Health Insurance Design Meets Saving Incentives: Consumer Responses to Complex Contracts
American Economic Journal: Applied Economics · 2022 · Adam A. Leive
中文摘要
为降低医疗保健成本，健康储蓄账户（HSAs）提供税收激励，鼓励人们在当前消费与未来消费之间进行权衡。本文检验消费者是否在生命周期中将HSAs用作自我保险。利用来自一家大型雇主的行政数据和断点回归设计，我估计从HSA资产中消费的边际倾向为0.85，并拒绝了新古典基准值0。与401(k)储蓄的比较表明，大多数员工并不将HSA资金与退休储蓄视为可替代。在此情境下，HSAs并未减少医疗支出，反而增加了免税融资的份额。（JEL D15, D82, G22, G51, I13）
Abstract
To lower health care costs, Health Savings Accounts (HSAs) offer tax incentives encouraging people to trade off current consumption against future consumption. This paper tests whether consumers use HSAs as self-insurance over the life cycle. Using administrative data from a large employer and a regression discontinuity design, I estimate the marginal propensity to consume from HSA assets is 0.85 and reject the neoclassical benchmark of 0. Comparisons with 401(k) saving show most employees do not treat HSA money as fungible with retirement savings. In this setting, HSAs did not reduce health spending and instead increased the share that was financed tax-free. (JEL D15, D82, G22, G51, I13)