Essays in Behavioral Health Economics PDF Download
Are you looking for read ebook online? Search for your book and save it on your Kindle device, PC, phones or tablets. Download Essays in Behavioral Health Economics PDF full book. Access full book title Essays in Behavioral Health Economics by Tarso Mori Madeira. Download full books in PDF and EPUB format.
Author: Tarso Mori Madeira Publisher: ISBN: Category : Languages : en Pages : 83
Book Description
This dissertation is composed of two chapters. Each chapter presents a study testing a theory from behavioral economics in a health economics setting using field data. The first chapter studies the role of present bias in the choice of health insurance. I analyze the consequences of a policy change that removes deadlines for enrollment in high-quality (5-star) Medicare drug coverage plans (Part D), while maintaining existing deadlines for enrollment in all other plans. Although the goals of the policy were to increase enrollment in 5-star plans and to provide incentives for insurers to improve quality, the removal of deadlines might lead to the opposite. First, rational beneficiaries might wait to enroll in 5-star plans only when a negative health event occurs, which would both decrease enrollment and increase adverse selection. Second, without deadlines, present-biased beneficiaries might procrastinate, which would also lead to a drop in enrollment, driven by an overall increase in inertia. I develop a model to examine these different hypotheses and test its predictions using Medicare administrative micro data for the period of 2009-2012. I employ a difference-in-differences design within a differentiated-product discrete-choice demand framework. My identification strategy takes advantage of the fact that the policy did not actually change enrollment rules everywhere in the United States, as most counties were not within the coverage area of a 5-star provider in 2012, the year the policy was implemented. I have three main findings. First, the policy backfires: it decreases enrollment in the Part D program by 2.55pp from a baseline of 51.76\%, and decreases average market share of 5-star plans by 1.37pp from a baseline of 7.78\%. Second, the policy does not seem to impact adverse selection, suggesting the rational model might not fully account for the results. Third, the removal of deadlines leads to a drop in the probability that a previously enrolled beneficiary switches plans of 3.18pp (baseline 9.08\%), suggesting that at least some Medicare beneficiaries are present-biased. The second chapter studies role of projection bias in mental health treatment decisions. Evidence from psychology suggests that on a bad-weather day, individuals may feel more depressed than usual. If people are not fully able to account for the effect of transient weather, they may take systematically biased treatment decisions. I derive a model of a person considering treatment for depression and show that when projection bias is present, transient weather might influence choice. I use detailed administrative medical records from the MarketScan \textregistered database and daily county-level meteorological data from the National Climatic Data Center. My period of analysis is 01/01/2003 through 12/31/2004. My main analysis focuses on patient behavior during a small interval of time after they have been seen by a physician. I look at how weather influences antidepressant filling decision within patient and only include appointments that involved a major diagnosis of a mental disease or disorder. I find that a one standard deviation increase in the amount of cloud coverage (2.73 oktas) leads to a 0.063 percentage point increase in the probability that a patient fills an antidepressant prescription on appointment day. That is a 1.04\% increase from the 6.07\% baseline. I also find effects associated with snow, rain, and temperature. All effects fade with time and are not significant within seven days of the appointment. Most of the impact of cloud coverage on antidepressant filling is due to an increase on the number of new prescriptions, not an increase in refills. Virtually all the effect happens at the pharmacy, not via mail order. Most regions have similar coefficients associated with cloud coverage, with stronger results in the Northeast and Upper Midwest. Finally, most of the impact happens during Winter.
Author: Tarso Mori Madeira Publisher: ISBN: Category : Languages : en Pages : 83
Book Description
This dissertation is composed of two chapters. Each chapter presents a study testing a theory from behavioral economics in a health economics setting using field data. The first chapter studies the role of present bias in the choice of health insurance. I analyze the consequences of a policy change that removes deadlines for enrollment in high-quality (5-star) Medicare drug coverage plans (Part D), while maintaining existing deadlines for enrollment in all other plans. Although the goals of the policy were to increase enrollment in 5-star plans and to provide incentives for insurers to improve quality, the removal of deadlines might lead to the opposite. First, rational beneficiaries might wait to enroll in 5-star plans only when a negative health event occurs, which would both decrease enrollment and increase adverse selection. Second, without deadlines, present-biased beneficiaries might procrastinate, which would also lead to a drop in enrollment, driven by an overall increase in inertia. I develop a model to examine these different hypotheses and test its predictions using Medicare administrative micro data for the period of 2009-2012. I employ a difference-in-differences design within a differentiated-product discrete-choice demand framework. My identification strategy takes advantage of the fact that the policy did not actually change enrollment rules everywhere in the United States, as most counties were not within the coverage area of a 5-star provider in 2012, the year the policy was implemented. I have three main findings. First, the policy backfires: it decreases enrollment in the Part D program by 2.55pp from a baseline of 51.76\%, and decreases average market share of 5-star plans by 1.37pp from a baseline of 7.78\%. Second, the policy does not seem to impact adverse selection, suggesting the rational model might not fully account for the results. Third, the removal of deadlines leads to a drop in the probability that a previously enrolled beneficiary switches plans of 3.18pp (baseline 9.08\%), suggesting that at least some Medicare beneficiaries are present-biased. The second chapter studies role of projection bias in mental health treatment decisions. Evidence from psychology suggests that on a bad-weather day, individuals may feel more depressed than usual. If people are not fully able to account for the effect of transient weather, they may take systematically biased treatment decisions. I derive a model of a person considering treatment for depression and show that when projection bias is present, transient weather might influence choice. I use detailed administrative medical records from the MarketScan \textregistered database and daily county-level meteorological data from the National Climatic Data Center. My period of analysis is 01/01/2003 through 12/31/2004. My main analysis focuses on patient behavior during a small interval of time after they have been seen by a physician. I look at how weather influences antidepressant filling decision within patient and only include appointments that involved a major diagnosis of a mental disease or disorder. I find that a one standard deviation increase in the amount of cloud coverage (2.73 oktas) leads to a 0.063 percentage point increase in the probability that a patient fills an antidepressant prescription on appointment day. That is a 1.04\% increase from the 6.07\% baseline. I also find effects associated with snow, rain, and temperature. All effects fade with time and are not significant within seven days of the appointment. Most of the impact of cloud coverage on antidepressant filling is due to an increase on the number of new prescriptions, not an increase in refills. Virtually all the effect happens at the pharmacy, not via mail order. Most regions have similar coefficients associated with cloud coverage, with stronger results in the Northeast and Upper Midwest. Finally, most of the impact happens during Winter.
Author: George Katona Publisher: Ann Arbor, Mich. : Survey Research Center, Institute for Social Research, University of Michigan ISBN: Category : Business & Economics Languages : en Pages : 120
Author: Kinga Posadzy Publisher: Linköping University Electronic Press ISBN: 9176854213 Category : Languages : en Pages : 16
Book Description
The objective of this thesis is to improve the understanding of human behavior that goes beyond monetary rewards. In particular, it investigates social influences in individual’s decision making in situations that involve coordination, competition, and deciding for others. Further, it compares how monetary and social outcomes are perceived. The common theme of all studies is uncertainty. The first four essays study individual decisions that have uncertain consequences, be it due to the actions of others or chance. The last essay, in turn, uses the advances in research on decision making under uncertainty to predict behavior in riskless choices. The first essay, Fairness Versus Efficiency: How Procedural Fairness Concerns Affect Coordination, investigates whether preferences for fair rules undermine the efficiency of coordination mechanisms that put some individuals at a disadvantage. The results from a laboratory experiment show that the existence of coordination mechanisms, such as action recommendations, increases efficiency, even if one party is strongly disadvantaged by the mechanism. Further, it is demonstrated that while individuals’ behavior does not depend on the fairness of the coordination mechanism, their beliefs about people’s behavior do. The second essay, Dishonesty and Competition. Evidence from a stiff competition environment, explores whether and how the possibility to behave dishonestly affects the willingness to compete and who the winner is in a competition between similarly skilled individuals. We do not find differences in competition entry between competitions in which dishonesty is possible and in which it is not. However, we find that due to the heterogeneity in propensity to behave dishonestly, around 20% of winners are not the best-performing individuals. This implies that the efficient allocation of resources cannot be ensured in a stiff competition in which behavior is unmonitored. The third essay, Tracing Risky Decision Making for Oneself and Others: The Role of Intuition and Deliberation, explores how individuals make choices under risk for themselves and on behalf of other people. The findings demonstrate that while there are no differences in preferences for taking risks when deciding for oneself and for others, individuals have greater decision error when choosing for other individuals. The differences in the decision error can be partly attributed to the differences in information processing; individuals employ more deliberative cognitive processing when deciding for themselves than when deciding for others. Conducting more information processing when deciding for others is related to the reduction in decision error. The fourth essay, The Effect of Decision Fatigue on Surgeons’ Clinical Decision Making, investigates how mental depletion, caused by a long session of decision making, affects surgeon’s decision to operate. Exploiting a natural experiment, we find that surgeons are less likely to schedule an operation for patients who have appointment late during the work shift than for patients who have appointment at the beginning of the work shift. Understanding how the quality of medical decisions depends on when the patient is seen is important for achieving both efficiency and fairness in health care, where long shifts are popular. The fifth essay, Preferences for Outcome Editing in Monetary and Social Contexts, compares whether individuals use the same rules for mental representation of monetary outcomes (e.g., purchases, expenses) as for social outcomes (e.g., having nice time with friends). Outcome editing is an operation in mental accounting that determines whether individuals prefer to first combine multiple outcomes before their evaluation (integration) or evaluate each outcome separately (segregation). I find that the majority of individuals express different preferences for outcome editing in the monetary context than in the social context. Further, while the results on the editing of monetary outcomes are consistent with theoretical predictions, no existing model can explain the editing of social outcomes.
Author: Juan Carlos Cantu Montoy Publisher: ISBN: Category : Languages : en Pages : 208
Book Description
This dissertation is comprised of three chapters, each of which contributes to the fields of health economics and psychology & economics. Two of the chapters investigate how choice architecture affects patients health care decisions. The third investigates the role of beliefs in the demand for health information. The underlying motivation for these studies stems from the observations that the proportion of HIV-infected persons in the United States who are undiagnosed has remained constant for over a decade, and those who are diagnosed are often diagnosed late in the course of their disease. Deeper understanding of how HIV test acceptance by patients depends on how the test is offered has the potential to decrease the frequency of missed opportunities for identifying infected persons. Choice architecture has the potential to influence patients' health and health care deci- sions. In particular, decisions with significant but delayed consequences can be very sensitive to small, immediate costs and benefits. I investigate how small monetary incentives and de- fault test policies affect patient decision making with regard to HIV testing. I conduct and analyze the results of a field experiment that takes place in an urban emergency depart- ment (ED). In parallel with routine care, patients are approached by research assistants and offered HIV tests and questionnaires according to treatment assignments. In a factorial design, patients are randomly assigned to be offered HIV tests according to default scripts; they are also offered small monetary incentives and a questionnaire eliciting HIV-related risk behaviors. Patients are offered the questionnaire either before or after the test offer. Among those assigned to an early questionnaire, half are assigned to an additional question asking whether they would hypothetically accept an HIV test, a f̀oot-in-the-door' question (FITD). In Chapter 1, "HIV Screening: To Test or Not to Test? It Depends on the Question," I examine three test defaults: traditional opt-in (test only those patients who request test- ing), opt-out (routine testing unless patients decline), and active-choice testing (patients are required to state whether they want to be tested). I find a test acceptance rate of 51.2% in the opt-in treatment. Active-choice and opt-out test schemes increased the proportion of patients who accepted HIV testing by clinically significant levels. Patients assigned to an active-choice test offer are 9.5 percentage points more likely to accept an HIV test; those assigned to an opt-out offer are 18.2 percentage points more likely than opt-in patients. I take up the issue of monetary incentives in "Conditional Cash Incentives for HIV Test- ing." Patients are offered monetary incentives ($0, $1, $5, $10), which vary by ED zone (four zones) by day. I find that cash incentives of $5 and $10 increase test acceptance rates by 11.7 and 12.8 percentage points, respectively, from a baseline of 57.9% with no incentive. The $1 treatment assignment has no significant effect on overall test rates. It does, however, have a differential effect on high- and low-risk patients: patients reporting HIV risk factors are 4.3 percentage points more likely to test when offered $1 than when offered no incentive, and patients denying any risk factors are 9.6 percentage points less likely to accept testing when offered $1 than when offered no incentive. I find no difference in test rates between patients assigned to the FITD treatment and those in the early questionnaire treatment who were not asked the hypothetical question. Across defaults and monetary incentives, I observe an effect of being offered a questionnaire: patients assigned to either of Early or FITD questionnaires are 10.8 percentage points less likely to accept testing than those who are offered the test prior to being offered the questionnaire. In "Perceptions and Misperceptions of HIV Transmission, Testing, and Treatment" I examine the relationship between beliefs regarding HIV transmission, testing, and treatment on subjects' testing behavior. I find that subjects grossly overestimate the probability of transmission for both real (e.g., injection drug use) and false (e.g., sharing a beverage) risk behaviors. Subjects also overestimate the prevalence of HIV. Despite these overestimates and self-reported risk behaviors, most consider themselves to be at no or very low risk of HIV infection, and few have ever tested for HIV. While these findings support both classical and behavioral interpretations (including psychological expected utility), these findings suggest that people's beliefs regarding HIV risk are biased and suggest that educating the public might be counterproductive, leading to more risky behaviors and lower testing rates.
Author: Janos Zsiros Publisher: ISBN: Category : Languages : en Pages : 298
Book Description
This dissertation consists of two distinct chapters that answer questions in behavioral economics about the relationship between labor supply and reference points. Each chapter is divided into two parts. The first part of the first chapter proposes the theoretical background to better understand labor supply decisions of workers with multiple reference points. The second part contains empirical results from a laboratory experiment. The second chapter analyzes a classical contract theory problem with agents who have non-standard, reference dependent, preferences. The first part of the second chapter analyzes the principal-agent model under full information, while the second part of the chapter introduces uncertainty into the model. The first essay uses a real effort experiment to test the predictions of models with expectation-based and history-based reference points. For the expectationbased reference point, an agent cares about outcomes relative to her expectation, and she experiences a loss in utility if the actual outcome is below her expectation. For the history-based reference point, an agent evaluates her actual outcome compared to an outcome that she had in the past, and she experiences a loss in utility if the actual outcome is below the one from the past. In the experiment, I manipulate participants' past earnings exogenously to establish a history-based reference point and manipulate expectations about future earnings to establish an expectation-based reference point. Consistent with the model's predictions, I found evidence of both kinds of reference points. Subjects work significantly more in the high expectation treatment; on average, they earn $1.1 more (a marginal effect of 18.2%) in the high expectation treatment compared to the average earnings of $6.03 in the low expectation treatment. Subjects in the high history treatment earn $0.46 more (a marginal effect of 7.2%) compared to the average earnings of $6.35 in the low history treatment. The sign of the effect is in line with the main model's prediction for effort level, but the size of the effect is not significantly different from zero due to the low power of the test. The second essay analyzes a principal-agent model with an agent who has reference-dependent preferences with exogenously given reference point over either money or effort level. I find that the optimal effort level, designed by the principal, does not depend on the reference salary. I show that employers with projects where effort is crucial hire agents with high reference points or push up the reference points of agents whose initial reference point is low. Finally, I discuss the predictions of the model for matching between employers and workers based on workers' reference dependence. I show that employers with projects where effort is crucial hire agents with high reference points or push up the reference points of agents whose initial reference point is low. The last part of the essay presents a theoretical model, in which the principal cannot observe the effort level produced by the agent, and is thus unable to make the optimal wage contract depend upon it. I analyze the Lagrangian corresponding to the problem with uncertainty and I derive conditions for the optimal wage contract and optimal effort level.
Author: Tarso Mori Madeira
Author: Tarso Mori Madeira
Author: Uri Gneezy
Author: George Katona
Author: Kinga Posadzy
Author: Juan Carlos Cantu Montoy
Author: George Katona
Author: Johannes Abeler
Author: Robert Jean Oxoby
Author: Chencan Ouyang
Author: Janos Zsiros