Transfer Payment Systems and Financial Distress: Insights from Health Insurance Premium Subsidies
研究瑞士强制健康保险中，从现金补贴转向保费补贴（实物转移）如何改善低收入群体的财务状况，发现实物转移显著降低保费拖欠和债务追缴风险，且无负面溢出效应。
Abstract How should payment systems of means-tested benefits be designed to improve the financial situation of needy recipients most effectively? We study this question in the context of mandatory health insurance in Switzerland, where recipients initially receive either a cash transfer or subsidized insurance premiums (a form of in-kind transfer). A federal reform in 2014 forced cantons (i.e. states) to universally switch to in-kind provision. We exploit this setting based on a difference-in-differences design, analyzing eight years of rich individual-level accounting data and applying a machine learning approach to identify cash recipients prior to the reform. We find that switching from cash to in-kind transfers persistently reduces the likelihood of late premium payments by about 20% and of government debt collection for long-term missed payments by approximately 12%. There is no evidence for a negative spillover effect on the timely payment of the non-subsidized co-pay bills for health services after the regime change.