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1. The Political Process Involved in Formulating Healthcare Policy in Japan: With a Particular Focus on Advisory Councils, Interest Groups and Medical Officers

Author:
Yukio Sakurai
Publication Date:
01-2025
Content Type:
Journal Article
Journal:
The Rest: Journal of Politics and Development
Institution:
Centre for Strategic Research and Analysis (CESRAN)
Abstract:
Japan’s healthcare policy is defined by a universal health insurance system that guarantees affordable healthcare for all citizens at any time and in any location. The system was established in 1961 and has since undergone a process of evolution through the implementation of national healthcare policies. Despite the existence of conflicts and issues, the mechanism of the Central Social Insurance Medical Council (“Chuikyo”) has continued to advance national healthcare interests. Nevertheless, this resulted in the commencement of criminal proceedings in 2004. The current demographic shifts present a challenge to the long-term sustainability of the national health insurance system, the long-term care insurance system, and the public pension system. This is occurring against a backdrop of rising costs associated with healthcare and long-term care, as well as an unsustainable national budget. The Chuikyo system is confronted with a multitude of challenges. This paper analyses the roles of three key actors in the Japanese national healthcare policy-making process. These actors include advisory councils such as Chuikyo, interest groups such as the Japan Medical Agency, and medical officers of the Ministry of Health, Labour and Welfare, who play a pivotal role in the policy-making process. The incremental improvements that Chuikyo produces are insufficient to address the long-term challenges facing the national healthcare policy. Japan’s healthcare model requires reconstruction to align it with the needs of an ageing society with a declining birthrate. Prior to embarking on this important policy work, it is essential to determine who should lead it. It is recommended that the Prime Minister and the Cabinet Office spearhead a study on radical reform, with strong political leadership and a capable technocrat team to facilitate collaboration with the National Diet and the public. Furthermore, it would be crucial to achieve a consensus through national forums on the fundamental concepts that citizens, as consumers, desire and are prepared to forego from a bottom-up approach. It is essential that the governance structure of the national healthcare system is changed to a decentralised structure so that citizens can be proactively involved in healthcare issues and make autonomous decisions.
Topic:
Politics, Insurance, and Healthcare System
Political Geography:
Japan and Asia

2. The Insurance Implications of Government Student Loan Repayment Schemes

Author:
Martin Gervais, Qian Liu, and Lance Lochner
Publication Date:
01-2023
Content Type:
Working Paper
Institution:
Centre for Human Capital and Productivity (CHCP), Western University
Abstract:
A large literature examines the extent to which consumption responds to idiosyncratic earnings shocks.1 This paper studies whether student loan repayments serve as a source of insurance, much like government tax and transfer programs.2 Indeed, this insurance mechanism is an explicit aim of formal income-contingent repayment schemes in many countries, where the efficient structure of contingencies depends on such market frictions as moral hazard, adverse selection, and costly income verification (Lochner and Monge-Naranjo, 2016). We use new administrative data that links detailed information on Canadian student loan recipients with their repayment and income histories from the Canada Student Loans Program (CSLP), income tax filings, and post-secondary schooling records to measure the extent to which student borrowers adjust loan repayments to insure against income variation.3 Several mechanisms are available for students to adjust loan repayments in response to income fluctuations: formal, like CSLP’s Repayment Assistance Plan (RAP); and informal, such as delinquency or default. Close to 30% of students are enrolled in RAP soon after graduation, although that fraction falls as incomes rise thereafter. ∗ Gervais: University of Georgia, Athens, mgervaisca@gmail.com. Liu: Brock University, St. Catharines, Canada, qliu@brocku.ca. Lochner: Western University, London, Canada, llochner@uwo.ca. We thank the Statistics Canada Research Data Centres at Western University and McMaster University. Lochner gratefully acknowledge support from the Social Sciences and Humanities Research Council of Canada. 1See, e.g., the survey by Meghir and Pistaferri (2011) and references therein. 2Brzozowski et al. (2010) show that the tax and transfer system in Canada is very effective at absorbing income movements. 3Lochner, Liu and Gervais (2021) document sizable transfers implicit in the CSLP through differences in repayment by expected post-school income. Within 5 years of graduation, nearly 10% of borrowers have defaulted on their debt. In addition, borrowers can make larger payments than required should they experience unexpectedly high income: 40% of borrowers have fully repaid their student debt within 5 years of graduation. Indeed, loan payments are shown to increase in income, more so in early years and for individuals with higher initial debt. More formally, we estimate that on average, an unexpected $1,000 change in yearover-year income is associated with a $30 change in loan payment: from a $50 change the year after graduation, declining to a $20 change 5 years after graduation. Loan repayments are also used to absorb income variation that is more permanent in nature: for borrowers whose income is consistently below or above expected income at graduation, the magnitude of average repayment adjustment is similar to the average yearly response.
Topic:
Debt, Education, Economy, Insurance, and Student Loans
Political Geography:
Canada and North America

3. The Labor Market Effects of Disability Benefit Loss

Author:
Anikó Bíró, Cecília Hornok, Judit Krekó, Dániel Prinz, and Ágota Scharle
Publication Date:
09-2023
Content Type:
Working Paper
Institution:
Kiel Institute for the World Economy (IfW)
Abstract:
Disability benefits are costly and tend to reduce labor supply. While spending can be contained by careful targeting, correcting past flaws in eligibility rules or assessment procedures may entail welfare costs. We study a major reform in Hungary that reassessed the health and working capacity of a large share of beneficiaries. Leveraging age and health cutoffs in the reassessment, we estimate employment responses to loss or reduction of benefits. We find that among those who left disability insurance due to the reform 58% were employed in the primary labor market, 6% participated in public works and 36% were out of work without benefits in the post-reform period. The consequences of leaving disability insurance sharply differed by pre-reform employment status. 81% of beneficiaries who had some employment in the pre-reform year worked, while only 33% of those without pre-reform employment did. The gains of the reform in activating beneficiaries were small and strongly driven by pre-reform employment status. This points to the importance of combining financial incentives with broader labor market programs that increase employability.
Topic:
Health, Employment, Economy, Disability, Fiscal Policy, Insurance, Labor Market, and Welfare State
Political Geography:
Europe and Hungary

4. How Well Does Korea's Employment Insurance System Support Workers Facing Trade Shocks?

Author:
Kyong Hyun Koo
Publication Date:
05-2023
Content Type:
Working Paper
Institution:
Korea Institute for International Economic Policy (KIEP)
Abstract:
This study uses worker-level longitudinal panel data and trade data to conduct an analysis of the performance of Korea's employment insurance system in supporting trade-affected workers. We find that the rapid economic growth of China and Vietnam since the 2000s has subjected some Korean industries to heightened import competition. The Korean workers who were employed in these industries in their earlier careers tended to experience a long-term (10-year) decline in the growth rate of labor income and a relative deterioration in their employment security as the probability of involuntary job separation increased. With an increased probability of involuntary job separation, workers in import-competing industries were more likely to receive unemployment benefits. This implies that the unemployment benefit system in Korea was relatively effective in the short term to alleviate employment shocks triggered by trade shocks. Nevertheless, the trade adjustment support function of the unemployment benefit system had certain limitations in that the receipt of unemployment benefits could not ultimately counteract the downward trend in long-term labor income for workers in import-competing industries. In contrast to unemployment benefits, government-supported vocational training holds the potential to increase the long-term earnings of workers more exposed to import competition. However, workers employed in import-competing industries were not more likely to participate in government-supported vocational training; on the contrary, workers in export-expanding industries were more likely to participate in government-supported vocational training. This finding implies that the jobs of workers in import-intensive industries were less likely to be covered by employment insurance than those in export-intensive industries. Consequently, workers in import-intensive industries, who are at greater risk of trade shocks, may be less safeguarded than their counterparts in export-growing industries under the prevailing employment insurance system.
Topic:
Economics, Employment, Trade, and Insurance
Political Geography:
Asia and South Korea

5. The Insurance Implications of Government Student Loan Repayment Schemes

Author:
Martin Gervais, Qian Liu, and Lance Lochner
Publication Date:
01-2023
Content Type:
Working Paper
Institution:
Centre for Human Capital and Productivity (CHCP), Western University
Abstract:
A large literature examines the extent to which consumption responds to idiosyncratic earnings shocks.1 This paper studies whether student loan repayments serve as a source of insurance, much like government tax and transfer programs.2 Indeed, this insurance mechanism is an explicit aim of formal income-contingent repayment schemes in many countries, where the efficient structure of contingencies depends on such market frictions as moral hazard, adverse selection, and costly income verification (Lochner and Monge-Naranjo, 2016). We use new administrative data that links detailed information on Canadian student loan recipients with their repayment and income histories from the Canada Student Loans Program (CSLP), income tax filings, and post-secondary schooling records to measure the extent to which student borrowers adjust loan repayments to insure against income variation.3 Several mechanisms are available for students to adjust loan repayments in response to income fluctuations: formal, like CSLP’s Repayment Assistance Plan (RAP); and informal, such as delinquency or default. Close to 30% of students are enrolled in RAP soon after graduation, although that fraction falls as incomes rise thereafter. Within 5 years of graduation, nearly 10% of borrowers have defaulted on their debt. In addition, borrowers can make larger payments than required should they experience unexpectedly high income: 40% of borrowers have fully repaid their student debt within 5 years of graduation. Indeed, loan payments are shown to increase in income, more so in early years and for individuals with higher initial debt. More formally, we estimate that on average, an unexpected $1,000 change in yearover-year income is associated with a $30 change in loan payment: from a $50 change the year after graduation, declining to a $20 change 5 years after graduation. Loan repayments are also used to absorb income variation that is more permanent in nature: for borrowers whose income is consistently below or above expected income at graduation, the magnitude of average repayment adjustment is similar to the average yearly response.
Topic:
Education, Insurance, and Student Loans
Political Geography:
Global Focus

6. Reformulating Index Insurance to Protect Women’s Assets and Well-being: Evidence from Pastoralist Communities in Kenya

Author:
Julian Arteaga, Michael Carter, and Andrew Hobbs
Publication Date:
08-2023
Content Type:
Working Paper
Institution:
BRAC Institute of Governance and Development (BIGD), Brac University
Abstract:
The novel insurance contracts for crop losses and livestock mortality that have been developed in low income countries typically protect against shocks in the male sphere of economic activity. Often overlooked are women, the particularities of their indirect exposure to this risk, and their socially constructed responsibility to manage family well-being. To fill this lacuna, this paper studies the effect of a low-cost intervention that reformulates a livestock insurance contract so that it directly addresses women's risk and is sold in units that are commensurate with women's expenditure responsibilities. We measure the effect of this contractual reformulation using a randomized trial amongst pastoralist communities in Kenya. Twenty-four percent of previously subsidized households that received the novel contractual formulation purchased insurance (without subsidy), compared to only 13\% of previously subsidized households offered insurance under the standard male-risk formulation. Households that had not received prior insurance subsidies purchased no insurance, irrespective of the framing. Protecting women, their assets and those who depend on them will require a combination of smart subsidies and gender-intentional insurance contract design.
Topic:
Agriculture, Women, Pastoralism, Insurance, and Assets
Political Geography:
Kenya and Africa

7. Experimental Field Evidence of Common Pool Resources: The Water Judge in Bolivia

Author:
Gabriela Agafitei
Publication Date:
05-2022
Content Type:
Working Paper
Institution:
Institute for Advanced Development Studies (INESAD)
Abstract:
In 2019, the Bolivian government began implementation of the Universal Health Insurance (SUS) scheme, with critics claiming the unpreparedness of the healthcare system to provide universal and free services. To date, there is no research that assesses the effects of the reform and to what extent it is providing universal, free services. The objective of this study is to fill this research gap by providing a diagnosis on access to public healthcare services after the SUS’s adoption. In this study, access is operationalized according to a theoretical framework developed by the World Health Organization (2010). The study has been conducted according to a combined method that compares data from before and after the SUS approval. First, data from the National Household Survey has been analyzed to provide an overview of dimensions related to access at the macro level. Secondly, the macro perspective is integrated with data collected through semi-structured interviews that provide a detailed analysis of the qualitative dimensions of accessing healthcare at the micro level, which are often not reflected by quantitative indicators. The results showed that on the one hand access to public healthcare services has increased in the first year of the SUS’s implementation compared to previous years. However, despite the supply of additional human resources and physical infrastructure, the sufficiency in availability of human resources remains questionable, as the values disaggregated per 1,000 inhabitants remained roughly the same. Similarly, spending at the macroeconomic level did not reach recommended levels for universal coverage. Data from the case study deepens the understanding of the findings at the macro level. In fact, access appears as characterized by considerable challenges, such as long waiting times, lack of medicines and of beds, and low-quality services that overall restrain access to the public services. The study has concluded that despite the fact that access has increased, insufficiency of resources and the structural characteristics of the Bolivian healthcare system represent severe limitations for the universal outreach of SUS.
Topic:
Services, Insurance, Healthcare System, and Universal Healthcare
Political Geography:
South America and Bolivia

8. The National Flood Insurance Program: Solving Congress’s Samaritan’s Dilemma

Author:
Peter Van Doren
Publication Date:
03-2022
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Who should pay for the damages caused by natural disaster? The American ethos has long called on personal responsibility and private charity, rather than broad public aid, to secure people’s welfare. Although public emergency services play a vital role during and immediately after a catastrophe, this ethos looks to private insurance and disaster‐​oriented organizations, such as the Red Cross, to be the main modes of recovery from a flood or storm, as well as prior care in siting and constructing buildings to blunt the effects of wind and rain.
Topic:
Government, Natural Disasters, Public Policy, and Insurance
Political Geography:
North America and United States of America

9. Private Insurance, Public Welfare, and Financial Markets: Alpine and Maritime Countries in Comparative-Historical Perspective

Author:
Arjen van der Heide and Sebastian Kohl
Publication Date:
09-2022
Content Type:
Working Paper
Institution:
Max Planck Sciences Po Center on Coping with Instability in Market Societies (MaxPo)
Abstract:
Contemporary capitalist societies use different institutions to manage economic risks. While different public welfare state and financial institutions (banks, capital markets) have been studied across coordinated and liberal market economies, this paper adds the private insurance sector to the study of countries’ security arrangements, following up on Michel Albert’s classical distinction between Alpine and Maritime insurance cultures. Building on extensive new insurance data collections (1880–2017) and institutional analysis, this paper corroborates the long-run historical existence of two worlds of private insurance. Maritime countries (USA, GBR, CAN) developed much bigger life and non-life insurance earlier, with no state-associated insurance enterprises and riskier investments steered towards financial markets. Alpine insurance (AUT, DEU, CHE), by contrast, was initially smaller, with strong state involvement, a significant reinsurance tradition and relatively heavy investments in mortgages and property, due to economic and financial backwardness. We argue that the larger and more “Maritime” the insurance sector, the more it made welfare states liberal and securities markets large. Insurance is thus a hidden factor for countries’ varieties of capitalism and world of welfare. The recent convergence on the Maritime model, however, implies that the riskier and risk-individualizing type of private insurance has added to privatization and securitization trends everywhere.
Topic:
History, Capitalism, Welfare, Insurance, and Financial Development
Political Geography:
Global Focus

10. Reviving the potency of monetary policy with recession insurance bonds

Author:
Julia Coronado and Simon Potter
Publication Date:
04-2020
Content Type:
Policy Brief
Institution:
Peterson Institute for International Economics (PIIE)
Abstract:
In the second part of their Policy Brief, Coronado and Potter discuss how the system of digital payment providers (DPPs) proposed in their first Policy Brief on this topic adds a new weapon to the monetary toolkit that could be implemented in a timely, effective, and inclusive manner. They describe how a digital currency backed by the Federal Reserve could augment automatic fiscal stabilizers and—more importantly—harness the power of “helicopter” money or quantitative easing directly to consumers in a disciplined manner. To implement QE directly to consumers, Coronado and Potter propose the creation of recession insurance bonds (RIBs)—zero-coupon bonds authorized by Congress and calibrated as a percentage of GDP sufficient to provide meaningful support in a downturn. Congress would create these contingent securities; Treasury would credit households’ digital accounts with them. The Fed could purchase them from households in a downturn after its policy rate hits zero. The Fed’s balance sheet would grow by the value of RIBs purchased; the initial matching liability would be deposits into the DPP system. The mechanism is easy for consumers to understand and could boost inflation expectations more than a debt-financed fiscal stimulus could.
Topic:
Economics, Government, Monetary Policy, and Insurance
Political Geography:
North America and United States of America