Modeling Health Insurance Expansions: Effects of Alternate Approaches

Dahlia K. Remler, Joshua Graff Zivin, Sherry A. Glied

Research output: Contribution to journalReview articlepeer-review


Estimates of the costs and consequences of many types of public policy proposals play an important role in the development and adoption of particular policy programs. Estimates of the same, or similar, policies that employ different modeling approaches can yield widely divergent results. Such divergence often undermines effective policymaking. These problems are particularly prominent for health insurance expansion programs. Concern focuses on predictions of the numbers of individuals who will be insured and the costs of the proposals. Several different simulation-modeling approaches are used to predict these effects, making the predictions difficult to compare. This paper categorizes and describes the different approaches used; explains the conceptual and theoretical relationships between the methods; demonstrates empirically an example of the (quite restrictive) conditions under which all approaches can yield quantitatively identical predictions; and empirically demonstrates conditions under which the approaches diverge and the quantitative extent of that divergence. All modeling approaches implicitly make assumptions about functional form that impose restrictions on unobservable heterogeneity. Those assumptions can dramatically affect the quantitative predictions made.

Original languageEnglish (US)
Pages (from-to)291-313
Number of pages23
JournalJournal of Policy Analysis and Management
Issue number2
StatePublished - Mar 2004

ASJC Scopus subject areas

  • General Business, Management and Accounting
  • Sociology and Political Science
  • Public Administration


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