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 Three Essays in Health Care Policy written by Larry Joe Forgy and published by . This book was released on 1989 with total page 358 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 Public Economics written by Andreea Balan Cohen and published by . This book was released on 2007 with total page 143 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the third essay, we use the variation in political incentives of state governors provided by term limits to show that the variation in the level of OAA benefits per recipient between 1931 and 1955 was due to governors' vote seeking behavior. Governors who faced reelection were more likely to increase benefits than "lame duck" office holders. The manipulation of OAA increased with the degree of political competition, and decreased in the presence of strong lobbying groups for alternate spending programs. We also find that the manipulation of OAA policy was greater in states with a smaller fraction of elderly in the population, presumably due to the increased costs of enacting programs. This paper provides evidence that the elderly wielded significant political power in the United States at least two decades earlier than previous studies have suggested.

Download or read book Essays on Public Finance and Health Economics written by Can Cui (Ph. D.) and published by . This book was released on 2016 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation examines several questions in public finance, including health care, workers' compensation program, and tax rebates. The first chapter, entitled, "Financial Incentives and Physicians’ Behavior: Evidence from Texas Workers’ Compensation Medical Claims", examines whether financial incentives influence the quantity and composition of medical care provided by physicians. I study this question by leveraging an administrative change in the maximum allowed reimbursement rates for surgical services performed in a hospital setting for Texas Workers' Compensation medical claims. I document evidence of strong substitution in the location of care, indicating that many surgical services can be provided in either a hospital or office setting. I find that the 2% increase in surgical services provided in a hospital setting in response to this reform is fully offset by reduced utilization in an office setting. I also find that nonsurgical services performed in a hospital increased in response to the reform, suggesting surgical and nonsurgical services are complements with respect to physician financial incentives. More generally, my results suggest that the location of care is responsive to financial incentives, and an optimal payment policy should account for substitution along this margin. The second chapter, entitled "Cash-on-Hand and Demand for Credit", examines the effect of tax rebates on demand for small dollar credit loans. Subprime consumers often use small dollar credit to meet short-term financial needs over pay cycles. However, relatively little is known about the income sensitivity of demand for credit in this market. This chapter provides a causal estimate of the effect of tax rebates on the demand for small dollar credit, using shocks from the Earned Income Tax Credit (EITC) benefits and a unique proprietary loan-level dataset. The results show that a $100 increase in EITC benefits leads to a 8.3% in the number of loan applications and a 6.6% reduction in the number of borrowers. This could translate into sizable reductions in loan volume and savings in financial charges. The estimates are robust to various specifications checks. The results further indicate that EITC recipients are liquidity constrained. More broadly, the results suggest that public programs with income benefits could help recipients with consumption smoothing in the presence of credit market frictions. The third chapter, entitled "Take-up of Workers' Compensation Insurance in Texas", is coauthored with Marika Cabral and Michael Dworsky. This chapter examines how employers choose to provide benefits for their workers. Workers' compensation program is a large government program which provides monetary and medical benefits to injured workers. Texas is currently the only state that allows voluntary participation. Using difference-in-differences variation in regulated manual premium, this paper empirically analyzes employers' take-up of workers' compensation insurance coverage. We find that 10% increase in regulated premium reduces the number of covered firms by 2%, with similar effect on covered payroll.

Download or read book Essays in Public Finance and Industrial Organization written by Neale Ashok Mahoney and published by Stanford University. This book was released on 2011 with total page 215 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation has four chapters. The first three chapters examine health insurance markets in the U.S., focusing in particular on contexts where there are important interactions between health insurance plans. The fourth chapter is on the U.S. budget, examining the implications of annual budget cycles on the quantity and quality of end-of-year spending. Chapter 1, entitled "Bankruptcy as Implicit Health Insurance" examines the interaction between health insurance and the implicit insurance that people have because they can file (or threaten to file) for bankruptcy. With a simple model that captures key institutional features, I demonstrate that the financial risk from medical shocks is capped by the assets that could be seized in bankruptcy. For households with modest seizable assets, this implicit "bankruptcy insurance" can crowd out conventional health insurance. I test these predictions using variation in the state laws that specify the type and level of assets that can be seized in bankruptcy. Because of the differing laws, people who have the same assets and receive the same medical care face different losses in bankruptcy. Exploiting the variation in seizable assets that is orthogonal to wealth and other household characteristics, I show that households with fewer seizable assets are more likely to be uninsured. This finding is consistent with another: uninsured households with fewer seizable assets end up making lower out-of-pocket medical payments. The estimates suggest that if the laws of the least debtor-friendly state of Delaware were applied nationally, 16.3 percent of the uninsured would buy health insurance. Achieving the same increase in coverage would require a premium subsidy of approximately 44.0 percent. To shed light on puzzles in the literature and examine policy counterfactuals, I calibrate a utility-based, micro-simulation model of insurance choice. Among other things, simulations show that "bankruptcy insurance" explains the low take-up of high-deductible health insurance. Chapter 2, entitled "Pricing and Welfare in Health Plan Choice", is coauthored with M. Kate Bundorf and Jonathan Levin. The starting point for the paper is the simple observation that when insurance premiums do not reflect individual differences in expected costs, consumers may choose plans inefficiently. We study this problem in health insurance markets, a setting in which prices often do not incorporate observable differences in expected costs. We develop a simple model and estimate it using data on small employers. In this setting, the welfare loss compared to the feasible risk-rated benchmark is around 2-11% of coverage costs. Three-quarters of this is due to restrictions on risk-rating employee contributions; the rest is due to inefficient contribution choices. Despite the inefficiency, the benefits from plan choice relative to each of the single-plan options are substantial. Chapter 3, entitled "The Private Coverage and Public Costs: Identifying the Effect of Private Supplemental Insurance on Medicare Spending, " is coauthored with Marika Cabral. While most elderly Americans have health insurance coverage through Medicare, traditional Medicare policies leave individuals exposed to significant financial risk. Private supplemental insurance to "fill the gaps" of Medicare, known as Medigap, is very popular. In this Chapter, we estimate the impact of this supplemental insurance on total medical spending using an instrumental variables strategy that leverages discontinuities in Medigap premiums at state boundaries. Our estimates suggest that Medigap increases medical spending by 57 percent--or about 40 percent more than previous estimates. Back-of-the-envelope calculations indicate that a 20 percent tax on premiums would generate combined revenue and savings of 6.2 percent of baseline costs; a Pigovian tax that fully accounts for the fiscal externality would yield savings of 18.1 percent. Chapter 4, entitled "Do Expiring Budgets Lead to Wasteful Year-End Spending? Evidence from Federal Procurement, " is coauthored with Jeffrey Liebman. Many organizations fund their spending out of a fixed budget that expires at year's end. Faced with uncertainty over future spending demands, these organizations have an incentive to build a buffer stock of funds over the front end of the budget cycle. When demand does not materialize, they then rush to spend these funds on lower quality projects at the end of the year. We test these predictions using data on procurement spending by the U.S. federal government. Using data on all federal contracts from 2004 through 2009, we document that spending spikes in all major federal agencies during the 52nd week of the year as the agencies rush to exhaust expiring budget authority. Spending in the last week of the year is 4.9 times higher than the rest-of-the-year weekly average. We examine the relative quality of year-end spending using a newly available dataset that tracks the quality of $130 billion in information technology (I.T.) projects made by federal agencies. Consistent with the model, average project quality falls at the end of the year. Quality scores in the last week of the year are 2.2 to 5.6 times more likely to be below the central value. To explore the impact of allowing agencies to roll unused spending over into subsequent fiscal years, we study the I.T. contracts of an agency with special authority to roll over unused funding. We show that there is only a small end-of-year I.T. spending spike in this agency and that the one major I.T. contract this agency issued in the 52nd week of the year has a quality rating that is well above average.

Download or read book Manage the Margins written by Ling Zhu and published by . This book was released on 2011 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation includes three studies, devoted to trying to understand inequality in health between people from different social groups in a democratic society. In the U.S., social inequality in health takes various forms and the key to understanding how democracy solves the problem of inequality lies in a complex set of political and social factors. I take an institutional approach and focus on examining how political and policy institutions, their administrative processes, and the policy implementation environment are linked to social inequality in health. The first essay, Whose Baby Matters More, uses a theoretical framework for evaluating heterogeneous group responses to public health policies and depicts how racial disparities in health are rooted in group heterogeneity in policy responses. The second essay, Anxious Girls and Inactive Boys, focuses on how state-level policy interventions and social capital interactively affect gender differences in health. The third essay, Responsibility for Equity, explores the link between publicness of state healthcare systems and social equity in healthcare access. In the first essay, I focus on racial disparities in infant mortality rates and pool state-level data from 1990 to 2006. The empirical analysis suggests that enhancing the capacity of state healthcare systems is critical to improving population health. Blacks and whites, nevertheless, exhibit different responses to the same policy. Racial disparities could be reduced only when policy interventions generate more relative benefits for Blacks. In the second essay, I find that social capital conditions the effect of public health policies with regard to managing childhood obesity. There are gender differences, moreover, in health outcomes and behavioral responses to state and local-level obesity policies. In the third essay, I find that different institutional factors exhibit different impact on inequality in healthcare access. While public finance resources may reduce inequality in healthcare access, public ownership and the public healthcare workforce do not have significant association with inequality in healthcare access. State Medicaid eligibility rules exhibit moderate impact on inequality in healthcare access.

Download or read book Three Essays on Health and Health Care in Society written by Nathaniel Lane Wade and published by . This book was released on 2019 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Each of the three essays in this dissertation examine an aspect of health or health care in society. Areas explored within this dissertation include health care as a public value, proscriptive genomic policies, and socio-technical futures of the human lifespan. The first essay explores different forms of health care systems and attempts to understand who believes access to health care is a public value. Using a survey of more than 2,000 U.S. citizens, this study presents statistically significant empirical evidence regarding values and other attributes that predict the probability of individuals within age-based cohorts identifying access to health care as a public value. In the second essay, a menu of policy recommendations for federal regulators is proposed in order to address the lack of uniformity in current state laws concerning genetic information. The policy recommendations consider genetic information as property, privacy protections for re-identifying de-identified genomic information, the establishment of guidelines for law enforcement agencies to access nonforensic databases in criminal investigations, and anti-piracy protections for individuals and their genetic information. The third and final essay explores the socio-technical artifacts of the current health care system for documenting both life and death to understand the potential for altering the future of insurance, the health care delivery system, and individual health outcomes. Through the development of a complex scenario, this essay explores the long-term socio-technical futures of implementing a technology that continuously collects and stores genetic, environmental, and social information from life to death of individual participants.

Download or read book Essays in Public Finance and Industrial Organization written by Neale Ashok Mahoney and published by . This book was released on 2011 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation has four chapters. The first three chapters examine health insurance markets in the U.S., focusing in particular on contexts where there are important interactions between health insurance plans. The fourth chapter is on the U.S. budget, examining the implications of annual budget cycles on the quantity and quality of end-of-year spending. Chapter 1, entitled "Bankruptcy as Implicit Health Insurance" examines the interaction between health insurance and the implicit insurance that people have because they can file (or threaten to file) for bankruptcy. With a simple model that captures key institutional features, I demonstrate that the financial risk from medical shocks is capped by the assets that could be seized in bankruptcy. For households with modest seizable assets, this implicit "bankruptcy insurance" can crowd out conventional health insurance. I test these predictions using variation in the state laws that specify the type and level of assets that can be seized in bankruptcy. Because of the differing laws, people who have the same assets and receive the same medical care face different losses in bankruptcy. Exploiting the variation in seizable assets that is orthogonal to wealth and other household characteristics, I show that households with fewer seizable assets are more likely to be uninsured. This finding is consistent with another: uninsured households with fewer seizable assets end up making lower out-of-pocket medical payments. The estimates suggest that if the laws of the least debtor-friendly state of Delaware were applied nationally, 16.3 percent of the uninsured would buy health insurance. Achieving the same increase in coverage would require a premium subsidy of approximately 44.0 percent. To shed light on puzzles in the literature and examine policy counterfactuals, I calibrate a utility-based, micro-simulation model of insurance choice. Among other things, simulations show that "bankruptcy insurance" explains the low take-up of high-deductible health insurance. Chapter 2, entitled "Pricing and Welfare in Health Plan Choice", is coauthored with M. Kate Bundorf and Jonathan Levin. The starting point for the paper is the simple observation that when insurance premiums do not reflect individual differences in expected costs, consumers may choose plans inefficiently. We study this problem in health insurance markets, a setting in which prices often do not incorporate observable differences in expected costs. We develop a simple model and estimate it using data on small employers. In this setting, the welfare loss compared to the feasible risk-rated benchmark is around 2-11% of coverage costs. Three-quarters of this is due to restrictions on risk-rating employee contributions; the rest is due to inefficient contribution choices. Despite the inefficiency, the benefits from plan choice relative to each of the single-plan options are substantial. Chapter 3, entitled "The Private Coverage and Public Costs: Identifying the Effect of Private Supplemental Insurance on Medicare Spending, " is coauthored with Marika Cabral. While most elderly Americans have health insurance coverage through Medicare, traditional Medicare policies leave individuals exposed to significant financial risk. Private supplemental insurance to "fill the gaps" of Medicare, known as Medigap, is very popular. In this Chapter, we estimate the impact of this supplemental insurance on total medical spending using an instrumental variables strategy that leverages discontinuities in Medigap premiums at state boundaries. Our estimates suggest that Medigap increases medical spending by 57 percent--or about 40 percent more than previous estimates. Back-of-the-envelope calculations indicate that a 20 percent tax on premiums would generate combined revenue and savings of 6.2 percent of baseline costs; a Pigovian tax that fully accounts for the fiscal externality would yield savings of 18.1 percent. Chapter 4, entitled "Do Expiring Budgets Lead to Wasteful Year-End Spending? Evidence from Federal Procurement, " is coauthored with Jeffrey Liebman. Many organizations fund their spending out of a fixed budget that expires at year's end. Faced with uncertainty over future spending demands, these organizations have an incentive to build a buffer stock of funds over the front end of the budget cycle. When demand does not materialize, they then rush to spend these funds on lower quality projects at the end of the year. We test these predictions using data on procurement spending by the U.S. federal government. Using data on all federal contracts from 2004 through 2009, we document that spending spikes in all major federal agencies during the 52nd week of the year as the agencies rush to exhaust expiring budget authority. Spending in the last week of the year is 4.9 times higher than the rest-of-the-year weekly average. We examine the relative quality of year-end spending using a newly available dataset that tracks the quality of $130 billion in information technology (I.T.) projects made by federal agencies. Consistent with the model, average project quality falls at the end of the year. Quality scores in the last week of the year are 2.2 to 5.6 times more likely to be below the central value. To explore the impact of allowing agencies to roll unused spending over into subsequent fiscal years, we study the I.T. contracts of an agency with special authority to roll over unused funding. We show that there is only a small end-of-year I.T. spending spike in this agency and that the one major I.T. contract this agency issued in the 52nd week of the year has a quality rating that is well above average.

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 Three Essays in Health Economics written by Ryuta Kato and published by . This book was released on 2000 with total page 214 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Three Essays on Public Finance and Economics of Education written by Estelle P. Dauchy and published by . This book was released on 2007 with total page 342 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Political Analysis and American Medical Care written by Theodore R. Marmor and published by Cambridge University Press. This book was released on 1983-01-01 with total page 292 pages. Available in PDF, EPUB and Kindle. Book excerpt: The role of government in medical care, however contentious and bewildering, is increasingly important given that the finance of medical care in Western democracies is now dominated by public expenditures. Why do governments choose the medical programs they do? How do particular struggles in medical care illustrate more general political conflicts? This book stems from Marmor's conviction that political science can provide answers to questions such as these. Furthermore, the essays presented here demonstrate that political analysis is a crucial element of any sensible approach to policy making. The essays are grouped intro three parts. Firstly, how the general findings of a political science illuminate disputes over medical care. Secondly, looks at political conflict in American medicine, such as paying doctors, representing consumers and restraining inflation. Lastly, the essays tie different sorts of political analysis to the appraisal of issues such as national health insurance in the 1970s and procompetitive reform in the early 1980s.

Download or read book Essays in Public Finance written by Ebonya Washington and published by . This book was released on 2003 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt: This thesis consists of three distinct essays in public finance economics. In the first I use the presence of minority candidates on the ballot to test two implications of the spatial theory of voting. I find, contrary to theoretical predictions, that the magnitude and types of voters who come out to the polls is responsive to the race of the candidate on the ballot. While both black and white voters turn out in greater numbers when there is a black on the ballot, the whites who are propelled to the polls are more often Republican than not. I use this shift in the electorate caused by the racial mix of the candidates as a test of candidate responsiveness, a second implication of the spatial theory. I find evidence in support of this prediction. In Chapter 2 I seek to understand why thirty-five to forty-five percent of low-income American households do not possess a bank account I demonstrate that the low-income household's banking decision responds to the price of savings accounts, particularly their minimum balance requirements. Despite this, I show that government banking regulation to this point has been ineffective in connecting households to transaction accounts. On the other hand, regulation of the fringe banking market has proved more successful. One approach to covering the uninsured that is frequently advocated by policy makers is subsidizing the employee portion of employer-provided health insurance premiums. In Chapter 3, joint with Jonathan Gruber, we study an example of such subsidies: the introduction of pre-tax premiums for postal employees in 1994, and then for the remaining federal employees in 2000. We find that there is a very small elasticity of insurance takeup with respect to its after-tax price, and a modest elasticity of plan choice. Our results suggest that the federal government did little to improve insurance coverage, but much to increase health care expenditures, through this policy change.

Download or read book Three Essays on the Economics of Health and Development written by Wesley Yin and published by . This book was released on 2005 with total page 137 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Three Essays in Finance Real Estate and Insurance written by Evgeny Radetskiy and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: There are three essays that comprise this dissertation. In the first essay we investigate how a country's enforcement of insider trading laws affects learning among stock market participants. We measure learning as the speed with which analyst forecast errors decline as the firm matures. We show that analyst forecast errors decline faster with progression in the firm's age (more learning), when insider trading laws are enforced. We find that learning improves and M/B ratios stabilize faster with the enforcement of insider trading laws. These learning effects are more pronounced among countries with stronger regulatory infrastructure. Also, we demonstrate that firms with higher analyst forecast errors and slower rates of learning before the 2008 financial crisis have a significantly higher probability of stock crash. In the second essay, we temporally examine the existence of price premiums for a sample of single family homes in gated residential communities relative to values in comporable non-gated communities in Shelby County, Tennessee. Controling for idiosyncratic attributes, we find that homes in gated communities carry significant price premiums relative to similar homes in non-gated communities. Price premiums are highest for medium size gated communities. Premiums were also evident in higher priced gated communities before 2008 but vanished after the financial crisis. We conclude that price premiums result from net gated community benefits. The third essay develops a risk management proposal for a two-tiered private-public national health insurance plan. Under this plan, private insurers underwrite basic plans and perform most administrative functions. A second-tier, public national health reinsurance plan allows truncated annual losses for private insurers. When private insurers' annual per person claims exceed a pre-specified level, additional claims are undeerwritten by a single payer, public national health reinsurance system. We develop an actuarial approach that considers possible contemporaneous correlation between paid claim frequency and severity and first-order serial correlation. Given a first-tier loss cutoff of $15,000, we demonstrate that premiums are reduced by approximately 60% when compared to current private insurer pure premiums. We suggest that a two-tiered health care system may better provide all citizens health insurance that is more affordable for employers and individuals.

Download or read book U S Health in International Perspective written by National Research Council and published by National Academies Press. This book was released on 2013-04-12 with total page 421 pages. Available in PDF, EPUB and Kindle. Book excerpt: The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people: even highly advantaged Americans are in worse health than their counterparts in other, "peer" countries. In light of the new and growing evidence about the U.S. health disadvantage, the National Institutes of Health asked the National Research Council (NRC) and the Institute of Medicine (IOM) to convene a panel of experts to study the issue. The Panel on Understanding Cross-National Health Differences Among High-Income Countries examined whether the U.S. health disadvantage exists across the life span, considered potential explanations, and assessed the larger implications of the findings. U.S. Health in International Perspective presents detailed evidence on the issue, explores the possible explanations for the shorter and less healthy lives of Americans than those of people in comparable countries, and recommends actions by both government and nongovernment agencies and organizations to address the U.S. health disadvantage.