Download or read book Essays on the Effects of Public Health Insurance Policies on Health Care Utilization Expenditure and Well being written by Tu Nguyen (Ph. D. in economics) and published by . This book was released on 2020 with total page 150 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Download or read book Impact of Health Insurance in Low and Middle income Countries written by Maria-Luisa Escobar and published by Brookings Institution Press. This book was released on 2010 with total page 239 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance-based care is key to the public policy debate of whether to extend insurance to low-income populationsand if so, how to do itor to serve them through other means.
Download or read book Communities in Action written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-27 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Download or read book Essays in Health and Labor Economics written by Ana Ines Rocca and published by . This book was released on 2015 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Essays on Public Policy and Health Care Market written by Shuyang Yang and published by . This book was released on 2017 with total page 129 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation focuses on examining the impact of public spending in health insurance and health care markets. Health care subsidies account for a fast-growing share of public expenditures in many developed and developing countries, making them an ever more important component of fiscal policy discussions. Two principle projects constitute my dissertation research. In the first project, I examine the heterogeneity in the impact of subsidized health insurance coverage on individual welfare, in the context of a Chinese public health insurance program. In the course of this research, I have also developed new econometric methods to address the empirical challenges of studying the effects of health insurance. These methods have broad applications beyond topics in health economics. In the second project, I look at the role of tax subsidies in the supply of health care. In particular, I exploit variations in state and federal level tax policies in the U.S to estimate the impact of government subsidies on ownership choice, provision of public services and the quality of hospitals. The first chapter of the dissertation mainly assesses the effect of public health insurance on program beneficiaries' welfare, by evaluating a new national public medical insurance program in China, Urban Resident Basic Insurance (URBMI). This program, introduced in 2007 and having an annual fiscal expenditure of 30 billion RMB, aims to provide coverage to more than 200 million urban residents including elderly, children, college students and unemployed adults. I exploit the city-variation in policy generosity as an exogenous determinant of URBMI enrollment. Using data from the Chinese Health and Nutrition Survey (CHNS), I find that URBMI increases welfare on several margins. Having insurance coverage increases health care spending while decreasing the out-of-pocket payments, providing protection from the financial risk. It also increases efficiency in medical spending by inducing the use of preventative care and reducing the probability of hospitalization. In terms of health outcomes, insurance coverage has a significant impact on subjective self-ratings in health and happiness. I also extend my examination to consider the labor market effects of URBMI. Since this program provides insurance coverage outside of employment status, it will potentially increase an individual's mobility between jobs and impact the retirement decision. In Chapter 2, building on the results of the first chapter, I explore the heterogeneity in the impact of health insurance through a semiparametric model. Since URBMI is a national program covering a wide range of subpopulations, observed and unobserved individual characteristics may play an important role in determining the response of an individual to insurance coverage. This chapter builds a panel data model with endogenous treatment, which incorporates unobserved individual heterogeneity non-additively into the outcome. The model is estimated in the context of a semiparametric setting. I first propose a two-stage semiparametric least square (SLS) method to consistently estimate the model parameters and then conduct a localized 2SLS procedure to recover the quantile treatment effect. Identification, consistency, and root-N asymptotic normality of estimators for parameters and marginal effects are proved. The estimation results reveal substantial variation in the impact of URBMI by age, income and gender. Children, the elderly above the age of 70, and females ages 25-40 benefit the most from the program. Adult males and individuals with incomes below the median level do not respond significantly to insurance coverage. The findings of heterogeneous insurance effects have important policy implications for the cost-effectiveness of URBMI across population groups, suggesting the need for differentiated insurance programs. In the third chapter, another form of subsidy in health care markets is studied. This chapter focuses on assessing the effect of government subsidies on the supply side of the health care market in the U.S. An important form of government subsidies to health care providers is the tax exemption for non-profit organizations. The validity and efficiency of such practice has long been under debate. Recently, many state and federal laws have been enacted that mandate the reporting of benefits provided to the community by non-profit providers. This chapter studies the hospital sector. Given the preferential tax treatment for nonprofit hospitals, the tax rate, in conjunction with community benefit reporting requirement (CRR), determine the net subsidy provided to a nonprofit hospital compared to its for-profit counterpart. I exploit the variation in tax policy across states and over time to identify the effect of tax subsidy on the ownership choice of hospitals. I further differentiate behavior between nonprofit versus for-profit hospitals, including cost, provision of undercompensated care as well as quality. Using Center for Medicare and Medicaid Services(CMS) hospital cost report data from 1996 to 2015, I estimate a 4-6 percent increase in the probability of non-profit conversion into for-profit hospitals due to the enactment of CRR. Moreover, the effect of CRR diminishes with the tax rate. My results further show that hospitals divert community benefit spending to teaching to meet the requirement of CRR, rather than increasing provision of uncompensated care.
Download or read book America s Children written by Institute of Medicine and National Research Council and published by National Academies Press. This book was released on 1998-10-27 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.
Download or read book Retooling for an Aging America written by Institute of Medicine and published by National Academies Press. This book was released on 2008-08-27 with total page 316 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the first of the nation's 78 million baby boomers begin reaching age 65 in 2011, they will face a health care workforce that is too small and woefully unprepared to meet their specific health needs. Retooling for an Aging America calls for bold initiatives starting immediately to train all health care providers in the basics of geriatric care and to prepare family members and other informal caregivers, who currently receive little or no training in how to tend to their aging loved ones. The book also recommends that Medicare, Medicaid, and other health plans pay higher rates to boost recruitment and retention of geriatric specialists and care aides. Educators and health professional groups can use Retooling for an Aging America to institute or increase formal education and training in geriatrics. Consumer groups can use the book to advocate for improving the care for older adults. Health care professional and occupational groups can use it to improve the quality of health care jobs.
Download or read book THREE ESSAYS IN HEALTH ECONOMICS written by Linh Tran and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the second leading cause of death and major contributor to the rise in health expenditures, cancer is a critical piece of US health care. My dissertation seeks to understand how cancer-related health policies and insurance coverage have affected cancer care utilization, access to care, affordability, and health outcomes. Specifically, Chapters 1 and 2 focus on the association between Dense Breast Notification (DBN) -- state laws intended to inform women who have undergone mammography about increased risk of breast cancer associated with dense breast tissue -- and healthcare utilization, expenditures, and patient outcomes. Chapter 3 explores the influence of Medicare coverage on the use of chemotherapy among patients with kidney cancer. Routine screening mammograms are critical for detecting and treating breast cancer at an early stage. However, dense breast tissue makes it more difficult for radiologists to evaluate the results of a mammogram and spot early signs of tumors. Recently, states have passed legislation to standardize the reporting of dense breast tissue to patients, which require women to be informed of their breast density as well as the clinical implications (e.g., more frequent screening or more advanced imaging) and risks related to dense breast tissue. Some states have also mandated health insurance plans to cover supplemental breast imaging for patients with dense breast tissue to remove cost- related barriers. Despite well-intentioned goals, evidence of the impact of these laws remains limited. Hence, the first chapter will examine the relationship between DBN legislation and women's health outcomes. The second chapter will explore the tradeoff between utilization and costs of additional testing resulting from the implementation of this law. Using longitudinal data from 2007 to 2016 at both the individual and state level, I estimate the effect of DBN laws comparing health outcomes (stage at diagnosis and 1-year mortality), utilization, and expenditures in states with and without such laws. I found that DBN laws were associated with improved early breast cancer detection and increased use of supplement imaging but only in states with DBN laws that mandate insurance coverage of supplemental breast imaging for dense breasts; however, changes in mortality and costs to patients were relatively small after the laws went into effect. Overall, the findings suggest that if one of the goals of DBN laws is to encourage supplemental imaging for women at the highest risk, coverage for supplemental imaging is important. On the other end of the cancer care continuum is chemotherapy. Given increasing numbers of kidney cancer patients and innovative therapeutic strategies that have occurred recently in the management of renal cell carcinoma (RCC), the third chapter focuses on chemotherapy use among Medicare beneficiaries with metastatic (i.e., advanced stage) RCC. One major policy concern is how patients' health insurance status may influence the ability to access timely and effective chemotherapy. Prior work has indicated that when patients become eligible for Medicare at age 65 their cancer-related health outcomes significantly improve. But no study has focused on how gaining insurance may affect the use of expensive chemotherapies in the RCC population. This chapter uses a regression discontinuities design -- an established approach that compares patients just before the age 65 cutoff to patients just after to assess the impact of Medicare on the use of targeted chemotherapy among patients with metastatic RCC. The approach uses the fact that patients become eligible for Medicare at 65 so evidence has shown a significant increase in health insurance coverage at this age as the uninsured or underinsured (those with minimal coverage) are able to gain Medicare coverage. Even though transition to Medicare has been found to substantially reduce medical-related financial strain and improved health outcomes, I found limited impact of Medicare on the chemotherapy use among patients with metastatic RCC. A possible explanation is that there might be limited variation in treatment for advanced disease further highlighting the complexity of health policies targeting cancer care. My dissertation suggests that policymakers should be careful when creating policy to improve cancer care. For example, DBN laws are most effective when paired with mandated coverage for subsequent advanced testing. Medicare coverage is critical to improving cancer health outcomes but may be limited in settings where advanced stage of diagnosis leaves less room for treatment decision making. Thus, careful consideration is need to ensure policy improvements and strategies are likely to benefit for patients in terms of increased survival, early-stage diagnosis and improved quality of life.
Download or read book Essays on Public Health Insurance Expansions written by Laura Rose Wherry and published by . This book was released on 2012 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation is comprised of two essays examining expansions in eligibility for public health insurance in the U.S. In the first essay, I focus on expanded eligibility for family planning services under Medicaid and the impact on fertility and the utilization of women's preventive care. In the second essay, which is joint work with Bruce D. Meyer, we examine the immediate and longer-term mortality effects of Medicaid eligibility expansions for children. Both of these papers use variation in public health insurance eligibility created by changes in federal or state eligibility rules to identify a causal relationship between public coverage and health-related outcomes.
Download or read book Report on the Situation of Human Rights in the Republic of Bolivia written by and published by . This book was released on 1981 with total page 117 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Effect of Health Insurance on Health Care Utilization written by Diether W. Beuermann and published by . This book was released on 2012 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper exploits the fact that insurance eligibility in the United States changes abruptly at age 65 due to universal coverage provided by Medicare. In that way, we adopt a regression discontinuity design to analyze the effect of health insurance coverage on health care access and utilization. The main findings suggest that groups with lower pre-65 coverage gain higher increases in the probability of being insured at 65. For instance, less educated persons (less likely to have pre-65 health insurance) appear to increase their likelihood of being insured at age 65 by more than their more highly educated counterparts. Furthermore, this increased insurance coverage appears to be associated with reductions in intergroup disparities in health care access. Therefore, the findings suggest that insurance matters in order to access health care services in a way that could potentially reduce inequalities between different ethnic groups.
Download or read book Essays in Health Insurance written by Hubert Piotr Janicki and published by . This book was released on 2011 with total page 88 pages. Available in PDF, EPUB and Kindle. Book excerpt: This work is driven by two facts. First, the majority of households in the U.S. obtain health insurance through their employer. Second, around 20% of working age households choose not to purchase health insurance. The link between employment and health insurance has potentially large implications for household selection into employment and participation in public health insurance programs. In these two essays, I address the role of public and private provisions of health insurance on household employment and insurance decisions, the distribution of welfare, and the aggregate economy. In the first essay, I quantify the effects of key parts of the 2010 health care reform legislation. I construct a lifecycle incomplete markets model with an endogenous choice of health insurance coverage and calibrate it to U.S. data. I find that the reform decreases the fraction of uninsured households by 94% and increases ex-ante household welfare by 2.3% in consumption equivalence. The main driving force behind the reduction in the uninsured population is the health insurance mandate, although I find no significant welfare loss associated with the elimination of the mandatory health insurance provision. In the second essay, I provide a quantitative analysis of the role of medical expenditure risk in the employment and insurance decisions of households approaching retirement. I construct a dynamic general equilibrium model of the household that allows for self-selection into employment and health insurance coverage. I find that the welfare cost of medical expenditure risk is large at 5% of lifetime consumption equivalence for the non-institutionalized population. In addition, the provision of health insurance through the employer accounts for 20% of hours worked for households ages 60-64. Finally, I provide an quantitative analysis of changes in Medicare minimum eligibility age in a series of policy experiments.
Download or read book Moral Hazard in Health Insurance written by Amy Finkelstein and published by Columbia University Press. This book was released on 2014-12-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: Addressing the challenge of covering heath care expenses—while minimizing economic risks. Moral hazard—the tendency to change behavior when the cost of that behavior will be borne by others—is a particularly tricky question when considering health care. Kenneth J. Arrow’s seminal 1963 paper on this topic (included in this volume) was one of the first to explore the implication of moral hazard for health care, and Amy Finkelstein—recognized as one of the world’s foremost experts on the topic—here examines this issue in the context of contemporary American health care policy. Drawing on research from both the original RAND Health Insurance Experiment and her own research, including a 2008 Health Insurance Experiment in Oregon, Finkelstein presents compelling evidence that health insurance does indeed affect medical spending and encourages policy solutions that acknowledge and account for this. The volume also features commentaries and insights from other renowned economists, including an introduction by Joseph P. Newhouse that provides context for the discussion, a commentary from Jonathan Gruber that considers provider-side moral hazard, and reflections from Joseph E. Stiglitz and Kenneth J. Arrow. “Reads like a fireside chat among a group of distinguished, articulate health economists.” —Choice
Download or read book Health Insurance Effects written by Milton Irwin Roemer and published by . This book was released on 1972 with total page 88 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Essays on the Economics of Health Insurance written by and published by . This book was released on 2012 with total page 294 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation focuses on the economics of health insurance. In the first essay, I take advantage of discontinuities in the structure of Wisconsin's Medicaid program to identify the effects of cost-sharing on insurance status, utilization, and health outcomes for low-income families. I use a three year administrative panel of enrollment data and health insurance claims for the universe of enrollees to inform my estimates. I find that an increase in the premium from zero to ten dollars results in 1.4 fewer months enrolled and reduces the probability of a one year enrollment spell by 12 percentage points, but other discrete changes in premium amounts do not affect enrollment. Copayments for emergency department visits of $15-60 reduce total visits by as much as 50%, but the reductions come from both necessary and unnecessary care, implying a potentially negative effect on health. In the second essay, which is joint work with colleagues from Wisconsin's BadgerCare Plus evaluation team (Thomas DeLeire, Donna Friedsam, Daphne Kuo, Lindsey Leininger, Sarah Meier, and Kristen Voskuil), I use administrative data from Wisconsin to estimate the percent of individuals newly enrolled in public health coverage that had access to private, employer-sponsored health insurance at the time of their enrollment and the percent that was uninsured. We estimate that among all new enrollees approximately 21% had access to private health insurance at the time of enrollment and that only 10% dropped this coverage. The third essay considers that in markets for health insurance consumers may have private information about their health risk that leads to self-selection into more generous insurance plans. This phenomenon, known as adverse selection, can result in market failures. In joint work with Gaston Palmucci, I use individual-level claims data covering the universe of private insurance enrollees in Chile from 2006-2009 to investigate the potential for adverse selection in the Chilean market for private health insurance using traditional reduced form tests. The results indicate the presence of asymmetric information in Chile.
Download or read book For Profit Enterprise in Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 1986-01-01 with total page 580 pages. Available in PDF, EPUB and Kindle. Book excerpt: "[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topicsâ€"from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." â€"Journal of Health Politics, Policy and Law.
