Download or read book Three Essays on Health Care Cost Containment written by Seidu Dauda and published by . This book was released on 2015 with total page 162 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation consists of three separate but closely related chapters, all focusing on health care cost containment. It primarily uses MarketScan data, a large data set on the U.S. privately insured population, from Truven Health Analytics. The first chapter briefly discusses the problem of rising health care costs and introduces the research questions that the remaining chapters seek to address. Recent consolidations among hospitals and health insurers have made U.S. health care markets less competitive, leading to some concerns. The second chapter uses inpatient claims data from 2005 to 2008 to examine the effects of hospital and insurer market concentration on actual transaction prices for inpatient hospital services. The findings indicate that hospital consolidation likely raised prices by about 2.6 percent (about $4.9 billion in annual hospital revenues from private payers) over the 2003-2008 period, while insurer consolidation likely depressed hospital prices by about 10.8 percent (about $20.7 billion in annual hospital revenues). The third chapter examines the impact of hospital market concentration on hospital care quality using panel analysis and inpatient claims data spanning the period 2003-2008. The results suggest that rising hospital concentration likely resulted in lower care quality for privately insured patients. Based on the observed increase in the average hospital concentration between 2003 and 2008, the estimate implies a 0.21 percentage point increase in the probability of AMI related deaths, which translates into about 6,175 life years lost and an economic cost of roughly $618 million in 2008 for the entire U.S. privately insured population. The idea that newer drugs are cost saving has been a debated topic in the health economics literature. The fourth chapter delves into the debate using new data and empirical methods. It uses the case of drug-taking patients diagnosed with hypertension over the 1999-2008 period to re-examine the question: Do newer drugs save more in nondrug spending than they cost? Overall, the obtained results show a lack of cost saving effect. While I find evidence that using newer monotherapy is associated with treatment substitution effect, the resulting expenditure reduction is generally not enough to "offset" the higher cost of newer drugs.

Download or read book Three Essays on Health Care Spending written by Minkyoung Yoo and published by . This book was released on 2012 with total page 110 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation is composed of three essays that consider the determinants and persistence of health care spending and how policies that control increasing health care costs affect the distribution of health care spending in the U.S. In the first essay, I study the association between education and health care spending for a set of health conditions amenable to self-management. Empirical findings from estimated health expenditure models reveal strong inverse relationships between education and health care spending among elderly adults with hypertension and/or asthma. Additionally, I find that greater educational attainment is associated with a reduced likelihood of being in the top 5% of health care spenders for elderly adults with hypertension and nonelderly adults with diabetes, and also with less severe conditions. The second essay assesses how the distribution of family out-of-pocket health care spending has been affected by changes in recent cost-sharing to understand the effectiveness of the risk protection function of private health insurance against high medical care expenses. The results suggest that families who rely more on health care because of one or more their member's existing health conditions are most affected by changes in cost sharing during the period 2001-2005 and the increased exposure to out-of-pocket spending occurrs primarily for families at higher percentiles of the out-of-pocket spending distribution, thus reducing the "return" to risk protection from holding private health insurance. The final essay examines the dynamics of out-of-pocket health care spending by looking at the persistence of such spending among Medicare beneficiaries. The findings suggest that having a certain chronic condition or a health shock clearly increases the probability of out-of-pocket health care spending persistence. Additionally, having an existing health insurance that supplements Medicare coverage or the acquisition of a new supplementary health insurance has a significant impact on the probability of persistence.

Download or read book Three Essays on the Impact of Cost Containment Policies on the Supply and Demand of Health Care Services and on Health Outcomes written by Brian Ken Chen and published by . This book was released on 2009 with total page 460 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Three Essays in Health Economics written by Eugenia Amporfu and published by . This book was released on 2004 with total page 210 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation consists of three independent essays addressing three separate health care policy issues. Essay 1, "Incentive Effects of Government Mandated Cost-Shifting," shows how mandated cost shifting, because it does not require resources to pass through the hands of government, can be an optimal form of income redistribution in providing health care to the poor of society when government is sufficiently costly. Under this system, the government mandates the proper treatment of illness regardless of ability to pay and enforces that mandate with investigation. The paper shows that under costly information on illness the physician cheats by providing the wrong treatment when treating a rich patient who has low severity illness and a poor patient who has high severity illness. In response the government also investigates the treatment of such patients. The paper also shows the conditions under which mandated cost shifting is less wastehl and beneficial to patients. Essay 2,"The Effects of the Relationship between Quantity and Quality of Care on Quality of Care," shows that the relationship between quality and quantity in the patient's utility as well as in the cost of care play an important role in determining the ability of a payment scheme to induce efficient quality and quantity of care. The payment schemes examined are fixed fee for service, prospective payment, and cost sharing. The paper shows that neither prospective payment nor fixed fee for service can be used to induce a first-best provision of quality and quantity. Cost sharing is the only scheme that can be used to induce the efficient supply of both quantity and quality. Essay 3, "The Effect of Hospital Downsizing in British Columbia on the Quality of Care for Maternity Patients" uses maternity data from the Canadian province of British Columbia to estimate the effect of the reduction in hospital utilization rates and the transfer of care from hospitals to communities and to patients7 homes on readmission rates. The results show that the policy reduced hospital length of stay and increased readmission rates for maternity patients.

Download or read book Three Essays on Health Insurance and Health Care Consumption written by Fei Liu and published by . This book was released on 2007 with total page 249 pages. Available in PDF, EPUB and Kindle. Book excerpt: The third essay investigates the switching behavior of non-elderly enrollees in U.S. managed care plans. Treatment effect analysis is used to examine the disaggregated expenditures of plan switchers and plan stayers prior to their decision to switch or stay. Propensity score matching methods are used to estimate the average treatment effects on the treated. The results, which are based on a national representative data set from the Medical Expenditure Panel Survey, indicate that switchers (from HMO to non-HMO) spend more on hospitalization. The other type of switchers (from non-HMO to HMO) spends less on prescribed medicine and office-based physician visits. The findings suggest that the non-HMO private managed care plans provide better coverage on hospitalization, office-based physician visits and prescribed medicine than the HMO plans.

Download or read book Spending on Health Care written by Marwa Farag and published by . This book was released on 2010 with total page 117 pages. Available in PDF, EPUB and Kindle. Book excerpt:

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 Three Essays in Health Economics written by Jakub Hlávka and published by . This book was released on 2018 with total page 49 pages. Available in PDF, EPUB and Kindle. Book excerpt: The emergence of high-cost treatments has accelerated the pace of discussions about alternative payment models that would simultaneously enable rapid patient access while ensuring sustainable health care spending. However, limited empirical research exists on the magnitude of the problem and the expected performance of such payment models. The first paper presents a pipeline analysis of regenerative treatments in clinical trials. It finds that there are nearly 50 late-stage clinical trials that could produce regenerative drugs with potentially high prices. Alzheimer's disease poses the largest budget impact risk for U.S. payers, with new spending likely to exceed $50 billion annually. Spending on several other regenerative treatments, including treatments for traumatic brain injury, X-linked retinoschisis and congestive heart failure, could each exceed $5 billion annually. The second paper studies a novel payment model linking a drug's performance to pre-negotiated price levels. Drawing on the Future Elderly Model (FEM), it estimates the clinical benefits of PCSK9 inhibitors under three different efficacy scenarios. It shows that an adaptive pricing approach has the potential to lower the cost per event avoided under a low-efficacy scenario, thus avoiding unnecessary spending, should the drug not meet clinical trial efficacy in the real world. The third paper studies deferred payment in a gene therapy for congestive heart failure. It draws on a simulation of more than 91,000 Medicare fee-for-service beneficiaries over a period of 3 years and finds that deferred payment results in a 26.1% reduction of cardiovascular admissions and a 23.3% reduction of deaths over a three-year period, both relative to status quo payment and assuming a fixed budget constraint. Financial gains to payers and manufacturers are relatively minimal, with savings on avoided admissions amounting to just 0.3% of total spending, primarily due to the small share of expected cost savings on the total cost of therapy. The dissertation finds that large budget pressures resulting from regenerative treatments will be driven by several specific indications, and tests how two different payment models could help address the uncertainty about clinical benefits and the high upfront cost of some emerging therapies.

Download or read book Three Essays in Health Economics and Industrial Organization written by Jee-Hun Choi and published by . This book was released on 2020 with total page 208 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation consists of three essays in the field of health economics and industrial organization, focusing on the policies on public health insurance in the United States. The first chapter investigates the impact of expanding public health insurance through private insurers on equilibrium insurance market outcomes. Using the Arkansas All-Payer Claims Database, I measure the impact of the Affordable Care Act (ACA) insurance expansions on hospital reimbursement rates and premiums for non-ACA private plans, including employer-sponsored insurance plans not directly affected by the ACA. Using a Nash bargaining model based on the Ho and Lee (2017) framework, I find that the publicly-subsidized expansion decreases hospital reimbursement rates by 5.3% and insurance premiums by 0.6% for privately-insured enrollees who are not covered by the ACA. This spillover effect on reimbursement rates is driven by the increased bargaining leverage of insurers participating in the expansion. The increase in leverage results mainly from the change in the composition of enrollees, which goes hand-in-hand with enrollment increase as a result of the expansion. The second chapter, co-authored with Claire Lim, explores the linkages between government ideology in U.S. states and geographic variation in Medicaid program design and operations. Medicaid eligibility criteria tend to be more generous in liberal states. Simultaneously, fee-for-service reimbursement rates for physician services have been notably lower in liberal states. These two patterns lead to the following question: to what extent does the partisan composition of the government drive eligibility and reimbursement over time? If cost-saving measures accompany eligibility expansion, then what are their consequences for resource allocation? We explore long-run linkages among partisan composition of the government, eligibility, cost-saving measures, and expenditures for the Medicaid expansion from the mid-1990s to 2010. Our analysis consists of four steps. First, we analyze how much the partisan composition of the state government drives eligibility expansion. Second, we explore the tradeoff between breadth of eligibility and fee-for-service reimbursement rates. Third, we investigate driving forces behind the evolution of the delivery systems, i.e., Medicaid managed care diffusion. Fourth, we analyze the resulting patterns of per-enrollee spending. We find that the partisan composition of the state house played a critical role in the relatively later stage of eligibility expansion and the reduction of fee-for-service reimbursement rates over time. While the HMO penetration in the private insurance market drove the Medicaid managed care diffusion, the diffusion also tends to go hand in hand with the reduction of fee-for-service reimbursement rates. Finally, Medicaid per-enrollee spending increased substantially over time despite the adoption of cost-saving measures. This unintended consequence was due to the systematic changes in HMO practices that coincided with the eligibility expansion. The third chapter, co-authored with Claire Lim, investigates determinants of government subsidy in the U.S. health care industry, focusing on the Medicaid Disproportionate Share Hospital (DSH) program. We find that the amount of Medicaid DSH payment per bed increases significantly with increase in hospital size for government hospitals. This is partially explained by the distinctive role that large government hospitals play in the provision of care to the indigent population. However, costs, financial conditions, or types of services by themselves are not enough to explain DSH payments. Large government hospitals tend to have a higher ratio of DSH payments to Medicaid and uninsured costs. The difference in the DSH payment-to-cost ratio across ownership types increases significantly with increase in hospital size. We argue that these key patterns are unlikely to be driven by unobserved heterogeneity, using the Altonji-Elder-Taber-Oster method. Our results on payment-to-cost ratios are consistent with targeting by the state government to counterbalance disparities in hospitals' capability to cross-subsidize across patient types.

Download or read book Three Essays in Medical Cost effectiveness Analysis written by Anirban Basu and published by . This book was released on 2004 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt:

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 on Healthcare Payments and Operations written by Shima Nassiri and published by . This book was released on 2017 with total page 177 pages. Available in PDF, EPUB and Kindle. Book excerpt: A common objective of my dissertation is to use analytical and empirical models to understand the impact of current healthcare policies on outcomes for stakeholders, cost containment, quality of care, and efficiency of the providers. Consequently, this dissertation focuses on two areas: 1- payment models in healthcare (Chapters 1 and 2), and 2- healthcare behavioral operations (Chapter 3). Healthcare spending accounts for 17.5\% of the GDP in the United States and has been rising year after year, which makes this a significant concern for society. There have been many proposals specifically related to the reimbursement models from insurers to providers to curb the healthcare cost. However, many of these proposals are not studied or thoroughly evaluated before they are implemented. I believe this has created a special opportunity to bridge the gap between practice and academia by developing new models to study the decisions and models that have been proposed. To this extent, the first two chapters of my thesis focus on healthcare payments, where I use mathematical models to investigate the current policies in healthcare payments, propose new payments that can better align the incentives of the stakeholders to the system optimum outcomes, compare and contrast different payment systems, and support the derivations with empirical evidence. The current reimbursement system for hospitals is fee-for-service (FFS), under which the hospital is reimbursed for every procedure, test, etc. This payment model motivates the hospitals to treat patients more than is needed and to perform unnecessary tests that contribute to excessive healthcare expenditures. There have been many proposals for alternative payment models especially from the Center for Medicare and Medicaid services (CMS). One way of controlling healthcare expenditures is by modifying the reimbursement schemes to share some of the insurers' risk with providers. This possibility, results in the first chapter of this dissertation. The second chapter is related to impacting healthcare spending through cost-sharing mechanisms with patients, which affects the providers' market shares and, subsequently their pricing strategies. The questions that I am trying to address are: what is the impact of new payment schemes and are they achieving their premises or are there some unintended consequences? In the third chapter, I mainly focus on the emerging problems that can affect the behavior of providers in healthcare operations, such as changing the facility layout of the exam rooms so that providers will share some resources. This change can potentially impact provider's efficiency, scheduling, and assignments. I use an empirical approach to address the effect of the layout change benefiting from over a year of patient-level data from an outpatient Clinic. The clinic recently implemented a flexible suite layout for their outpatient department in which a physician can share the bed and some examination equipments with another provider. This is in contrast to the traditional exam rooms where each provider is assigned to a room with all the equipments. We investigate the impact of new intervention, multitasking, competition, and load on provider behavior and efficiency.

Download or read book Three Essays in Healthcare Operations Management written by Sarang Deo and published by . This book was released on 2007 with total page 276 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays on Development and Health Economics written by Jianan Yang and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation is a collection of three essays on development and health economics. In the first essay, we studied two interventions that provide patients with information on antibiotic resistance through text messages in Beijing, China. The "self-health" intervention emphasizes the threat to one's own health and is found to have negligible effects. In contrast, the "social-health" intervention highlighting the threat to society reduces antibiotic purchases by 17% without discouraging healthcare visits and other medicine purchases. Survey evidence suggests the perceived severity being a potential explanation. The messages were sent once every month for five months, and a gradual decrease in the effect size is observed over time. The second essay evaluated the affordability and overuse trade-off in pharmaceutical pricing by studying a drug procurement program in China, which brought down the prices of 10 chronic condition drugs by an average of 78%. Using a difference-in-differences design with a set of comparable drugs as controls, we find that this improvement in affordability led to a significant increase in demand by uninsured patients, whose purchases of treated drugs increased by 28.4% more than the insured. This demand response came both from new and existing medication takers. Drug adherence was improved for the uninsured who had poorer adherence at baseline but overuse was not affected. The third essay proposes two experiments related to low disease awareness, treatment take-up, and adherence in developing countries. Because of lacking access to primary care services, chronic condition awareness in developing countries is usually low. The first experiment proposes to provide people in low-income areas with physical exams and health reports to examine whether raising disease awareness could increase control. The second experiment proposes to provide patients with information on the expected benefit from treatment including the expected reduction in risk if their condition is under control, and the cost of a major health event. This experiment is designed to test the hypothesis that misperception of treatment benefits is one of the underlying causes for low take-up and adherence rates conditional on disease awareness in developing countries.

Download or read book Three Essays on Public Finance and Health Care written by Thomas K. Ross and published by . This book was released on 1995 with total page 414 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Health Care Under the Knife written by Howard Waitzkin and published by NYU Press. This book was released on 2018-03-15 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: Disobedience : doctor workers unite! / Howard Waitzkin -- Becoming employees : the deprofessionalization and emerging social class position of health professionals / Matt Anderson -- The degradation of medical labor and the meaning of quality in health care / Gordon Schiff and Sarah Winch -- The political economy of health reform / David Himmelstein and Steffie Woolhandler -- The transformation of the medical industrial complex : financialization, the corporate sector, and monopoly capital / Matt Anderson and Robb Burlage -- The pharmaceutical industry in the context of contemporary capitalism / Joel Lexchin -- Obamacare : the neoliberal model comes home to roost in the United States, if we let it / Howard Waitzkin and Ida Hellander -- Austerity and health / Adam Gaffney and Carles Muntaner -- Imperialism's health component / Howard Waitzkin and Rebeca Jasso-Aguilar -- U.S. philanthrocapitalism and the global health agenda : the Rockefeller and Gates foundations, past and present / Anne-Emanuelle Birn and Judith Richter -- Resisting the imperial order and building an alternative future in medicine and public health / Rebeca Jasso-Aguilar and Howard Waitzkin -- The failure of Obamacare and a revision of the single payer proposal after a quarter century of struggle / Adam Gaffney, David Himmelstein, and Steffie Woolhandler -- Overcoming pathological normalcy : mental health challenges in the coming transformation / Carl Ratner -- Confronting the social and environmental determinants of health / Carles Muntaner and Rob Wallace -- Conclusion : moving beyond capitalism for our health / Adam Gaffney and Howard Waitzkin

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