Download or read book Essays on Health Economics and Technology Adoption written by Leila Shaw Agha and published by . This book was released on 2011 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt: This thesis studies the economics of technology adoption in the healthcare industry. The first chapter analyzes the impact of health information technology (HIT) on the quality and intensity of care delivered to Medicare inpatients. Building an organizational model, I show how the adoption of HIT may improve patient health and may either increase or decrease medical expenditures. Using Medicare claims data from 1998-2005, I estimate the effects of HIT by exploiting variation in hospitals' adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with an initial 1.3% increase in billed charges. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, medical complication rates, adverse drug events, and readmission rates. These results are robust to the addition of rich controls for pre-trends. The findings suggest that HIT is not associated with improvements in either the efficiency or quality of hospital care for Medicare patients, through five years after adoption. In the second chapter, I investigate the scope for physician learning about the value and applications of new medical technologies across geographic regions. In particular, I analyze the diffusion of positron emission tomography and deep brain stimulation, using data on Medicare claims from 1998-2005. The mix of patient diagnoses treated with the new technologies changes substantially during the early stages of diffusion. Moreover, states that are late to adopt these technologies do not repeat the process of experimental learning undertaken by early adopters to discover which patients should receive the new treatment In the third chapter, I analyze several policy initiatives that aim to manage the usage of medical technologies and discuss key determinants of technology adoption that may be fruitful targets for future research and policy intervention. Effective technology policy must balance cost, control with a recognition that new medical technologies have been associated with tremendous health and longevity gains. I find that existing Medicare coverage determinations and state certificate of need programs appear to have little influence on actual resource utilization, in part driven by lack of enforcement of existing policies.

Download or read book Essays in Health Economics and Productivity written by Adam Jon Sacarny and published by . This book was released on 2014 with total page 160 pages. Available in PDF, EPUB and Kindle. Book excerpt: The first chapter studies how incentives drive adoption by looking at a technology that generates revenue for hospitals: the practice of submitting detailed documentation about patients. After a 2008 reform, hospitals were able to raise their total Medicare revenue over 2% by always specifying a patient's type of heart failure. I find that hospitals only captured around half of this revenue. The key barrier to take-up is a principal agent problem, since doctors supply the valuable information but are not paid for it. Exploiting the fact that many doctors practice at multiple hospitals, I find that four-fifths of the dispersion in adoption reflects differences in the ability of hospitals to extract documentation from physicians. Hospital adoption is also robustly correlated with the ability to generate survival for heart attack patients and the use of inexpensive survival-raising standards of care. My results suggest that agency conflicts may drive disparities in health care performance more generally. The second chapter (co-authored with Amitabh Chandra, Amy Finkelstein, and Chad Syverson) challenges the conventional wisdom in health economics that large differences in average productivity across hospitals are the result of idiosyncratic, institutional features of the healthcare sector which dull the role of market forces. Strikingly, we find that productivity dispersion in heart attack treatment across hospitals is, if anything, smaller than in narrowly defined manufacturing industries such as ready-mixed concrete. We also find evidence against the conventional wisdom that the healthcare sector does not operate like an industry subject to standard market forces. In particular, we find that hospitals that are more productive at treating heart attacks have higher market shares at a point in time and are more likely to expand over time. These facts suggest that the healthcare sector may have more in common with "traditional" sectors than is often assumed. The third chapter explores whether hospitals change their treatment decisions when they are paid more for certain treatment approaches. I exploit a Medicare reform that altered payment rates depending on whether patients were relatively healthy or sick. Looking at three treatment approaches for lung cancer patients, I demonstrate economically significant own-price elasticities and right-signed cross-price elasticities - though these estimates sometimes lack statistical power and should be interpreted with caution due to concerns about endogeneity. These findings indicate that payment reforms, including movements toward capitation and away from fee-for-service, may have large effects on the intensity of care that patients receive in the hospital.

Download or read book Three Essays in Development and Health Economics written by Shamma Adeeb Alam and published by . This book was released on 2014 with total page 87 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation is on three essays on issues in development and health economics. In these essays, I try to examine how different health issues affect economic outcomes and vice versa. I examine individual and household responses to different economic and health issues in Bangladesh and Tanzania. In the first two chapters, I examine how different shocks affect family's fertility decisions and decision to make investments on their children in Tanzania. In the third chapter, I examine how information regarding dangers of pesticide affects the likelihood of pesticide exposure for farmers in Bangladesh. In the first chapter, I examine how parental illness affects child labor and schooling outcomes using panel data from Tanzania. Prior literature provides limited empirical evidence on the impact of parental illness on child labor and schooling outcomes. I examine if parental illness causes households to reallocate children's time from school to work. I find that a father's illness hinders child schooling by decreasing attendance and hours spent in school. These effects on schooling are substantially greater for severe illnesses. There is also evidence that a father's illness has long-term impact on child education, as it decreases their likelihood of completing primary school and leads to fewer total years of schooling. However, a father's illness has no effect on child labor. In contrast, a mother's illness does not affect child education, but does cause a small increase in children's work. Surprisingly, parental illness does not have a differential impact by children's gender. Additionally, illness of other household members, such as grandparents, adult siblings, and child siblings, has no effect on children's schooling. Thus, overall, there is no evidence that parental illness or illness of other household members affects children's schooling through increased child labor. Instead, the results suggest that only illness of fathers, who are typically the primary income earners in Tanzanian households, reduces household income and severely decreases the family's ability to afford child education. In the second chapter, which is a joint work with Claus Portner, we examine the relationship between household income shocks and fertility decisions. Using panel data from Tanzania, we estimate the impact of agricultural shocks on contraception use, pregnancy, and the likelihood of childbirth. To account for unobserved household characteristics that potentially affect both shocks and fertility decisions we employ a fixed effects model. Households significantly increase their contraception use in response to income shocks from crop loss. Furthermore, pregnancies and childbirth are significantly delayed for households experiencing a crop shock. We argue that these changes in behavior are the result of deliberate decisions of the households rather than income shocks' effects on other factors that in influence fertility, such as women's health status, the absence or migration of spouse, and dissolution of partnerships. In the third chapter, which is a joint work with Hendrik Wolff, we examine how different information sources influence precautionary behavior when using pesticide and likelihood of pesticide exposure. Modern agriculture heavily depends on the use of pesticides and has successfully increased productivity, but also led to increasing concerns regarding farmers' health. Mishandling of pesticides continues to pose a serious health problem for farmers especially in developing countries. This chapter describes supply side and demand side regulations for pesticide handling, health outcomes and adoption of health technologies using a detailed household level dataset from Bangladesh. The dataset is unique as it spans the chain from: `where do farmers obtain information from', `which precautionary tools (i.e. masks, gloves) are used' and `what are subsequent health outcomes after spraying'. Previous studies hypothesized that pesticide sellers in developing countries misguide farmers regarding pesticide use. On the other hand, government field extension workers reduce pesticide exposure by training farmers in Integrated Pest Management (IPM) techniques. In our dataset we cannot confirm these hypotheses. In contrast, we find that those famers that use information from pesticide sellers increase the adoption of precautionary tools. These same farmers also enjoy subsequently improved health outcomes. Further, our results show that the agricultural extension program does not significantly impact technology adoption or health. We find instead evidence of social learning as peer farmers, especially those trained in handling pesticides, have a substantial influence. We conclude with policy recommendations.

Download or read book Essays on the Economics of Information Sharing in Healthcare written by Yeongin Kim and published by . This book was released on 2018 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act to reform the U.S. healthcare system, health information technology (IT) has attracted much attention from researchers, care practitioners, patients, and policy makers. Among various aspects of IT use in healthcare, information sharing has been considered as a key component in improving U.S. healthcare. In spite of numerous efforts to meaningfully use IT for information sharing, inefficiency issues still remain. This dissertation studies the economics of information sharing in healthcare and provides insights to formulate the right mechanisms to achieve the goal of IT-driven healthcare reform. The first essay examines the contract issues between a policy maker and care providers that can cooperate by implementing health information exchanges (HIEs). Using a gametheoretical model, we show that neither the traditional fee-for-service (FFS) payment model nor the pay-for-performance (P4P) models induce socially optimal outcomes, while an episodebased payment (EBP) model we identified induces the socially desirable effort levels and HIEs adoption. We further show that the value of an HIE is the highest under the FFS model and the lowest under the P4P models. Our findings imply that as payment models evolve over time, there is a real need to reevaluate the value of information sharing though HIE and the government policies that induce providers to adopt an HIE. The second essay studies the role of information sharing in formulation of policy instruments under the new risks of providers’ medical ligation owing to health IT. Specifically, we examine the role of information sharing in formulation of policies on healthcare operations in the presence of physicians’ liability concerns by using a game-theoretic model. We find when litigation is a concern, an underprovisioning policy may become optimal under the litigation risk, depending on the benefit and cost of the health service. We further show that strategically controlling the sharing of risk information restores the optimality of a standard policy (non-underprovisioning). The results of this study imply that the widespread practice of information sharing may induce underutilization of care resources to mitigate the medico-legal risks due to health IT. In the last essay, we study the impact of patient portals on treatment outcomes in the context of kidney allocation for transplant. Using a longitudinal data set of kidney transplant cases, we empirically show that with the implementation of patient portals for information sharing, patients are more likely to use care resources (donated kidneys) that are underutilized without access to a patient portal. However, the impact could be heterogeneous on sub-populations. This indicates that the efforts to bridge the digital divide may benefit some groups of patients at the expense of other groups, leading to further service disparities in the care service.

Download or read book Three Essays in Development Economics written by Lire Ersado and published by . This book was released on 2001 with total page 110 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays on the Evolution of Health Care Technology written by Ashley Renee Hodgson and published by . This book was released on 2011 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation looks at health care technology using the tools and methods of economics. The particular focus is on the causes and implications of dynamic changes in health care technology over time. The dissertation utilizes methodologies developed in public finance to consider the effects of policy change on technological innovation and adoption. I first look at the impact of Medicare's prospective payment system and how it influences which technologies get developed and adopted. This presents an ideal case study because the government implemented the system nationwide in 1983, and there have been many years for innovators to respond to the different financial incentives. Prospective payment theoretically penalizes hospitals for adopting technologies that treat illnesses common among the elderly. This chapter evaluates weather we see empirical evidence that there has been fewer innovative developments targeting illnesses common among the elderly compared to illnesses common among the non-elderly. The data paint a picture that supports the theoretical predictions, and upholds the idea that payment incentives do indeed impact which technologies get developed in the first place. The next chapter looks at a much smaller government change and its short run effect on hospital behavior. Every year, the government adds a few new procedures to the list of icd-9-cm codes. These codes make it easier for hospitals to bill insurers for procedures. This chapter investigates empirically and finds that there is a sudden jump in the number of procedures performed in the quarter when a new code is introduced and that this jump persists going forward. It also looks at different sub-groups of insurers and hospitals, and finds that patients whose insurers depend most heavily on the icd-9-cm codes have the largest jump in the probability of undergoing the procedure in the quarter when it is introduced. The jump in treatment is non-existent for Medicare patients and self-pay patients, for whom the icd-9-cm procedure code is irrelevant. The final chapter investigates changes in ADHD medication over time. Understanding these changes is important in understanding the diffusion of new technology. This project looks at a time period, 2001 to 2003, when a long-acting version of ADHD medication was spreading, which makes it interesting from a technological standpoint. The project particularly asks why some counties have higher growth rates in medication than other counties. What factors lead to faster diffusion in a particular geographic region? My co-authors and I find that supply side characteristics, such as physicians per capita and a younger age distribution among physicians, leads to a faster rate of diffusion. These findings together shed light on some specific key questions about health care technology and how it changes over time. These issues will become increasingly important as health care costs escalate and as policymakers strive to make health care more affordable. Economists have long claimed that new technology plays the biggest role in cost growth. While new technology brings benefits as well as costs, economists will need more tools for evaluating technology cost-effectiveness if cost containment becomes an important enough political goal. This project sheds light on some of the matters that will need to be fleshed out in greater detail if we eventually want to understand innovation's role in rising costs.

Download or read book Three Essays in Experimental and Behavioral Economics of Technology Adoption in India written by Pallavi Shukla and published by . This book was released on 2019 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Fairness Technology Adoption Water Sanitation and Pandemic Control written by and published by . This book was released on 2020 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays on Health Economics and Development Policies written by Henrique Veras De Paiva Fonseca and published by . This book was released on 2019 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays in Health Economics written by Tatyana Avilova and published by . This book was released on 2022 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation consists of three essays in health economics. The three chapters focus specifically on prescription drug use and treatment in various national and state settings and evaluate the impact of government policies and interventions on this sector of the health care market. The first two chapters focus on opioid prescribing in the United States. Prescription drug monitoring programs (PDMPs or PMPs)--online systems that health care providers and pharmacists can use to query patient prescription records--are one of the most widely-used state tools in regulating the prescribing and dispensing of opioids. However, the staggered adoption of PDMPs over time has created opportunities for patients to evade monitoring by going to a state that does not have a PDMP. Chapter 1 evaluates how spillovers attributable to policy non-coordination between neighboring states impact the effectiveness of PDMPs. I find that after prescribers gain access to PDMPs, opioid volume and prescription opioid deaths decrease in counties with a PDMP that are insulated from opportunities for evasion.

Download or read book Essays on Health Economics Using Big Data written by Samane Zarebanadkoki and published by . This book was released on 2019 with total page 125 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays on Learning and Technology Adoption written by Bruce Peter McWilliams and published by . This book was released on 1995 with total page 164 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Economics of New Health Technologies written by Joan Costa-Font and published by Oxford University Press. This book was released on 2009-05-14 with total page 312 pages. Available in PDF, EPUB and Kindle. Book excerpt: Technological change in healthcare has led to huge improvements in health services and the health status of populations. Although offering remarkable benefits, these changes often entail significant financial, physical and social risks. This book analyses the impact of advances in medical technology from an economic perspective.

Download or read book Essays in Health Economics and Public Policy written by Colin D. Cannonier and published by . This book was released on 2011 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays in Health Economics written by Yuriy Pylypchuk and published by . This book was released on 2007 with total page 115 pages. Available in PDF, EPUB and Kindle. Book excerpt: Essay III. Does participation in the food stamp program affect the incidence of obesity? I investigate the impact of participation in the FSP on adult obesity for a low income population using the 2000--2003 Medical Expenditure Panel Survey (MEPS). I implement two estimators to test for sensitivity of results. First, I estimate bivariate models which account for unobservables that vary over time and that are time invariant. Second, I implement propensity score matching methods. The results from both techniques suggest small and positive effect of Food Stamps Program on obesity among women. The study finds no consistent relationship between Food Stamps Participation and weight status among men.

Download or read book Essays in Health Economics and Health Policy written by Salama S. Freed and published by . This book was released on 2018 with total page 95 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Three Essays in Healthcare Economics written by Marco D. Huesch and published by . This book was released on 2008 with total page 522 pages. Available in PDF, EPUB and Kindle. Book excerpt: