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Sickness Insurance: Design and Behavior

Rikner, Klas LU (2002) In Lund Economic Studies no. 103.
Abstract (Swedish)
Popular Abstract in Swedish

De fyra essäerna i Sickness Insurance: Design and Behavior studerar sjukförsäkringens utformning ur både ett empiriskt och ett teoretiskt perspektiv. Den första essän bygger på en enkätstudie och innehåller två delar. I den första delen undersöks människors preferenser för olika utformningar av sjukförsäkringen, där de olika utformningarna förväntas ge ungefär samma kostnader. En jämförelse görs mellan ett system med en karensdag och därefter 75 procents ersättning, ett system utan karensdagar och 65 procents ersättning och ett system med 90 procents ersättning efter 3 karensdagar. Studien visar att de flesta föredrar systemet med en karensdag. I den andra delen undersöks människors beslut att gå... (More)
Popular Abstract in Swedish

De fyra essäerna i Sickness Insurance: Design and Behavior studerar sjukförsäkringens utformning ur både ett empiriskt och ett teoretiskt perspektiv. Den första essän bygger på en enkätstudie och innehåller två delar. I den första delen undersöks människors preferenser för olika utformningar av sjukförsäkringen, där de olika utformningarna förväntas ge ungefär samma kostnader. En jämförelse görs mellan ett system med en karensdag och därefter 75 procents ersättning, ett system utan karensdagar och 65 procents ersättning och ett system med 90 procents ersättning efter 3 karensdagar. Studien visar att de flesta föredrar systemet med en karensdag. I den andra delen undersöks människors beslut att gå till jobbet eller sjukskriva sig. De svarande får ta ställning till om de skulle gå till jobbet eller stanna hemma, under antagande om att de känner sig sjuka. De får ta ställning till samma fråga för flera olika, hypotetiska, ersättningssystem. Det visar sig att faktorer relaterade till individens kostnader för sjukskrivning har stor betydelse för beslutet att jobba eller sjukskriva sig. I den andra essän undersöks i vilken utsträckning människor väljer att ta semester istället för att sjukskriva sig, därför att det är kostsamt att sjukskriva sig. Essän bygger dels på enkätdata och dels på registerdata. Enkäten visar att nästan 20 procent av de svarande någon gång under de tolv månader som föregick undersökningen tagit semester istället för att sjukskriva sig, därför att det är kostsamt att sjukskriva sig. Studien av registerdatan tyder dock inte på att detta beteende skulle ha haft någon betydande inverkan på den totala sjukskrivningsnivån. Den tredje essän är en teoretisk studie av försäkringar med uniforma premier, såsom socialförsäkringar, och försäkringar där premierna beror på de försäkrades tidigare utfall, sk ’experience rating’. Dessa två försäkringsformer jämförs för att studera när den ena eller andra försäkringsformen är att föredra. Jämförelsen görs speciellt utifrån lågriskindividers perspektiv. Det visar sig att även lågriskindivider i vissa fall kan föredra uniforma premier trots att de sannolikt får en lägre premie i ett system med ’experience rating’. Ett system med uniforma premier minskar dock osäkerheten vad gäller den framtida premien. Den fjärde essän är en teoretisk uppsats där den optimala ersättningsnivån undersöks i ett system där arbetsgivaren betalar sjuklön och ett system där en offentlig försäkringsgivare betalar sjukpenning. Modellen visar sig att det under vissa förutsättningar kan vara optimalt att betala full ersättning för inkomstbortfall. Det gäller speciellt om man antar att ett system där människor emellanåt går till jobbet trots att de är sjuka leder till en högre sjukfrånvaro i framtiden. Modellen visar också att arbetsgivarna i vissa fall har en mer restriktiv inställning till en hög sjukpenningnivå än till en hög sjuklönenivå. (Less)
Abstract
The first essay presents the results from a questionnaire study of sickness insurance and sickness absence behavior in Sweden. In the first part, people’s preferences for the design of a sickness insurance are discussed. Three combinations of qualifying days and compensation rates, with approximately the same costs within the insurance system, are compared. From the questionnaire it is concluded that a system with one qualifying day is the most preferred, compared to no qualifying day at all (and lower compensation) or three qualifying days (and higher compensation). The second part of this paper focuses on factors that influence people’s decision whether or not to report sick. In the questionnaire individuals were asked whether they would... (More)
The first essay presents the results from a questionnaire study of sickness insurance and sickness absence behavior in Sweden. In the first part, people’s preferences for the design of a sickness insurance are discussed. Three combinations of qualifying days and compensation rates, with approximately the same costs within the insurance system, are compared. From the questionnaire it is concluded that a system with one qualifying day is the most preferred, compared to no qualifying day at all (and lower compensation) or three qualifying days (and higher compensation). The second part of this paper focuses on factors that influence people’s decision whether or not to report sick. In the questionnaire individuals were asked whether they would go to work or not, presupposing that they actually feel ill. Respondents were asked the same questions under different hypothetical compensations. The results indicate strong effects of factors related to the financial loss of being absent on the propensity to report sick. The second essay analyzes to what extent Swedish employees choose to take a holiday instead of reporting sick, in an attempt to avoid the costs related to sickness absence. The data used comes both from a questionnaire survey and from the Labour Force Survey by Statistics Sweden. The data from the questionnaire shows that individuals sometimes actually choose a holiday instead of reporting sick, with the intention of avoiding costs. The Labour Force Survey study does not confirm that this type of behavior has a considerable effect on the overall sickness absence. The third essay focuses on the main differences between insurance with uniform premiums and insurance with experience-rated premiums. The purpose is to explore the complex interaction between, on the one hand, probability of failure, risk-aversion, discount rate and probability of changing risk group, and, on the other hand, people’s preferences for uniform premiums and experience-rated premiums. In the paper, both a theoretical model and a simulation model illustrate the differences. One important conclusion is that the complex nature of experience-rated insurance precludes simple and general conclusions about the preferences for this insurance. It is shown that an insurance with quite considerable redistribution between risk-groups might be preferred even by good risk individuals. This can be seen as support for social insurance. The fourth essay is a theoretical study of temporary sickness absence and insurance. The purpose is twofold; first to refine the theoretical model for temporary sickness absence and insurance, and second to analyze the optimal level of compensation in an employer-provided sickness insurance and a public sickness insurance, and to compare these two. It is found that full compensation, under some circumstances, could possibly be optimal in both employer-provided and public sickness insurance. (Less)
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author
opponent
  • Professor Palmer, Edward, National Social Insurance Board
organization
publishing date
type
Thesis
publication status
published
subject
keywords
ekonometri, ekonomisk teori, ekonomiska system, ekonomisk politik, Social economics, Social ekonomi, Nationalekonomi, economic systems, economic policy, econometrics, economic theory, Economics, Social insurance, Experience rating, Asymmetric information, Insurance, Sickness insurance, Sickness absence
in
Lund Economic Studies
volume
no. 103
pages
133 pages
defense location
Holger Crafoords Ekonomicentrum III, sal 210, Lund University
defense date
2002-05-03 14:15
ISSN
0460-0029
language
English
LU publication?
yes
id
ff1b1473-f99b-45c9-88c7-a2ed7738bb03 (old id 464604)
date added to LUP
2007-09-27 11:48:27
date last changed
2016-09-19 08:45:00
@phdthesis{ff1b1473-f99b-45c9-88c7-a2ed7738bb03,
  abstract     = {The first essay presents the results from a questionnaire study of sickness insurance and sickness absence behavior in Sweden. In the first part, people’s preferences for the design of a sickness insurance are discussed. Three combinations of qualifying days and compensation rates, with approximately the same costs within the insurance system, are compared. From the questionnaire it is concluded that a system with one qualifying day is the most preferred, compared to no qualifying day at all (and lower compensation) or three qualifying days (and higher compensation). The second part of this paper focuses on factors that influence people’s decision whether or not to report sick. In the questionnaire individuals were asked whether they would go to work or not, presupposing that they actually feel ill. Respondents were asked the same questions under different hypothetical compensations. The results indicate strong effects of factors related to the financial loss of being absent on the propensity to report sick. The second essay analyzes to what extent Swedish employees choose to take a holiday instead of reporting sick, in an attempt to avoid the costs related to sickness absence. The data used comes both from a questionnaire survey and from the Labour Force Survey by Statistics Sweden. The data from the questionnaire shows that individuals sometimes actually choose a holiday instead of reporting sick, with the intention of avoiding costs. The Labour Force Survey study does not confirm that this type of behavior has a considerable effect on the overall sickness absence. The third essay focuses on the main differences between insurance with uniform premiums and insurance with experience-rated premiums. The purpose is to explore the complex interaction between, on the one hand, probability of failure, risk-aversion, discount rate and probability of changing risk group, and, on the other hand, people’s preferences for uniform premiums and experience-rated premiums. In the paper, both a theoretical model and a simulation model illustrate the differences. One important conclusion is that the complex nature of experience-rated insurance precludes simple and general conclusions about the preferences for this insurance. It is shown that an insurance with quite considerable redistribution between risk-groups might be preferred even by good risk individuals. This can be seen as support for social insurance. The fourth essay is a theoretical study of temporary sickness absence and insurance. The purpose is twofold; first to refine the theoretical model for temporary sickness absence and insurance, and second to analyze the optimal level of compensation in an employer-provided sickness insurance and a public sickness insurance, and to compare these two. It is found that full compensation, under some circumstances, could possibly be optimal in both employer-provided and public sickness insurance.},
  author       = {Rikner, Klas},
  issn         = {0460-0029},
  keyword      = {ekonometri,ekonomisk teori,ekonomiska system,ekonomisk politik,Social economics,Social ekonomi,Nationalekonomi,economic systems,economic policy,econometrics,economic theory,Economics,Social insurance,Experience rating,Asymmetric information,Insurance,Sickness insurance,Sickness absence},
  language     = {eng},
  pages        = {133},
  school       = {Lund University},
  series       = {Lund Economic Studies},
  title        = {Sickness Insurance: Design and Behavior},
  volume       = {no. 103},
  year         = {2002},
}