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Author: Boris Viktorovich Vabson
Publisher:
ISBN:
Category :
Languages : en
Pages : 394
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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.
Author: Boris Viktorovich Vabson
Publisher:
ISBN:
Category :
Languages : en
Pages : 394
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Book Description
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.
Author: Can Cui (Ph. D.)
Publisher:
ISBN:
Category :
Languages : en
Pages : 328
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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.
Author: Nayan Krishna Joshi
Publisher:
ISBN:
Category : Economics
Languages : en
Pages : 117
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In the third essay, I examine the impacts of the public health insurance eligibility during childhood on longer-term financial outcomes. Exploiting the variation provided by the Medicaid expansions that took place in the 1980's and 1990's and applying the simulated eligibility instrumental variables approach, I show that Medicaid eligibility during childhood increases homeownership rate, mortgage ownership rate, and financial market participation rate later in life. This finding is robust to only use of variation provided by federal Medicaid expansions.
Author: Colin D. Cannonier
Publisher:
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Category :
Languages : en
Pages :
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Author: Andreea Balan Cohen
Publisher:
ISBN: 9780549022923
Category :
Languages : en
Pages : 143
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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.
Author:
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Category :
Languages : en
Pages : 202
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Chapter 1: Recently enacted state laws that limit how much hospitals can charge uninsured patients provide a unique opportunity to study how financial incentives of healthcare providers affect the care they deliver. Using an event study framework, we find that these fair pricing laws lead to a seven to nine percent reduction in the average length of hospital stay for uninsured patients. Although the longer-term effects of these care reductions are uncertain, they are not accompanied by worsening of short-term measures of quality of care. Overall, our results provide strong evidence that hospitals actively alter their behavior in response to financial incentives, and are consistent with the laws promoting a shift towards more efficient care delivery. Chapter 2: The list price for an average unit of care is more than three times what a hospital will be paid for treating a typical patient, and different hospitals charge widely different prices for the same service. These facts may seem innocuous, but many uninsured and out-of-network patients do pay list price. This paper uncovers patterns in hospital list prices, and explores several potential explanations. We find that markups vary much more across hospitals than within, but geography and quality of care explain little of the overall variation. Further, large, urban, well-equipped, for-profit hospitals have the highest list prices. A quirk in the Medicare Outlier Payment formula appears to have contributed to rapid price increases prior to 2004. Overall, our findings are consistent with more financially-sophisticated and profit-motivated hospitals more aggressively pursuing revenue from uninsured and out-of-network patients. Chapter 3: Many researchers and policy makers worry that Americans are not saving adequately for retirement. However, it is difficult to agree upon what constitutes adequate savings. This paper compares wealth accumulation patterns of different cohorts of Americans born in the first half of the 20th century. This comparative standard frames the retirement prospects of future and recent retirees in terms of the documented retirement experiences of older generations. Contrary to common perception, I find that the wealth accumulation of Americans nearing and entering retirement today is very similar to that of older generations.
Author: Olga V. Milliken
Publisher:
ISBN:
Category : Health insurance
Languages : en
Pages :
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Author: Tomasz Zawisza
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ISBN:
Category :
Languages : en
Pages :
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Author: Leigh Ann Leung
Publisher:
ISBN:
Category :
Languages : en
Pages : 194
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The second essay examines the effect of mortgage debt on health. Homeownership in the U.S. is promoted through the use of financing. These policies improve the liquidity of the housing market and make homeownership more affordable. But it also encourages greater consumption of mortgage debt. Using mortgage loan to value (LTV) as a proxy for financial stress, I show that homeowners with high LTVs are more likely to be in poor health.
Author: Eun Young Kim
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ISBN:
Category : Electronic Dissertations
Languages : en
Pages : 101
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This dissertation is a compilation of three essays. The first essay critiques a recent paper by Wilper et al. (2009) for its inappropriate model calibration in analyzing the association of health insurance and mortality. Using the individual-level data from a nationwide survey with more recent mortality follow-up information, it shows that the privately-insured do not significantly fare better in mortality risk compared to the uninsured. Moreover, hazard ratio estimate for the Medicaid suggests that public provision of insurance increases mortality. The second essay addresses the role of income in explaining the differential public health outcomes across developed countries. Noting that the growing arguments for socioeconomic gradient in health are based mostly on cross-sectional studies, panel analyses of five different public health outcomes are conducted. Results demonstrate that economic development remains critical in explaining health improvements at the aggregate level. The third essay analyzes the association of income and health care spending at the aggregate level. Using a large panel data from 24 industrialized nations for more than three decades, the close relationship between income and health care spending is established. In contrast to earlier cross-sectional studies, the panel analysis suggests that health expenditure growth is not as rapid as income growth in almost all nations.
