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Targeting with In-kind Transfers: Evidence from Medicaid Home Care

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  • Ethan M.J. Lieber
  • Lee M. Lockwood
Abstract
Making a transfer in kind reduces its value to recipients but can improve targeting. We develop an approach to quantifying this tradeoff and apply it to home care. Using randomized experiments by Medicaid, we find that in-kind provision significantly reduces the value of the transfer to recipients while targeting a small fraction of the eligible population that is sicker and has fewer informal caregivers than the average eligible. Under a wide range of assumptions within a standard model, the targeting benefit exceeds the distortion cost. This highlights an important cost of recent reforms toward more flexible benefits.

Suggested Citation

  • Ethan M.J. Lieber & Lee M. Lockwood, 2018. "Targeting with In-kind Transfers: Evidence from Medicaid Home Care," NBER Working Papers 24267, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:24267
    Note: AG EH PE
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    3. de Bresser, Jochem & Knoef, Marike & van Ooijen, Raun, 2022. "Preferences for in-kind and in-cash home care insurance," Journal of Health Economics, Elsevier, vol. 84(C).
    4. Abhijit Banerjee & Rema Hanna & Benjamin A Olken & Elan Satriawan & Sudarno Sumarto, "undated". "Food vs. Food Stamps: Evidence from an At-Scale Experiment in Indonesia," Working Papers 2373, Publications Department.
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    11. Rema Hanna & Benjamin A Olken & Elan Satriawan & Sudarno Sumarto & Abhijit Banerjee, "undated". "Pangan versus Kupon Makanan: Bukti dari Eksperimen Berskala Besar di Indonesia," Working Papers 3537, Publications Department.
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    16. Svetlana Pashchenko & Ponpoje Porapakkarm, 2019. "Reducing Medical Spending of the Publicly Insured: The Case for a Cash-out Option," American Economic Journal: Economic Policy, American Economic Association, vol. 11(3), pages 390-426, August.
    17. Takanori Ida & Takunori Ishihara & Koichiro Ito & Daido Kido & Toru Kitagawa & Shosei Sakaguchi & Shusaku Sasaki, 2021. "Paternalism, Autonomy, or Both? Experimental Evidence from Energy Saving Programs," Papers 2112.09850, arXiv.org.
    18. Shang Wu & Hazel Bateman & Ralph Stevens & Susan Thorp, 2022. "Flexible insurance for long‐term care: A study of stated preferences," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(3), pages 823-858, September.
    19. de Bresser, Jochem & Knoef, Marike & van Ooijen, Raun, 2021. "Preferences for In-Kind and In-Cash Home Care Insurance," Discussion Paper 2021-033, Tilburg University, Center for Economic Research.
    20. de Bresser, Jochem & Knoef, Marike & van Ooijen, Raun, 2021. "Preferences for In-Kind and In-Cash Home Care Insurance," Other publications TiSEM fca83bd4-09cc-4072-81c6-0, Tilburg University, School of Economics and Management.
    21. Maria Polyakova & Stephen P. Ryan, 2019. "Subsidy Targeting with Market Power," NBER Working Papers 26367, National Bureau of Economic Research, Inc.
    22. Diego Jimenez-Hernandez & Enrique Seira, 2022. "Should the government sell you goods? Evidence from the milk market in Mexico," Working Paper Series WP 2023-19, Federal Reserve Bank of Chicago.
    23. Latha Thimmappa & Ashrita Saran & Sonia R. B. D'Souza & Binil V., 2021. "PROTOCOL: The effectiveness of social protection interventions in low‐ and middle‐income countries: An evidence and gap map," Campbell Systematic Reviews, John Wiley & Sons, vol. 17(3), September.
    24. Arapakis, K. & French, E. & Jones, J. & McCauley, J., 2022. "How should we fund end-of-life care in the USA?," Cambridge Working Papers in Economics 2249, Faculty of Economics, University of Cambridge.

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    More about this item

    JEL classification:

    • H21 - Public Economics - - Taxation, Subsidies, and Revenue - - - Efficiency; Optimal Taxation
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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