Download or read book Essays on the Role of Government Regulation and Policy in Health Care Markets written by Grayson L. Forlines and published by . This book was released on 2018 with total page 210 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays on the Impact of Supply side Regulation in US Health Care Markets written by Bryan J. Perry and published by . This book was released on 2017 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this thesis, I take up the question of how government regulations impact the supply side of the US health care market. In Chapter 1, I exploit the Medicare rural floor, a discontinuity in geographic adjustments to Medicare payments to hospitals, in a regression kink design to estimate the impact of Medicare reimbursement rate changes on the level and mix of hospital services provided. I find that hospitals respond to higher Medicare reimbursement by admitting more Medicare patients, but that the average duration of a patient stay declines. I also document a previously unstudied spillover of Medicare reimbursement on the volume of admitted patients with non-Medicare insurance. For the remainder of my thesis, I turn my attention to Certificate of Need regulation-restrictions on capital investment-in North Carolina. I use newly collected data on the MRI market in North Carolina to estimate the dynamic effects of marginal relaxations of CON restrictions on provider investment. Thresholds in the regulatory approval process enable me to employ a regression discontinuity model to estimate the effects of CON on hospitals and patients. In Chapter 2 I document three key findings. First, health care providers essentially always adopt newly allowed MRI scanners within two years of a CON approval. This suggests that CON regulations are a binding constraint on investment. Second, there is an active market for unregulated mobile MRI scanners that enable health care providers to mitigate the impact of CON restrictions. Finally, MRI utilization increases after new machines are acquired, indicating CON rules affect not only hospital investment but also medical practice. In Chapter 3 I combine the North Carolina regulatory data with patient-level Medicare claims data to estimate the effects of CON on patient care. Hospitals do not offset reductions in MRI services with increased usage of alternative diagnostic imaging technologies. CON regulations reduce the number of scans patients with lower back pain receive by more than a third in the month following their first hospital encounter, reducing medical spending by roughly $400. There is no evidence that this decrease in the intensity of care comes at the cost of increased future lower back pain.

Download or read book Government Failure written by Wilfred Dolfsma and published by Edward Elgar Publishing. This book was released on 2013-01-01 with total page 167 pages. Available in PDF, EPUB and Kindle. Book excerpt: 'Starting from the idea that market and state are intertwined domains, and explaining the economy as a system of communication evolving through innovation, this excellent book makes a valuable contribution to understanding government rule setting in knowledge-based economies. It provides a taxonomy of ways in which government rules function more or less successfully, and addresses the important problem of institutional vulnerability. Intellectual property rights laws and reform of health care systems are perceptively discussed. This book is strongly recommended for public policy experts and researchers investigating the publicprivate economy.' John Davis, Marquette University, US and University of Amsterdam, The Netherlands 'Since the 1970s the conventional wisdom has been that governments should retreat from the economic sphere and enhance the role of markets. The financial crash of 2008 has brought that into question. This stimulating set of essays considers the role of government in modern complex economies. Addressing the potential for both government failure and market failure, and drawing on empirical evidence, these studies are important contributions to a revived debate.' Geoffrey M. Hodgson, University of Hertfordshire, UK 'The idea that governments as well as markets can fail has been central to the public choice literature for the last half century. Typically government failure is described and measured as excessive expenditures or unbalanced budgets. This original book points out that government failures often take the form of inappropriate or inconsistent rules governing the private sector. The argument is nicely illustrated using real-world examples in the areas of healthcare, innovation, and intellectual property. The book is a timely and important contribution to the literature.' Dennis C. Mueller, University of Vienna, Austria This highly unique book takes a fundamental look at when and how a government can fail at its core responsibility of formulating rules. Government, representing society, relates to the economy by formulating the rules within which (market) players should operate. Although market and business failure are much discussed in the economics literature, government failure is often overlooked. This book addresses this gap, exploring in detail what constitutes government failure. Wilfred Dolfsma illustrates that it is not adequate to discuss government failure simply with reference to its level of expenditure, as is usually the case. Defining government failure and analysing it in the domains of health care, innovation and technology, he explores topics such as how market and society relate, consequences of conflicts between government policies, how government should (not) intervene, the vulnerability of institutions and rules (set out by government), and suggests a welfare perspective for evaluative purposes. This stimulating and thought provoking book will prove a fascinating read for academics, researchers and advanced students in economics particularly public choice and institutional economics public administration, policy studies, and law and economics.

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 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 The Privatization of Health Care Reform written by M. Gregg Bloche and published by Oxford University Press. This book was released on 2002-10-17 with total page 245 pages. Available in PDF, EPUB and Kindle. Book excerpt: Markets, not politics, are driving health care reform in America today. Inventive entrepreneurs have transformed medicine over the past ten years, and no end to this period of rapid change is in sight. Consumer anxieties over managed care are mounting, and medical costs are again soaring. Meanwhile, the federal government remains mostly on the health policy sidelines, as it has since the collapse of the Clinton administration's campaign for health care reform. This book addresses the changes that the market has wrought- and the challenges this transformation poses for courts and regulators. The law that governs the medical marketplace is an incomplete, overlapping patchwork, conceived mainly without medical care specifically in mind. The ensuing confusion and incoherence are a central theme of this book. Fragmentation of health care lawmaking has foreclosed coordinated, system-wide policy responses, and lack of national consensus on many of the central questions in health care policy has translated into legal contradiction and bitter controversy. Written by leading commentators on American health law and policy, this book examines the widely-perceived failings of managed care and the law's relationship to them. Some of the contributors treat law as a cause of trouble; others emphasize the law's potential and limits as a corrective tool when the market disappoints. The first two chapters present contrasting overviews of how the doctrines and decision-makers that constitute health law work together, for better or worse, to constrain the medical marketplace. The next six chapters address particular market developments and regulatory dilemmas. These include the power of state versus federal government in the health sphere, conflict between insureres and patients and providers over medical need, financial rewards to physicians for frugal practice, the role of antitrust law in the organization of health care provision and financing, the future of public hospitals, and the place of investor-owned versus non-profit institutions. Acknowledging the health sphere's complexities, the authors seek remedies that fit this country's legal, political, and cultural constraints and can contribute to reasoned regulatory goverance. Within limits they believe a measure of rationality is possible.

Download or read book The Public Private Health Care State written by Rosemary A. Stevens and published by Transaction Publishers. This book was released on 2009-06-30 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: The distinctive mixing and continuous remixing of public and private roles is a defining feature of health care in the United States. The Public-Private Health Care State explores the interweaving of public and private enterprise in health care in the United States as a basis for thinking about health care in terms of its history and its continuing evolution today. Historian and policy analyst Rosemary Stevens has selected and edited seventeen essays from both her published and unpublished work to illustrate continuing themes, such as: the flexible meanings of the terms "public" and "private," and how useful their ambiguity has been and is; the role of ideology as ratifying rather than preordaining change; and the common behavior of public leaders and corporate entities in the face of fiscal opportunity. The topics--covering the period of 1870 through the twenty-first century--represent Stevens' research interests in hospital history and policy, the medical profession, government policy, and paying for health care. The volume also considers her involvement with policy questions, which include health services research, health maintenance organizations, and physician workforce policy. Section I demonstrates the long history of state government involvement with private not-for-profit hospitals from the 1870s through the 1930s. Section II examines the federal role in health care from the 1920s through the 1970s, including the establishment of veterans' hospitals and the implementation of Medicaid. Section III shows how shifting governmental roles require constantly changing organizing rhetoric, whether for inventing a federal role for health services research and HMOs, "regionalization" in the 1970s, or defining civil rights and "equity" as mobilizing vehicles in the 1980s. Section IV examines growing concerns from the 1970s through the present about the traditional "public" role of the largely "private" medical profession. Section V returns to the ambiguous public-private status of not-for profit hospitals, buffeted in the 1980s and 1990s by assumptions about the efficiency of the market.

Download or read book Managed Care and Monopoly Power written by Deborah HAAS-WILSON and published by Harvard University Press. This book was released on 2009-06-30 with total page 251 pages. Available in PDF, EPUB and Kindle. Book excerpt: As millions of Americans are aware, health care costs continue to increase rapidly. Much of this increase in health care costs is due to the development of new life-sustaining drugs and procedures, but part of it is due to the increased monopoly power of physicians, insurance companies, and hospitals, as the health care sector undergoes reorganization and consolidation. There are two tools to limit the growth of monopoly power: government regulation and antitrust policy. In this timely book, Deborah Haas-Wilson argues that enforcement of the antitrust laws is the tool of choice in most cases. Focusing on the economic concepts necessary to the enforcement of the antitrust laws in health care markets, Haas-Wilson provides a useful roadmap for guiding the future of these markets.

Download or read book Individual and Social Responsibility written by Victor R. Fuchs and published by University of Chicago Press. This book was released on 2008-04-15 with total page 366 pages. Available in PDF, EPUB and Kindle. Book excerpt: Does government spend too little or too much on child care? How can education dollars be spent more efficiently? Should government's role in medical care increase or decrease? In this volume, social scientists, lawyers, and a physician explore the political, social, and economic forces that shape policies affecting human services. Four in-depth studies of human-service sectors—child care, education, medical care, and long-term care for the elderly—are followed by six cross-sector studies that stimulate new ways of thinking about human services through the application of economic theory, institutional analysis, and the history of social policy. The contributors include Kenneth J. Arrow, Martin Feldstein, Victor Fuchs, Alan M. Garber, Eric A. Hanushek, Christopher Jencks, Seymour Martin Lipset, Glenn Loury, Roger G. Noll, Paul M. Romer, Amartya Sen, and Theda Skocpol. This timely study sheds important light on the tension between individual and social responsibility, and will appeal to economists and other social scientists and policymakers concerned with social policy issues.

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 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 the Economics of Health Care and the Regulation of Medical Technology written by Ariel Dora Stern and published by . This book was released on 2014 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The first chapter of this dissertation explores how the regulatory approval process affects innovation incentives in medical technologies. While prior studies of medical innovation under regulation have found an early mover regulatory advantage for drugs, I find the opposite to be true for medical devices. Using detailed data on over three decades of high-risk medical device approval times in the United States, I show pioneer entrants spend approximately 34 percent (7.2 months) longer in the approval process than the first follow-on innovator. Back-of-the-envelope calculations suggest that the opportunity cost of capital of a delay of this length is upwards of 7 percent of the total cost of bringing a new device to market. I consider how different types of regulatory uncertainty affect approval times and find that a product's technological novelty is largely unrelated to time spent under review. In contrast, uncertainty about application content and format appears to play a large role: when objective guidelines for evaluation are published, approval times quicken for subsequent entrants. Finally, I consider how the regulatory process affects firms' market entry strategies and find that financially constrained firms are less likely to enter new device markets as pioneers.

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.

Download or read book The Economics of Public Health Care Reform in Advanced and Emerging Economies written by Mr.David Coady and published by International Monetary Fund. This book was released on 2012-04-13 with total page 381 pages. Available in PDF, EPUB and Kindle. Book excerpt: Using cross-country analysis and case studies, this book provides new insights and potential policy responses for the key fiscal policy challenges that both advanced and emerging economies will be facing.

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 Leadership by Example written by Institute of Medicine and published by National Academies Press. This book was released on 2003-05-21 with total page 206 pages. Available in PDF, EPUB and Kindle. Book excerpt: The federal government operates six major health care programs that serve nearly 100 million Americans. Collectively, these programs significantly influence how health care is provided by the private sector. Leadership by Example explores how the federal government can leverage its unique position as regulator, purchaser, provider, and research sponsor to improve care - not only in these six programs but also throughout the nation's health care system. The book describes the federal programs and the populations they serve: Medicare (elderly), Medicaid (low income), SCHIP (children), VHA (veterans), TRICARE (individuals in the military and their dependents), and IHS (native Americans). It then examines the steps each program takes to assure and improve safety and quality of care. The Institute of Medicine proposes a national quality enhancement strategy focused on performance measurement of clinical quality and patient perceptions of care. The discussion on which this book focuses includes recommendations for developing and pilot-testing performance measures, creating an information infrastructure for comparing performance and disseminating results, and more. Leadership by Example also includes a proposed research agenda to support quality enhancement. The third in the series of books from the Quality of Health Care in America project, this well-targeted volume will be important to all readers of To Err Is Human and Crossing the Quality Chasm - as well as new readers interested in the federal government's role in health care.

Download or read book Evidence Based Medicine and the Changing Nature of Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 2008-09-06 with total page 202 pages. Available in PDF, EPUB and Kindle. Book excerpt: Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.