HOUSEHOLD DEMAND FOR EMPLOYER-BASED HEALTH INSURANCE

以雇主为基础的医疗保险制度，65%的美国人通过它获得保险，正在随着联邦和州保险法规、劳动力市场参与度的变化以及有管理的医疗保健增长而发生变化。雇主一级关于提供医疗保险的决定决定了受雇个人及其家属就其保险需求作出决定所依据的选择集。本项目的目的是审查家庭对雇主赞助的健康保险的决策。具体地说，这项研究将确定影响覆盖决策的特定家庭和特定健康计划的因素，使用两个具有全国代表性的数据集估计需求模型，并讨论与健康计划转换、雇主提供和反垄断执法相关的经验结果。将采用预期效用框架来组织分析，并将使用离散选择建模方法来进行经验估计。1987年全国医疗支出调查(NMES)和最新发布的1996年医疗支出小组调查(MEPS)被建议用于这项研究。该项目将做出三个主要贡献。首先，它将通过明确建模单工和双工家庭的决策过程，帮助我们了解医疗保险的需求。其次，它将评估管理式保健以及雇主赞助的健康保险在1987至1996年间对家庭决策的影响。最后，这项研究将提供目前对可推广到全国人口的医疗保险需求的估计。

The institution of employer-based health insurance, through which 65 percent of Americans receive coverage, is changing in response to federal and state insurance regulations, changes in labor market participation, and managed care growth. Employer-level decisions regarding the provision of health care coverage determine the choice set from which employed individuals and their dependents make decisions about their demand for insurance. The purpose of this project is to examine household decision- making regarding employer-sponsored health insurance. Specifically, this study will identify household-specific and health plan-specific factors that affect coverage decisions, estimate a model of demand using two nationally representative data sets, and discuss the empirical results as they relate to health plan switching, employer offerings, and antitrust enforcement. An expected utility framework will be adopted to structure the analysis and a discrete-choice modeling approach will be used for empirical estimation. The 1987 National Medical Expenditure Survey (NMES) and the newly released, 1996 Medical Expenditure Panel Survey (MEPS) are proposed for use in this study. This project will make three primary contributions. First, it will contribute to our knowledge of the demand for health care coverage by explicitly modeling the decision-making process of both single worker and two-worker households. Second, it will provide an assessment of the impacts of managed care and subsequent changes in employer-sponsored health insurance on household decision-making between 1987 and 1996. Finally, this study will provide current estimates of the demand for health care coverage that are generalizable to a national population.