Essays on Institutions in Health Care and Labor Markets PDF Download

Author: Rebekka Müller-Rehm
Publisher:
ISBN: 9783933812346
Category :
Languages : de
Pages : 0

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Author: Matthew Mark Knepper
Publisher:
ISBN: 9781321894424
Category : Health insurance
Languages : en
Pages : 132

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This dissertation looks at the interaction of the legal environment with health and labor market outcomes in a variety of settings. The first chapter examines the effect of state public health insurance expansion decisions on private insurance costs by comparing how private insurance plan costs have evolved over time according to whether a state has pursued a Medicaid coverage expansion as part of the Patient Protection & Affordable Care Act. The second chapter explores how one can test for judicial ingroup biases and applies the test to workplace sex discrimination cases. The third chapter evaluates the potential efficacy of federal incentive payments designed to boost physician access to electronic health records on patient outcomes in an Emergency Department setting.

Author: Ana Ines Rocca
Publisher:
ISBN:
Category :
Languages : en
Pages : 148

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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: Erin Metcalf Johnson
Publisher:
ISBN:
Category :
Languages : en
Pages : 190

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This dissertation uses tools and models from labor economics to study two information problems in healthcare markets: the uncertainty of patients regarding the quality of medical care and the asymmetry of information between physicians and patients. These problems may lead to market failure and impact patient care, but our current understanding of the consequences of each is imperfect. I first consider patients' difficulty in determining the quality of medical services, focusing on technical skill of cardiac specialists. While it is difficult for patients to judge the skill of cardiac specialists due to information problems, referring doctors may have access to quality information unavailable to patients. This chapter considers whether the referral relationship between primary care physicians and specialists mitigates problems arising from patients' lack of information in this context. In particular, I measure the extent to which referring doctors learn about specialist quality by observing patient outcomes and use this information to select specialists on patients' behalf. This chapter presents a model of the referral relationship with public learning by PCPs about specialist quality. The model makes predictions for specialists' careers. In general terms, the model predicts that careers of specialists should diverge by quality over time. I test predictions of the model using the universe of Medicare claims filed by cardiac specialists in the U.S. from 1996-2005. Specifically, I compare careers of higher and lower quality specialists using a new measure of specialist quality that is robust to nonrandom patient sorting. The evidence suggests some degree of learning by PCPs: lower quality specialists are significantly more likely to drop out of the labor market and to change geographic markets over time. For young cohorts, learning also results in improved sorting of patients to providers based on risk characteristics over time. The next chapter, which is joint work with M. Marit Rehavi, addresses the asymmetry of information between physicians and patients. Specifically, it measures the extent of agency problems arising from this inequality, focusing on the decision to perform C-sections. We do this by comparing the probability of receiving a C-section for physician-patients with the probability for non-physician professionals. The research design exploits the fact that physicians are better informed regarding the appropriateness of recommendations and treatments than the average professional. As such, treatments for this group provide a near-fully-informed baseline that allows us to isolate the effects of information and agency problems. We carry out this analysis using vital statistics data from the state of Texas, including every registered birth from 1995-2008. We find evidence consistent with agency problems in the physician-patient relationship. Physician-patients are approximately 5% less likely to have a C-section than other highly educated patients, controlling for relevant medical factors. This difference is even larger when the mother is the physician, and it comes almost entirely from non-emergecy C-sections. Findings are consistent with significant agency problems, and these appear to have increased in importance over the sample period.

Author: Shanshan Liu
Publisher:
ISBN: 9781321224344
Category :
Languages : en
Pages : 78

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The third part is the combination of labor and health economics, which is concerned with the question how economic recessions affect the aggregate health outcomes of a population living in the same community. This chapter uses all inpatient data in Pennsylvania for the 2000-2011 period, during which people experienced two recessions, uses county unemployment rates as the primary indicator of recessions, and analyzes the effects of recessions on the percentage of total population in a community that are hospitalized for certain stress-related diseases, while controlling for the community's socio-demographic characteristics. This chapter finds that recessions significantly increase the risk of hospitalization due to alcohol-related conditions among all communities, but decrease the hospitalization rates for AMI and stroke among the high-population-density and high-poverty communities, respectively. Finally, there is no evidence showing any persistent effects of recessions on health.

Author: Joseph Shinn
Publisher:
ISBN:
Category :
Languages : en
Pages : 127

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This dissertation consists of three empirical essays on labor, health, and real estate economics. The first essay theoretically and empirically analyzed the effects of the costs of firing an employee and hiring a replacement in a labor market with imperfect information. The theory suggested that increased expected firing or replacement costs contributed to a ``lemons effect" for the fired worker through the negative signal received in the labor market regarding the worker's ability. To test this theory, data from the Displaced Worker's Supplement to the Current Population Survey from 2004 to 2014 was used. The results were mixed, but suggested that workers in the United States who were displaced from their job experienced decreased probabilities of finding reemployment as firing costs increased. The essay also examined whether this ``lemons effect" contributed to larger wage decreases, but the estimates did not support this conclusion. The second essay estimated the impacts of the 2001 elimination of the Medicare 24-month waiting period for non-elderly Amyotrophic Lateral Sclerosis (ALS) patients. Using data from the National Hospital Discharge Survey, this essay estimated the effects of the elimination on health insurance coverage and utilization of health care services. By applying a difference-in-difference OLS estimation technique, it was estimated that, as a result of the waiting period elimination, non-elderly ALS patients were more likely to be insured, but there was a significant crowd-out of private insurance. These non-elderly patients who were admitted to the hospital with serious symptoms were also more likely to be transferred to long- or short-term care facilities while non-serious patients were more likely to receive a high (four or more) number of medical services while hospitalized. In the third essay, the effects of a new suburban casino on local housing prices were evaluated. Similar to the second essay, a difference-in-difference approach was applied, but it was combined with a spatial hedonic pricing model. Using data from a GIS product from the Maryland Department of Planning and local-area data from the American Community Survey, the effects that the opening of Maryland Live! Casino had on home sales prices of properties located in primary (one-mile radius) and secondary (one to three miles) impact areas were estimated. The results of the estimations indicated that the opening of the casino had a positive impact on housing prices in the primary impact area and this impact likely began during the construction period. No impacts, however, were evident in the secondary impact area.

Author: Chelsea Jo Crain
Publisher:
ISBN:
Category : Health insurance
Languages : en
Pages : 130

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We compare the changes in insurance coverage and labor market outcomes over time of adults in states that expanded Medicaid and in states that did not. Our estimates suggest that the recent expansion significantly increased Medicaid coverage with little decrease in ESI. Overall, the expansion did not impact labor market outcomes, including labor force participation, employment, and hours worked. In the third chapter, I examined the impact of competition among dentists on the labor supply of dentists. I focus on how dentists' working hours will changes when the level of competition increases by examining the effect of the National Health Service Corps (NHSC). The NHSC was created to increase the supply of rural physicians, which might increase the competition in rural areas. I examine the number of dentists (extensive margins of labor supply) and the change in the working hours of dentists (intensive margins of labor supply) in response to the increased level of physician competition. I found that 1 percent increase in NHSC-approved sites increases 5.4% increases in the number of providers and 0.2% of competition in a rural county. In addition, I found that there is a positive relationship between the number of NHSC-approved sites and providers' working hours. If the competition among dentists increases about 1, then working hours of providers increase about 6 hours per week.

Author: Sarah Marie Abraham
Publisher:
ISBN:
Category :
Languages : en
Pages : 156

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This thesis consists of three chapters on the economics of health and healthcare. The first and third chapters explore geographic variation in health outcomes within the United States. The second chapter focuses on empirical methods for obtaining causal estimates of treatment effects with an application to healthcare settings. In the first chapter I study geographic variation in health care utilization under two different insurance systems: traditional Medicare and employer-provided private insurance. For each system, I use patient migration as a source of identification combined with empirical Bayes methods to construct optimal linear forecasts for the causal effects of place on utilization. These place effects measure the causal differences in treatment intensity across areas. I find similar levels of variation in the causal place effects for the publicly and privately insured patients, with a correlation of .39 across the two systems. These findings emphasize that insurance systems are affecting the forces that drive the causal component of geographic variation in utilization. In the second chapter, Liyang Sun and I explore event studies, a model for estimating treatment effects using variation in the timing of treatment. Researchers often run fixed effects regressions for event studies that implicitly assume treatment effects are constant across cohorts first treated at different times. In this paper we show that these regressions produce causally uninterpretable estimands when treatment effects vary across cohorts. We propose alternative estimators that identify convex averages of the cohort-specific treatment effects, hence allowing for causal interpretation even under heterogeneous treatment effects. We illustrate the shortcomings of fixed effects estimators in comparison to our proposed estimators through an empirical application on the economic consequences of hospitalization. In the third chapter, Raj Chetty, Michael Stepner, Shelby Lin, Benjamin Scuderi, Nicholas Turner, Augustin Begeron, David Cutler and I use newly available administrative data to quantify the relationship between income and mortality in the United States. Although it is well known that there are significant differences in health and longevity between income groups, debate remains about the magnitudes and determinants of these differences. We use new data from 1.4 billion anonymous earnings and mortality records to construct more precise estimates of the relationship between income and life expectancy at the national level than was feasible in prior work. We then construct new local area (county and metro area) estimates of life expectancy by income group and identify factors that are associated with higher levels of life expectancy for low-income individuals. Our study yields four sets of results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years for men and 10.1 years for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but increased by only 0.32 years for men and 0.04 years for women in the bottom 5%. Third, life expectancy varied substantially across local areas. For individuals in the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking, but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low income individuals was positively correlated with the local area fraction of immigrants, fraction of college graduates, and local government expenditures. Additional information on this project is available at https: //healthinequality. org/.

Author: Patrick Gray
Publisher: Springer Nature
ISBN: 3031064771
Category : Business & Economics
Languages : en
Pages : 477

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This anthology honors the life and work of American economist John E. Murray, whose work on the evolution of the standard of living spanned multiple disciplines. Publishing extensively in the areas of the history of healthcare and health insurance, labor markets, religion, and family-related issues from education to orphanages, fertility, and marriage, Murray was much more than an economic historian and his influence can be felt across the wider scholarly community. Written by Murray’s academic collaborators, mentors, and mentees, this collection of essays covers topics such as the effect of the 1918 influenza pandemic on U.S. life insurance holdings, the relationship between rapid economic growth and type 2 diabetes, and the economics of the early church. This volume will be of use to scholars and students interested in economic history, cliometrics, labor economics, and American and European history, as well as the history of religion.

Author: Emily P. Hoffman
Publisher:
ISBN:
Category : Business & Economics
Languages : en
Pages : 192

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Collection of essays examining labour market discrimination, the impact of laws and policies, the treatment of children compared to the elderly, discrimination within the family, the economic underclass, and the treatment of minority members of society.