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Employee Cost-Sharing and the Welfare Effects of Flexible Spending Accounts

William Jack
World Bank

Arik Levinson
Georgetown University - Department of Economics; National Bureau of Economic Research (NBER)

Sjamsu Rahardja
Georgetown University - Department of Economics


May 2, 2005

Georgetown Economics Working Paper No. 05-12

Abstract:     
In recent years, employees have been shouldering an increasing share of the costs of employee-provided health care. At the same time, more and more employers have been allowing employees to pay their out-of-pocket health care costs using pre-tax earnings, through tax-subsidized flexible spending accounts (FSAs). We use a cross-section of firm-level data from 1993 to show empirically that these FSAs can explain a significant fraction of the shift in health care costs to employees, and that this shift may be efficient, given the distortionary effects of the existing tax-subsidy to premiums. Correcting for selection effects, we find that FSAs are associated with insurance contracts with coinsurance rates that are about 7 percentage points higher, relative to a sample average coinsurance rate of 17 percent. Meanwhile, coinsurance rates net of the subsidy are approximately unchanged, providing evidence that FSAs are welfare-neutral.

Keywords: Health expenditure subsidies, moral hazard, Flexible Spending Accounts

JEL Classifications: D60, H21, I18

Working Paper Series

Date posted: May 06, 2005 ; Last revised: June 09, 2005

Suggested Citation

Jack, William G., Levinson, Arik M. and Rahardja, Sjamsu, Employee Cost-Sharing and the Welfare Effects of Flexible Spending Accounts (May 2, 2005). Georgetown Economics Working Paper No. 05-12. Available at SSRN: http://ssrn.com/abstract=716081 or doi:10.2139/ssrn.716081


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Contact Information

William G. Jack (Contact Author)
World Bank ( email )
1818 H Street, N.W.
Washington, DC 20433
United States
Arik M. Levinson
Georgetown University - Department of Economics ( email )
Washington, DC 20057
United States
202-687-5571 (Phone)
202-687-6102 (Fax)
National Bureau of Economic Research (NBER)
1050 Massachusetts Avenue
Cambridge, MA 02138
United States
Sjamsu Rahardja
Georgetown University - Department of Economics ( email )
Washington, DC 20057
United States
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