Author: Ilya Rahkovsky
Publisher:
ISBN:
Category : Disclosure of information
Languages : en
Pages : 176

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Author: Ilya Rahkovsky
Publisher:
ISBN:
Category :
Languages : en
Pages : 75

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Author: Hideki Ariizumi
Publisher:
ISBN:
Category :
Languages : en
Pages : 262

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Author: Chenyuan Liu
Publisher:
ISBN:
Category :
Languages : en
Pages : 0

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Health care markets have great economic importance and represent a large share of GDP in the U.S. Health insurance plans play a key role in the efficiency of these markets. My dissertation studies the design of health insurance contracts and how they affect market efficiency. Chapter 1 of my dissertation the prevalence of financially dominated options in health plan menus. We analyze Kaiser Family Foundation data on health plans that firms offer to their employees. For firms offering both a high-deductible and lower-deductible health plan, 62 percent of the time the high-deductible option has lower maximum spending risk for the employee. We estimate that the high-deductible plan dominates at roughly half of firms. We identify adverse-selection pricing as a likely mechanism for these surprising patterns and discuss implications for our understanding of the value of plan choice in employer-sponsored health insurance. Chapter 2 of my dissertation identifies both theoretically and empirically a new channel of sorting in insurance markets under asymmetric information: sorting by plan design. A model allowing for rich contract designs predicts high-risk individuals will sort into risk-minimizing straight-deductible plans, while lower-risk individuals prefer plans that trade higher maximum expenditure risk for coverage against small losses. Analyzing data from the ACA Exchange, I find that within coverage tiers, plans vary significantly along multi-dimensional cost-sharing attributes. Further, straight-deductible plans attract higher-risk enrollees than other designs as the model predicts. I discuss how these insights can inform discussions around the standardization of insurance plans. Chapter 3 of my dissertation studies the effects of capitated payment models on physicians' treatment decisions in the treatment of lower back pain in the U.S. We use a large employer-sponsored health insurance claim database from 2003 to 2006, and leverage capitation variation within the plan and physician to mitigate selection concerns. We find that the treatment intensity of capitated patients is 5 to 10 percent lower than otherwise similar non-capitated patients, mainly from therapy, diagnostic testing, and drugs. We also find no evidence of increased readmission rates for capitated patients.

Author: Kevin David Frick
Publisher:
ISBN:
Category :
Languages : en
Pages : 368

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Author: Marika Ilona Cabral
Publisher: Stanford University
ISBN:
Category :
Languages : en
Pages : 290

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This dissertation consists of four distinct essays. In an essay entitled "Claim Timing and Ex Post Adverse Selection: Evidence from Dental 'Insurance, ' " I explore the impact of strategic timing on insurance market allocations. If people can delay a claim just long enough to buy more insurance coverage in anticipation of it, severe adverse selection may result, and in extreme cases, this can lead to the complete unraveling of an insurance market. I study these forces by analyzing dental treatments and insurance, with the goal of understanding insurance in the market for dental care and also revealing lessons that apply to insurance markets more broadly. Using rich claim-level data from a large firm, my analysis reveals that the strategic delay of treatment and the associated adverse selection may be an important factor in explaining why so few people have dental coverage in the US and why typical dental "insurance" contracts provide so little insurance. More generally, my results suggest that insurance products without contract features designed to limit coverage for strategically delayed costs (e.g., open-enrollment periods, pricing pre-existing conditions) may generate unraveling. An essay entitled "The Hated Property Tax: Salience, Tax Rates, and Tax Revolts" (with Caroline Hoxby), explores the relationship between the salience of the property tax and observed property tax rates. We hypothesize that high salience explains the unpopularity of the property tax, the level of the property tax, and prevalence of property tax revolts. To identify variation in the salience of the property tax over local jurisdictions and over time, we exploit conditionally random variation in tax escrow, a method of paying the property tax that makes it much less salient. We find that areas in which the property tax is less salient are areas in which property taxes are higher and property tax revolts are less likely to occur. In an essay entitled "Private Coverage and Public Costs: Identifying the Effect of Private Supplemental Insurance on Medicare Spending" (with Neale Mahoney), we explore the impact of private supplemental insurance on Medicare spending. Private supplemental insurance to "fill the gaps" of Medicare, known as Medigap, is very popular. 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 suggest. Back-of-the-envelope calculations indicate that a 20 percent tax on premiums would generate combined revenue and savings of 6.2 percent of Medicare baseline costs. An essay entitled "The Effect of Insurance Coverage on Preventive Care" (with Mark Cullen), explores the effect of insurance coverage on preventive care utilization. Using health insurance claims data from a large company, this paper examines the implementation of an insurance benefit design which differentially increased the marginal price of curative care (non-preventive care) while decreasing the marginal price of prevention. We examine the effect of the differential price change on the use of preventive procedures. We reveal evidence consistent with an important negative cross-price effect; that is, increases in the price of curative care can depress preventive care utilization.

Author: Eliot Freidson
Publisher: Yale University Press
ISBN: 9780300041583
Category : Medical
Languages : en
Pages : 292

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Present-day health care policies in the United States are moving toward a system in which patients will be treated like industrial objects by doctors forced to work mechanically, says the distinguished medical sociologist Eliot Freidson in Medical Work in America. He offers a number of controversial proposals designed both to reduce costs and to avoid such dehumanization. In a series of essays that includes some of his classic work as well as significant new material, Freidson discusses the doctor-patient relationship, relations between physicians in various forms of medical practice, and the forces now reorganizing medical work. He shows how increasingly restrictive health insurance contracts insert a new, problematic element into both doctor-patient and colleague relations, and how bureaucratic methods of controlling medical decisions affect those relations. Finally, Freidson advances some basic principles to guide health care policy. He emphasizes that the physician's freedom to exercise discretion is essential if patients are to be treated as individuals rather than as administratively defined diagnostic categories. His recommendations include eliminating fee-for-service compensation, controlling health industry profits, and limiting the external administrative regulation of medical decisions while organizing medical work in such a way as to maximize effective and responsible self-governance.

Author: Daniel Lawver
Publisher:
ISBN:
Category : Contracts
Languages : en
Pages : 80

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This dissertation consists of three essays. The first essay studies quality increases in the medical sector. A large and growing share of income is spent on medical goods and services each year. Existing measures of the price and quantity of medical goods and services do not take changes in quality into account. Ample micro evidence suggests the quality of medical goods and services has, in fact, improved over time. This essay estimates changes in medical quality at the aggregate level. To do so, this essay develops and estimates a dynamic structural model of the demand for medical purchases. The main result of this essay is that the quality of medical goods and services has increased by 2.2 percent per year between 1996 and 2007. One implication is that, after adjusting for changes in medical quality, the relative price of medical goods and services fell by 0.5 percent per year over this period, whereas Bureau of Labor Statistics estimates suggest it rose by 1.6 percent per year. The second essay develops a method to infer the life cycle profile of the quality of medical care in accumulating of health capital and the depreciation rate of health capital. To do so, this essay develops a life cycle model of the demand for medical purchases in which individuals invest in health capital. The use of these methods is illustrated by inferring the life cycle profile of the quality of medical care and the depreciation rate of health capital for 25-84 year old males between 1996 and 2007. The third essay studies implementable outcomes in partnership games. In this setting, it is well known that contracts which satisfy budget balance cannot implement efficient outcomes. Then, it is natural to ask which outcomes can be implemented. This essay characterizes the outcomes of all budget balancing contracts. With standard regularity conditions on production and utility functions, all outcomes which can be implemented by a budget balancing contract can be implemented by a linear contract. This implies that, with respect to welfare, we can consider a compact set of implementable outcomes without loss of generality. The budget-balancing contract whose outcome maximizes welfare, therefore, exists.

Author: Natalia Serna
Publisher:
ISBN:
Category :
Languages : en
Pages : 0

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Rising health care costs motivate the use of demand- and supply-side mechanisms to control the consumption of health services, and generate incentives for insurers to engage in risk selection strategies. Using data from the Colombian health care system, I first measure how demand for different health services responds to cost-sharing using a regression discontinuity design. I then study how cost-sharing impacts negotiated service prices between insurers and hospitals using a model of Nash-in-Nash bargaining. Finally, I quantify the impact of risk selection incentives on hospital network breadth using a model of insurer competition in networks. I find that cost-sharing is effective at reducing health care costs, but that consumption reductions happen across necessary and unnecessary services. Counterfactual simulations show that negotiated hospital prices are U-shaped with respect to the coinsurance rate, and minimized at a coinsurance rate of 30 percent. Findings of the model of insurer competition in networks show that insurers engage in risk selection by providing narrow networks. Improving the risk adjustment formula reduces selection incentives and motivates insurers to expand their networks in every health service. Allowing insurers to compete on premiums and networks, shows that price and non-price characteristics of insurance contracts are substitute mechanisms for risk selection.

Author: Omar Azfar
Publisher:
ISBN:
Category :
Languages : en
Pages : 158

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