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

医疗保险旨在改善获得医疗保健的机会，并减少65岁以上个人的自付费用，其中许多人收入低，医疗费用高，没有医疗保险。1966年7月1日，所有1900万65岁及以上的美国人都有资格享受医疗保险。在医疗保险快速实施后的一年内，个人破产率开始逐渐下降，一直持续到1974年。该项目的目的是确定医疗保险的实施在多大程度上通过减少医疗债务来促进破产率的下降。为了增加公开可用的汇总数据，本论文将使用新收集的数据，这些数据来自20世纪60年代和70年代的原始破产法庭案件档案。由于自1996年以来，自付医疗费用增长了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；然而，估计因医疗债务而破产的比例在17%到62.1%之间。这一估计并不准确，部分原因是如今很多医疗债务都包含在信用卡债务中。由于信用卡在20世纪60年代并未广泛使用，法院案件档案中的新数据将使人们能够更准确地了解申请破产的申请人的医疗债务。破产可以被看作是一种保险。它将损失风险从债务人转移到债权人，以换取更高的利率。虽然偶尔会注意到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，但没有研究关注过其中一种对另一种的影响。了解健康保险如何影响破产，对于设计一揽子减少经济脆弱性的政策至关重要。具体而言，本项目考察了美国第一个公共健康保险方案的实施如何通过考察破产的三个不同方面来减少破产下的医疗债务：-州破产率，-破产请愿者的医疗债务，以及-请愿者的人口特征。结果将显示医疗保险是否有效地减轻了65岁以上老人的医疗债务负担。此外，研究结果将增加对公共健康保险影响申请破产人群医疗债务的机制的理解。因此，它将为今后关于健康保险如何更普遍地影响医疗债务的工作提供信息。了解健康保险如何影响破产下的医疗债务，对于分析公共健康保险的好处和设计可能降低个人破产率的政策至关重要。了解医疗保险的实施如何影响医疗债务对于制定政策至关重要，这样个人就不必因疾病或受伤而宣布破产。为了对医疗保险计划的未来做出明智的决定，政策制定者需要了解医疗保险过去的好处，包括它帮助了谁。

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.