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Author: Bradley Thomas Howells Publisher: ISBN: Category : Languages : en Pages : 218
Book Description
This dissertation contributes in two distinct ways to our understanding of the economics of healthcare and health insurance. Chapter 2 studies the decision process by which physicians allocate medical treatments to heart attack patients. The approach provides insight into the sources of well documented, but unexplained, disparities across demographic dimensions in health care utilization rates and health outcomes. In the model medical providers know how treatment alternatives affect patient-specific probabilities of three final health outcomes - death, readmission, and survival without readmission - and assign implicit values to each outcome that vary by patient age. The model does well in explaining the joint variation in treatments and outcomes, especially when including unobserved patient heterogeneity. Using decomposition methods, I show that a substantial fraction of gender differences in the use of intensive treatment is explained by a combination of the differences in the relative efficacy of treatment options for female patients, and the smaller implicit weight given to final outcomes of older patients. Chapter 3 explores how reforms to cash-assistance welfare programs in the United States in the mid 1990s acted as a structural shift in the health insurance and employment environment of lower income single mothers and find there may have been unintended consequences for this population's access to health insurance. With a more structured approach than is common in the literature, I estimate short and long run employment and insurance dynamics before and after the reforms. I show that reform reduced use of cash-assistance and increased the probability of employment, but created a less stable employment and health insurance environment. After the reform low income single mothers were less likely to retain the same employment and insurance status over a four month period. Although policy did not target Medicaid eligibility, individuals were less likely to retain Medicaid enrollment over the short and longer run after reform.
Author: Bradley Thomas Howells Publisher: ISBN: Category : Languages : en Pages : 218
Book Description
This dissertation contributes in two distinct ways to our understanding of the economics of healthcare and health insurance. Chapter 2 studies the decision process by which physicians allocate medical treatments to heart attack patients. The approach provides insight into the sources of well documented, but unexplained, disparities across demographic dimensions in health care utilization rates and health outcomes. In the model medical providers know how treatment alternatives affect patient-specific probabilities of three final health outcomes - death, readmission, and survival without readmission - and assign implicit values to each outcome that vary by patient age. The model does well in explaining the joint variation in treatments and outcomes, especially when including unobserved patient heterogeneity. Using decomposition methods, I show that a substantial fraction of gender differences in the use of intensive treatment is explained by a combination of the differences in the relative efficacy of treatment options for female patients, and the smaller implicit weight given to final outcomes of older patients. Chapter 3 explores how reforms to cash-assistance welfare programs in the United States in the mid 1990s acted as a structural shift in the health insurance and employment environment of lower income single mothers and find there may have been unintended consequences for this population's access to health insurance. With a more structured approach than is common in the literature, I estimate short and long run employment and insurance dynamics before and after the reforms. I show that reform reduced use of cash-assistance and increased the probability of employment, but created a less stable employment and health insurance environment. After the reform low income single mothers were less likely to retain the same employment and insurance status over a four month period. Although policy did not target Medicaid eligibility, individuals were less likely to retain Medicaid enrollment over the short and longer run after reform.
Author: Robin McKnight Publisher: ISBN: Category : Languages : en Pages : 116
Book Description
This thesis brings together three essays on issues in the economics of health insurance. The first study considers the effects of average per-patient caps on Medicare reimbursement for home health care, which took effect in October 1997. I use regional variation in the restrictiveness of per-patient caps to identify the short-run effects of this reimbursement change on home health agency behavior, beneficiary health care utilization, and health status. The empirical evidence suggests that agencies responded to the caps by shifting the composition of their caseload towards healthier beneficiaries. In addition, I find that decreases in home care utilization were associated with an increase in outpatient care, and had little adverse impact on the health status of beneficiaries. In the second paper, I examine the impact of Medicare balance billing restrictions on physician behavior and on beneficiary spending. My findings include a significant decline in out-of-pocket expenditures for medical care by elderly households, but no impact on the quantity of care received or in the duration of office visits. The third paper (written with Jonathan Gruber) explores the causes of the dramatic rise in employee contributions to employer-provided health insurance over the past 20 years. We find that there was a large impact of falling tax rates, rising eligibility for insurance through the Medicaid system and through spouses, and deteriorating economic conditions (in the late 1980s and early 1990s). We also find more modest impacts of increased managed care penetration and rising health care costs. Overall, this set of factors can explain about one-quarter of the rise in employee contributions over the 1982-1996 period.
Author: Clarence Rufus Rorem Publisher: ISBN: Category : Business & Economics Languages : en Pages : 224
Book Description
This book contains essays from the 1930s to 1970s on medical economics and describe efforts to achieve certainty in the costs and quality of health care, especially through group practice, group payment and areawide planning.
Author: Natalia Serna Publisher: ISBN: Category : Languages : en Pages : 0
Book Description
Rising health care costs motivate the use of demand- and supply-side mechanisms to control the consumption of health services, and generate incentives for insurers to engage in risk selection strategies. Using data from the Colombian health care system, I first measure how demand for different health services responds to cost-sharing using a regression discontinuity design. I then study how cost-sharing impacts negotiated service prices between insurers and hospitals using a model of Nash-in-Nash bargaining. Finally, I quantify the impact of risk selection incentives on hospital network breadth using a model of insurer competition in networks. I find that cost-sharing is effective at reducing health care costs, but that consumption reductions happen across necessary and unnecessary services. Counterfactual simulations show that negotiated hospital prices are U-shaped with respect to the coinsurance rate, and minimized at a coinsurance rate of 30 percent. Findings of the model of insurer competition in networks show that insurers engage in risk selection by providing narrow networks. Improving the risk adjustment formula reduces selection incentives and motivates insurers to expand their networks in every health service. Allowing insurers to compete on premiums and networks, shows that price and non-price characteristics of insurance contracts are substitute mechanisms for risk selection.
Author: Patricia Kuan-Pei Foo Publisher: ISBN: Category : Languages : en Pages :
Book Description
In this dissertation, I study three related topics regarding the economics of health care in the United States. I begin with a broad look at the recent U.S. health care reform law in Chapter 1. In Chapters 2 and 3, I narrow my focus to study the impact of changing either demand-side incentives (Chapter 2) or supply-side incentives (Chapter 3) on the utilization of medical services. In Chapter 1, Wichsinee Wibulpolprasert and I study changes in firms' asset prices around the passage of the ACA by the House of Representatives to identify the long- run expected impact of the reform for a given firm, including general equilibrium effects (e.g., price changes). The ACA includes a wide-reaching set of reforms to ensure more universal and comprehensive health insurance benefits. The bill has the potential to impact U.S. firms through regulations on employer-sponsored insurance (ESI) and general equilibrium effects. Among 321 publicly traded firms from 19 sec- tors (defined by the 2-digit North American Industry Classification System code), we find that firms experienced heterogeneous effects on their asset prices that are consis- tent with predictions from a partial equilibrium analysis of labor market equilibria. Shareholders of firms with a relatively higher proportion of uninsured employees or employees with ESI prior to the reform experienced a negative impact on their asset prices, while shareholders of firms with a relatively higher proportion of employees who would qualify for the Medicaid expansion or who would qualify for premium subsidies on the health insurance exchanges experienced a positive impact on their asset prices. Our results suggest that the ACA's incidence lies partly on shareholders, but that coverage through public insurance or publicly-supported insurance markets is incident on taxpayers or possibly on the employees of the affected firms. In Chapter 2, Mark Cullen and I study the impact of changing demand-side in- centives on the use of generic drugs during an era of slowing prescription drug ex- penditures. We examine the interaction of two factors that have contributed to this trend change: cost-sharing and generic entry. Specifically, we examine a case in which a large, self-insured company introduced prescription drug plans that increased the difference in the marginal price of brand-name and generic drugs between 2004 and 2006. Using prescription drug claims data, we estimate an elasticity of substitution of -0.03. At the same time, we find that approximately 90% of individuals substitute to generics within two years of first-time generic entry, and that the switching decision is not affected by the change in cost-sharing. We discuss potential policy implications of these two divergent substitution patterns. Finally, in Chapter 3, Robin S. Lee, Kyna Fong and I study the effect of changing the price differential for cesarean versus vaginal deliveries paid by commercial insurers to hospitals and physicians on cesarean rates. Using eight years of claims data con- taining negotiated prices, we exploit within-hospital-physician-group price variation arising from contract renegotiations over time. We find that increasing the physician price differential by $100 yields a 0.55 percentage point (1.9%) increase. Increas- ing the hospital price differential by $1000 for births delivered by hospital-exclusive physician groups yields a 1.1 percentage point (3.7%) increase. Our findings have implications for understanding hospital-physician principal-agent problems and for the future of accountable care organizations.
Author: Hui Ding Publisher: ISBN: Category : Languages : en Pages :
Book Description
This dissertation explores various topics in health economics, specifically the use of different types of health care (i.e., mental health, durable medical equipment, and chronic disease management in primary care settings) and how public insurance policies affect the price and utilization of health care products and services. In Chapter 1, I explore the geographic variation in mental health care use among the Medicare population. Using administrative data from Medicare, I isolates the patient- and place-specific drivers of the geographic variation in mental health care use among elderly adults. Specifically, I use an event-study framework with individual fixed effects to study changes in mental health care utilization for patients who move across areas with differing rates of average utilization. My results show that 60 percent of the geographic variation is attributed to place-specific factors. I then explore components of the "place effect", finding that mental health care provider capacity explains only one tenth of it. Beyond that, local attitudes toward mental health play an important role, as shown by asymmetric responses for people who move from low-to-high and high-to-low care utilization areas, especially among those who were never diagnosed with any mental illness before moving. Lastly, I find a strong negative correlation between area-level mental health care utilization and suicide rates, and evidence that moving to high utilization areas is associated with a lower risk of self-harm-related Emergency Department visits. These findings suggest that promoting mental health care could benefit the elderly population, and that there is substantial scope for achieving this goal with interventions targeting place-specific factors. In Chapter 2, along with co-authors Mark Duggan and Amanda Starc, I study Medicare's competitive bidding program (CBP) for durable medical equipment (DME). We use Medicare claims data to examine the effect on prices and utilization, focusing on continuous positive airway pressure (CPAP) devices for sleep apnea. We find that spending falls by 47.2% percent after a highly imperfect bidding mechanism is introduced. This is almost entirely driven by a 44.8% price reduction, though quantities also fall by 4.3\%. To disentangle supply and demand, we leverage differential cost sharing across Medicare recipients. We measure a demand elasticity of -0.272 and find that quantity reductions are concentrated among less clinically appropriate groups. In Chapter 3, along with co-authors Yiwei Chen, Min Yu, Jieming Zhong, Ruying Hu, Xiangyu Chen, Chunmei Wang, Kaixu Xie and Karen Eggleston, I investigate the effect of chronic disease management provided in primary health care (PHC) setting in rural China. Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management and PHC system. We provide evidence on China's efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% fewer inpatient admissions, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.
Author: Ana Ines Rocca Publisher: ISBN: Category : Languages : en Pages : 148
Book Description
In the United States, health insurance is often necessary for access to regular, affordable health care. With only eight of every hundred Americans buying private insurance plans on the individual market, the main sources for health insurance traditionally have been employers and the government. As new laws are being debated and introduced to reform an expensive health care industry in which nearly one-sixth of the population is uninsured, research is needed in order to evaluate the costs and benefits of these policy changes and to predict their success. To this end, in addition to understanding how likely individuals are to adopt new health insurance policies, we also should be interested in knowing how the demand for health insurance and changes in its accessibility will affect non-medical decisions. Specifically, labor market choices have been theorized to be directly related to decisions involving insurance coverage. If the availability of health insurance distorts a workers' job-related decisions, then the changing the landscape for how to access insurance may reverberate in employment outcomes. My dissertation focuses on understanding the factors that influence the demand for health insurance and the role that health insurance plays in an individual's decision to work, where to work, and how much to work. Specifically, I focus on the following three related questions: how does the demand for insurance affect labor market decisions such as when to exit unemployment? what drives insurance demand, and in particular, what motivators work best to increase demand for health coverage among the uninsured? and lastly, what are the supply-side employment responses to the provision of free or reduced-cost public health insurance? My first chapter explores how the demand for health insurance can change re-employment decisions among the unemployed, as well as the speed at which individuals return to work. Past research on this issue focuses on job-to-job switches and "job lock" but has yet to focus on individuals looking for work. This chapter uses data on laid-off individuals from the Medical Expenditure Panel Survey to compare the job search behavior and outcomes of individuals who differ in their demand for health insurance. I use three proxies for demand, based on spousal health and past insurance offer take-up decisions. Although each is potentially confounded by unobserved determinants of job search, I use a difference-in-differences and propensity score designs to isolate plausibly causal effects. I find consistent patterns across all three proxies (despite different potential omitted variables biases). Overall unemployment durations do not vary with demand for insurance, but this masks variation in the types of jobs taken. Individuals with higher demand for insurance have higher hazards for exiting unemployment into a job with insurance, but lower hazards for exiting to a job without insurance. This points to effects of insurance demand on both search effort and reservation wages, and to potentially important distorting effects of employer-linked health insurance. Whereas the first chapter takes variation in demand for insurance as a given, my second chapter digs deeper into the basis for this variation and whether it can be affected. In this chapter, I investigate the reasons the uninsured choose to forego insurance coverage and the impact of different messages on their insurance demand. Working with Enroll America, a large non-profit dedicated to decreasing the number of uninsured Americans, I conducted a stratified experiment to determine the best communication strategies to encourage participation in the healthcare exchanges. We test a combination of the following behavioral and information treatments: a risk treatment that emphasizes the average financial risk for someone without health insurance; a norms treatment that alerts our participants that staying uninsured will be against the law; a savings treatment that highlights the average savings available at the exchanges; a wording treatment where we refer to the Affordable Care Act (ACA) as "Obamacare"; and lastly, a cost-calculator treatment that allows individuals to explore the likely cost of insurance based on their own characteristics. Among the uninsured, we find that the cost-calculator treatment, the risk treatment, and the mandate are most effective in increasing intention to purchase insurance. The cost-calculator and the risk treatment increase informedness among this population, but the cost-calculator (when paired with the savings treatment) is the only treatment that increases willingness to pay for insurance. We use the information on willingness to pay to construct sub-group price elasticities of demand to compare to previous work interested in the demand for health insurance. Overall, the results of this chapter highlight the importance of informational campaigns to increase awareness of the costs and benefits of health coverage, particularly after large changes such as those implemented by the ACA. My third chapter continues by looking at the changes that have been introduced as a result of the ACA. Specifically, it explores whether expanding access to government-provided insurance affects individuals' decisions regarding employment and overall hours of work. Recent findings have suggested that increasing access to health insurance outside of employment has a sizable, negative impact on labor force participation. Along these lines, the Congressional Budget Office predicted that the expansion of Medicaid and private health insurance will cause a 1.5 to 2% reduction in hours worked in the first ten years. Comparing states by whether they chose to expand Medicaid under reforms introduced by the ACA, I look at changes in the probability a childless adult receives Medicaid, as well as changes in this group's employment likelihood and hours of work. Using household survey data from the CPS monthly survey and ASEC Supplement, I confirm a marked increase in the percent of childless adults insured by Medicaid but find no statistically significant changes in employment outcomes. I compare these results to other estimates of "employment lock" in recent literature. These results, though imprecise, align with the findings in Chapter 1 which suggest that overall employment is not drastically affected by insurance demand.
Author: Andrew Olenski Publisher: ISBN: Category : Languages : en Pages : 0
Book Description
Our findings establish that insurers can affect health care well outside their direct purview, raising the question of how to match their private objectives with their scope of influence.
Author: Peter J. Hammer Publisher: Duke University Press ISBN: 0822385023 Category : Business & Economics Languages : en Pages : 373
Book Description
This volume revisits the Nobel Prize-winning economist Kenneth Arrow’s classic 1963 essay “Uncertainty and the Welfare Economics of Medical Care” in light of the many changes in American health care since its publication. Arrow’s groundbreaking piece, reprinted in full here, argued that while medicine was subject to the same models of competition and profit maximization as other industries, concepts of trust and morals also played key roles in understanding medicine as an economic institution and in balancing the asymmetrical relationship between medical providers and their patients. His conclusions about the medical profession’s failures to “insure against uncertainties” helped initiate the reevaluation of insurance as a public and private good. Coming from diverse backgrounds—economics, law, political science, and the health care industry itself—the contributors use Arrow’s article to address a range of present-day health-policy questions. They examine everything from health insurance and technological innovation to the roles of charity, nonprofit institutions, and self-regulation in addressing medical needs. The collection concludes with a new essay by Arrow, in which he reflects on the health care markets of the new millennium. At a time when medical costs continue to rise, the ranks of the uninsured grow, and uncertainty reigns even among those with health insurance, this volume looks back at a seminal work of scholarship to provide critical guidance for the years ahead. Contributors Linda H. Aiken Kenneth J. Arrow Gloria J. Bazzoli M. Gregg Bloche Lawrence Casalino Michael Chernew Richard A. Cooper Victor R. Fuchs Annetine C. Gelijns Sherry A. Glied Deborah Haas-Wilson Mark A. Hall Peter J. Hammer Clark C. Havighurst Peter D. Jacobson Richard Kronick Michael L. Millenson Jack Needleman Richard R. Nelson Mark V. Pauly Mark A. Peterson Uwe E. Reinhardt James C. Robinson William M. Sage J. B. Silvers Frank A. Sloan Joshua Graff Zivin
Author: Bradley Thomas Howells
Author: Bradley Thomas Howells
Author: Robin McKnight
Author: Clarence Rufus Rorem
Author: Natalia Serna
Author: Patricia Kuan-Pei Foo
Author: Laia Bosque Mercader
Author: Hui Ding
Author: Ana Ines Rocca
Author: Andrew Olenski
Author: Peter J. Hammer