Download or read book Essays on the Economics of Health Care Markets written by Andrew Olenski and published by . This book was released on 2023 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Download or read book Essays on Competition in Health Care Markets written by Xing Wu and published by . This book was released on 2018 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over the last decades, health economics has turned into one of the most active research fields within economics. The structure of health care markets varies enormously across countries, largely influenced by competition among suppliers, the regulation of markets and patient preferences. This dissertation presents an analysis of health care markets especially focusing on price competition and quality competition. Under price competition, a pair of asymmetric pure strategy price equilibria exists in a model with income constraints for the specific case that two physicians locate at the maximum distance from each other and patients pay the same marginal transportation cost. Under quality competition, I investigate the interplay of market transparency and semi-altruism - a specific and interesting aspect unique to markets for health care. Market transparency and semi-altruism show ambiguous effects on welfare. The more altruistic physicians provides weakly higher quality than the less altruistic one. Moreover, I explore individual and social incentives for hospital mergers and their interaction with transparency and find that higher transparency does not always lead to higher quality and higher social welfare. The results indicate that quality is lower after merger. A hospital merger leads to a higher social welfare if the efficiency gains from the merger are sufficiently large. ; eng

Download or read book Essays on the Economics of Health Insurance Markets written by Richard Domurat and published by . This book was released on 2018 with total page 200 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation includes three chapters on the health insurance markets established by the Affordable Care Act (ACA), known as exchanges. Chapter 1 estimates the demand for each plan in the California exchange using a discrete choice model. The model incorporates heterogeneity in consumer preferences and in product characteristics, including hospital and primary care physician (PCP) networks. Endogeneity of prices is addressed using networking hospital costs as instruments, and prices for any given plan can vary across consumers within a market. Consumers are highly sensitive to prices, with market shares declining by 3%-5% for just a $1 increase in the premium. Demand also responds to hospital and PCP networks, but to a relatively small degree. Along the take-up margin, a $1 increase in premium subsidy increases take-up by 1.4%. Chapter 2 uses a structural model of demand and supply to examine how two insurance market regulations--community rating and risk adjustment--affect prices and enrollment in the ACA exchange in California. Without risk adjustment, community rating in the ACA would lead to a significant reduction in enrollment in desirable plans and in take-up overall. Risk adjustment under the ACA roughly restores relative shares across plans to what they would be without community rating; however, the reduction in take-up is not restored. An alternative risk adjustment method can increase enrollment by 3.0% and would have little impact on government spending. Chapter 3, written jointly with Isaac Menashe and Wesley Yin, examines the impact of information on insurance take-up in the ACA. We exploit experimental variation in the information mailed to 87,000 households in California's exchange to study the role of frictions in insurance take-up. We find that a basic reminder of the enrollment deadline raised enrollment by 1.4 pp (or 16 percent). Compared to the reminder alone, also reporting personalized subsidy benefits increases take-up among low-income individuals, but decreases take-up among higher-income individuals. This is despite reminder-only recipients eventually observing their subsidies before purchase. Finally, the letter interventions induced healthier individuals into the market, lowering aggregate spending risk by 5.9 percent, suggesting these interventions can improve both enrollment and average market risk.

Download or read book Essays in the Economics of Health and Medical Care written by Victor R. Fuchs and published by New York : National Bureau of Economic Research distributed by Columbia University Press. This book was released on 1972 with total page 272 pages. Available in PDF, EPUB and Kindle. Book excerpt: Collection of essays on the economics of health and health services in the USA - covers supply and demand, budgetary resources, cost and objectives with regard to medical care, and considers wages and income distribution among medical personnel, effects of health care on labour productivity, etc. References and statistical tables.

Download or read book Essays in the Labor Economics of Healthcare written by Erin Metcalf Johnson and published by . This book was released on 2010 with total page 190 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Download or read book Uncertain Times written by Peter J. Hammer and published by Duke University Press. This book was released on 2003-12-08 with total page 373 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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

Download or read book Essays on the Economics of Health Care in the United States written by Patricia Kuan-Pei Foo and published by . This book was released on 2013 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.

Download or read book Five Essays on Competition and Regulation in Health Care Markets written by Kurt Richard Brekke and published by . This book was released on 2003 with total page 142 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Three Essays on Healthcare Markets and Political Economy written by Jason Alan Snyder and published by . This book was released on 2006 with total page 260 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation examines three important topics in healthcare and political economy. The unifying theme behind this dissertation is to examine the process of getting a job and keeping a job in health and political labor markets.

Download or read book From Scientific Research to Healthcare Markets written by Dennis Byrski and published by . This book was released on 2021 with total page 11 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays in Health Economics and Public Finance written by Boris Viktorovich Vabson and published by . This book was released on 2015 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation focuses on topics in health economics and public finance. I deal with questions that have importance for health policy, and that are simultaneously of general economic interest; in particular, I consider the efficiency impact of privatization, the effects of competition in health care markets, and the effects of incomplete contracting and imperfect competition on rates of pass-through to consumers and governments. In Chapter One, I examine the extent to which contracting out by governments yields efficiency improvements, by looking to Medicaid contracting in New York State. To identify the efficiency impact of private, relative to public Medicaid, I exploit involuntary switching between the two; primarily, I leverage age-based rules forcing individuals to switch from private to public Medicaid at 65. I also leverage unique administrative data, which longitudinally tracks individual utilization across the public and private Medicaid settings. I find evidence that private Medicaid yields efficiency improvements, but find no evidence that these improvements are passed on to either governments or patients. Instead, I find that pass-through is substantially limited by incomplete contracting, with plans shifting costs to medical services that remain under government provision. In Chapter Two, I examine the effects of cost-sharing among a previously understudied population-those dually enrolled in Medicaid and Medicare. I leverage an exogenous court ruling that resulted in loss of Medicaid coverage in Tennessee, among 25,000 individuals who had previously been dually-enrolled. This disenrollment resulted in an increase in average cost-sharing rates, from around 0% to around 20%. I find that this cost-sharing increase resulted in a utilization reduction of about 30%, implying an arc-elasticity in spending of about -.2. In Chapter Three, with Mark Duggan and Amanda Starc, we examine how contracts are affected by their generosity, by looking to the Medicare Advantage program. In doing so, we exploit a substantial policy-induced increase in MA reimbursement in metropolitan areas with a population of 250,000 or more relative to MSAs below this threshold. Our findings also reveal that about one-eighth of the additional reimbursement is passed through to consumers in the form of better coverage.

Download or read book Essays in Health Economics written by Eric Scott Wilkinson and published by . This book was released on 2019 with total page 194 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this dissertation, I study three issues in the field of health economics. Chapter 1, ``The Effect of Internet Gambling Laws on Suicide: Evidence From New Jersey,'' examines the effect of legalizing Internet gambling on suicide rates following the introduction of legal Internet gambling in New Jersey. The emergence and subsequent rapid growth of Internet gambling has raised significant public health questions and concerns. The relationship between Internet gambling and pathological gambling has been studied extensively. However, the link between them is not well understood. This study exploits a change in the legal status of Internet gambling to estimate the effects of Internet gambling on state level suicide rates using both a differences-in-differences model and a synthetic control model. I find no statistically significant effect of the law on suicides. Secondary analyses using Internet search data find evidence of an effect on mental health and addiction. These results are important because they show that, once endogenous correlation in Internet gambling participation is controlled for, the effects of its legalization on public health may diminish. This is in sharp contrast to the heft of existing literature and may help to better understand the link between Internet gambling and pathological gambling. Chapter 2, ``The Effect of Increased Cost-Sharing on Low-value Service Use,'' examines the effect of a value-based insurance design (VBID) program implemented at a large public employer in the state of Oregon. The program substantially increased cost-sharing for several healthcare services likely to be of low-value for most patients: diagnostic services (e.g., imaging services) and surgeries (e.g., spinal surgeries for pain). Using a differences-in-differences design coupled with granular, administrative health insurance claims data over the period 2008 to 2013, we estimate the change in low-value service use among beneficiaries before and after program implementation relative to a comparison group not exposed to the VBID. Our findings suggest that the VBID significantly reduced the use of targeted services, with implied elasticities of demand somewhat larger than estimates for general healthcare services. We find no evidence that increasing cost-sharing for these low-value services led to substitution to non-targeted services or increased overall healthcare costs. These findings have implications for both public and private healthcare policies as VBID principles are proliferating in United States healthcare markets. Chapter 3, ``The Effect of Mandatory Managed Care on Preventable Hospitalizations for the Aged, Blind, and Disabled Population of Medicaid in New Jersey,'' examines the effect of a mandatory transition to Medicaid managed care for the aged, blind, and disabled population in New Jersey Medicaid. Medicaid has grown over the last few decades to a program which now covers one in five Americans and costs over half of one trillion dollars to administer. Medicaid represents the largest item on a state's budget; the largest share of that money is spent on a small group of high-cost individuals: the disabled. Seeking to expand upon the successes, no mater how limited, and the ability to smooth costs over time, states began to shift these high-cost, complex patients into managed care plans. The evidence on how well these plans can handle the demanding needs of this population is still debated. In this paper, I utilize the variation induced from a shift to mandatory managed care in preventable hospitalizations for the physically and developmentally disabled in New Jersey's Medicaid program to asses the impact on access to care for this extremely vulnerable population. Using a difference-in-differences model I find the introduction of managed care reduced the monthly preventable hospitalization rate 6.4%[-11.5,-1.3]. To my knowledge, this would be one of the first causal estimates for this population, and the first for New Jersey.

Download or read book Essays on the Economics of Health Insurance Labor Markets and Migration written by Ricki Marie Sears Dolan and published by . This book was released on 2016 with total page 368 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation contains three chapters, two which focus on health insurance and one focusing on migration. The first chapter examines how a policy expanding public health insurance for young children affected their parents' labor market and health insurance outcomes. I use variation in the initial income thresholds, children's age cutoffs and timing of implementation across states to estimate the effect of a person's youngest child gaining access to public health insurance on self-employment. I find that having a child become Medicaid eligible increases a father's self-employment and increases his business income. I find no significant effect on self-employment for mothers, but I find that the increasing eligibility is associated with a large negative effect on their probability of remaining in a wage job. The second chapter examines how expanding dependent health insurance for young adults affects the health insurance and labor market outcomes of those young adults and their parents. I exploit two sources of variations in the age at which young adults age out of their parents' health insurance: i) state reforms passed between 2000 and 2010 that extended the maximum age of health insurance dependents beyond 18 and ii) the Affordable Care Act that extended coverage for all young adults in the United States until their 26th birthdays. Using regression discontinuity, I find evidence that the policies increased young adult dependent coverage. Dependent coverage for eligible young adults increased by 8 percentage points over ineligible young adults, while health insurance in the young adults' own name decreased by 6.5 percentage points. I also see evidence that parents of eligible young adults responded by changing their own coverage. The final chapter investigates the relationship between children and migration using data from the American Communities Survey. To address the issue that both migration and fertility might be correlated with unobserved variables I use twin births as an instrumental variable for the number of children. I find that that an additional child decreases migration by 0.6 percentage points and decreases the probability that a woman lives in her birth state by 1.4 percentage points. This suggests that more children hinder migration.

Download or read book Essays in Health Economics and Industrial Organization written by Paul Evan Wong and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation presents three essays in health economics and industrial organization. In the first essay, titled "Entry and Long-Run Market Structure in Nongroup Health Insurance, " I examine why there are many highly concentrated markets for nongroup (individual) health insurance in the United States. I do this by estimating a static model of entry, with which I show two results. First, incumbent insurers attract disproportionately high market share but do not get a disproportionate share of the most profitable consumers via underwriting (screening). Due to their high market share, they partially deter entry by other more marginal insurers, contributing to high market concentration. Second, rural areas have low population, unprofitable demographics (low-income, high disease incidence), and higher fixed costs of entry (isolated, few physicians). All three confluent factors at once cause rural areas to face significantly more market concentration than others. I use the estimated model to simulate the long-run changes in market concentration under the Affordable Care Act. Most urban areas face a decline in market concentration, but most rural areas - which were already highly concentrated - face an increase in market concentration. In the second essay, titled "Competition and Innovation: Did Monsanto's Entry Encourage Innovation in GMO Crops?, " I examine the relationship between competition and innovation using Monsanto's entry into agricultural biotechnology. In 1996, Monsanto - then a chemical firm - bought a plant breeder that had developed a new corn hybrid, which could withstand Monsanto's powerful herbicide Roundup. Due to the pre-existing structure of the US plant-breeding industry, this acquisition and Monsanto's acquisition of five other corn breeders meant that Monsanto had also entered soy breeding, in addition to corn. As a result, the market structure of soy breeding shifted from a quasi monopoly (by Pioneer Hi-Bred) to a duopoly with a competitive fringe. At the same time, Monsanto's acquisitions created no significant change in the market structure for other crops, such as wheat or cotton. Using new data on field trials, I study the effects of these changes on innovation. These data indicate that Pioneer and the competitive fringe innovated less in response to Monsanto's entry. Data on patent applications, however, indicate that Pioneer and the competitive fringe patented more after Monsanto entered. In the third essay, titled "Studying State-Level Variation in Nongroup Health Insurance Regulation: Insurers' Incentives to Screen Consumers, " I compare different state-level regulations for nongroup (individual) health insurance, and I use the comparison to show how regulation may affect insurers' incentives to screen and reject high-cost consumers. The study is possible because of historical variation in regulation - various states instituted high-risk pool (HRP), community rating (CR), and guaranteed issue (GI) regulation in the 1990s. I compare rejections of individual insurance applications across the different regulatory regimes. Rejections do not decline under HRP regulation. Historically, HRPs have generated little change to demand for private nongroup insurance among high-cost consumers, leaving underwriting (i.e. screening) unchanged. CR by itself (without GI) increases rejections. Insurers have a stronger incentive to underwrite when it is allowed but pricing is restricted. GI (with CR) decreases rejections, but they are not fully eliminated - a non-zero fraction of consumers are still rejected. Insurers face substantial incentive to screen consumers, which may outweigh the implicit cost of screening that regulation imposes. In light of insurers' behavior under these three regulations, future policy should decrease insurers' incentives to screen consumers. This reduces wasted resources devoted to underwriting.

Download or read book Supplementary Products in the Health Insurance Market and Its Implications written by Alexander Ellert and published by . This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Triumph of the Market written by Edward Herman and published by . This book was released on 1997-02-04 with total page 298 pages. Available in PDF, EPUB and Kindle. Book excerpt: **** The third edition (1990) is cited in Brandon-Hill. A text that focuses on the decision-making process which precedes and governs the selection of treatment of various pediatric orthopedic conditions. Each author provides the basic science that relates to the condition under discussion and the scientific basis for treatment decisions. This revised and updated edition is also completely reorganized, adding a second editor and 16 new authors. New chapters deal with orthopedic genetics, history taking and examination of the pediatric patient, syndromes and localized disorders affecting bone, neuromuscular disorders, and fracture treatment, a major portion of pediatric orthopedic practice. Thoroughly illustrated in bandw. Annotation copyright by Book News, Inc., Portland, OR

Download or read book Five Essays on the Economics of Health and Health Care written by Gregory Gill Lubiani and published by . This book was released on 2012 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This doctoral dissertation consists of five essays in applied microeconomics with focus on healthcare economics and health services research. The first three are innovative being the first in the health economics literature to investigate different distinct aspects of modeling the economic contents of U.S. physical therapy production using the generalized flexible translog (GTL) dual cost model and iterative seemingly unrelated regression estimation (ISURE) technique. Using the higher frequency (bi-weekly) panel dataset, pair-wise input factor relationships of three distinct labor types are examined for the fast growing industry, which has up to now lacked current economic investigation due to data paucity. Pair-wise factor relationships (isoquant curvature) were investigated for three competing conceptual measures of the elasticity of substitution (own- and cross-price, Allen-Uzawa, Morishima, and shadow), as well as scale economies at constant output. Second, three Pythagorean means (arithmetic, harmonic and geometric) were investigated for appropriateness as the mean expansion point for the GTL model. Finally, statistical tests were conducted indicating that pediatric and adult clinics operate with distinct underlying technologies. The final two essays incorporate health economics and health services, research in the study of patient care decision, as it relates to Do Not Resuscitate (DNR) orders, and the impact of the decision on health outcomes. The DNR papers, using Probit and propensity score research methodologies, are the first to utilize a large, comprehensive patient discharge dataset to provide insights into the potential implications for healthcare policy, patient awareness and care, most notably for the rapidly aging baby-boomer population.