了美国医疗保健和健康保险部门的重要制度细节，因此非常适合分析各种医疗改革理念的影响，包括其对福利和增长的财政和宏观经济影响。这是对公共健康保险和卫生保健定量宏观理论的贡献。我们分析了以下三种改革思路。项目1 -健康储蓄账户：我们分析消费者驱动的医疗保健计划，如新建立的健康储蓄账户（HSAs）是否可以减少美国的医疗保健支出，并增加拥有医疗保险的人口比例。数值模拟的初步结果表明，HSAs的成功在很大程度上取决于卫生生产力和HSAs的年缴款限额。我们的结果还强调了考虑一般均衡效应的重要性，这进一步证明了我们的宏观建模方法是正确的。项目2 -全民健康保险凭证：我们调查了一个政府资助的凭证计划，该计划允许消费者在私人保险市场购买健康保险。我们的初步结果表明，代金券制度将导致美国人口的全面覆盖，但也会使医疗保健支出占GDP的比例增加0.6%。同时，我们观察到一定数量的储蓄被挤出，导致长期资本存量下降。逆向选择问题完全消失，因为保险自动提供给所有人。这导致风险分担的改善和健康水平的提高，从而增加福利。我们发现，选择合适的税收工具来资助代金券将是实现积极福利的关键。项目3 -公共选择和医疗保险购买：在这个项目中，我们扩展了以前的模型，包括医疗补助和私人医疗保险市场价格设定机制的细节。然后我们引入一个公共选择（独立项目或医疗保险购买），只对某些类型的家庭有效。低收入家庭接受转移支付以购买保险。我们分析了对增长、福利和政府预算的影响。

DESCRIPTION (provided by applicant): Two of the major issues in the U.S. health care system are the low health insurance coverage rates and the high costs of health care that threaten the solvency of American households and government. Many economists and policymakers call for a comprehensive reform. However, current research in health economics which relies mainly on microeconomic and econometric models falls short in providing a framework suitable for analyzing macroeconomic consequences of health care reforms. We propose a new approach to addresses these issues using macroeconomic modeling techniques. Our research agenda: We integrate the Grossman model (Grossman (1972a)) of health capital into a large scale stochastic life cycle macroeconomic model. Our goal is to develop quantitative macroeconomic models with micro foundations for the demand of health care and health insurance. In order to make our model more convincing, we provide extensive data analysis using the Medical Expenditure Panel Survey (MEPS) and demonstrate that our model is able to generate realistic health spending patterns and insurance take-up ratios over the life-cycle. In addition, the model accounts for important institutional details of the U.S. health care and health insurance sector and is therefore ideal to analyze the effects of various Health Care Reform ideas, including its fiscal and macroeconomic impacts on welfare and growth. This is a contribution to the quantitative macro theory of public health insurance and health care. We analyze the following three reform ideas. Project 1 - Health Savings Accounts: We analyze whether a consumer driven health care plan like the newly established Health Savings Accounts (HSAs) can reduce health care expenditures in the United States and increase the fraction of the population with health insurance. Our preliminary results from numerical simulations indicate that the success of HSAs depends critically on the productivity of health and the annual contribution limit to HSAs. Our results also highlight the importance of accounting for general equilibrium effects which further justifies our macro modeling approach. Project 2 - Universal Health Insurance Vouchers: We investigate a government financed voucher program that allows consumers to buy health insurance in the private insurance market. Our preliminary results suggest that a voucher system would result in full coverage of the U.S. population but also increases the share of GDP spent on health care by 0.6 percent. Simultaneously, we observe a certain amount of crowding out of savings that leads to lower long-run capital stocks. Adverse selection problems disappear completely as insurance is automatically available to the entire population. This leads to improvements in risk pooling and higher levels of health which increases welfare. We find that choosing the right taxation instrument to finance the vouchers will be critical in achieving positive welfare. Project 3 - Public option and Medicare buy-in: In this project we extend the previous model by including Medicaid and the details of the price setting mechanism in private health insurance markets. We then introduce a public option (stand alone program or Medicare buy-in) that will only be available for certain types of households. Low income households receive transfers in order to buy insurance. We analyze the effects on growth, welfare, and the government budget. PUBLIC HEALTH RELEVANCE: This project integrates the Grossman model (Grossman (1972a)) of health capital into large scale dynamic general equilibrium macroeconomic models to study the life cycle behavior of health spending and health insurance. We apply our models to conduct health care policy analysis and provide welfare, growth and fiscal analyses of (i) Health Savings Accounts (HSAs), (ii) Universal Health Insurance Vouchers, and (iii) a Medicare buy-in plan coupled with a public option. We focus on whether these reform ideas are able to lower total U.S. health care spending and the number of individuals without health insurance.