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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: 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: Sijbren Cnossen
Publisher: MIT Press
ISBN: 9780262033046
Category : Business & Economics
Languages : en
Pages : 584
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Book Description
The 16 essays in this book were written to celebrate the 90th birthday of Richard Musgrave and to commemorate the tenth anniversary of CES, the Center for Economic Studies at the University of Munich. Musgrave is considered to be a founding father of modern public economics. He belongs to the intellectual tradition that views government as an instrument that can be used to correct market failure and to establish the society that people want. Although his work fits within the individualistic framework of modern economics, he also draws on principles of moral philosophy.
Author: Can Cui (Ph. D.)
Publisher:
ISBN:
Category :
Languages : en
Pages : 328
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Book Description
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: Hui Ding
Publisher:
ISBN:
Category :
Languages : en
Pages :
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This dissertation explores various topics in health economics, specifically the use of different types of health care (i.e., mental health, durable medical equipment, and chronic disease management in primary care settings) and how public insurance policies affect the price and utilization of health care products and services. In Chapter 1, I explore the geographic variation in mental health care use among the Medicare population. Using administrative data from Medicare, I isolates the patient- and place-specific drivers of the geographic variation in mental health care use among elderly adults. Specifically, I use an event-study framework with individual fixed effects to study changes in mental health care utilization for patients who move across areas with differing rates of average utilization. My results show that 60 percent of the geographic variation is attributed to place-specific factors. I then explore components of the "place effect", finding that mental health care provider capacity explains only one tenth of it. Beyond that, local attitudes toward mental health play an important role, as shown by asymmetric responses for people who move from low-to-high and high-to-low care utilization areas, especially among those who were never diagnosed with any mental illness before moving. Lastly, I find a strong negative correlation between area-level mental health care utilization and suicide rates, and evidence that moving to high utilization areas is associated with a lower risk of self-harm-related Emergency Department visits. These findings suggest that promoting mental health care could benefit the elderly population, and that there is substantial scope for achieving this goal with interventions targeting place-specific factors. In Chapter 2, along with co-authors Mark Duggan and Amanda Starc, I study Medicare's competitive bidding program (CBP) for durable medical equipment (DME). We use Medicare claims data to examine the effect on prices and utilization, focusing on continuous positive airway pressure (CPAP) devices for sleep apnea. We find that spending falls by 47.2% percent after a highly imperfect bidding mechanism is introduced. This is almost entirely driven by a 44.8% price reduction, though quantities also fall by 4.3\%. To disentangle supply and demand, we leverage differential cost sharing across Medicare recipients. We measure a demand elasticity of -0.272 and find that quantity reductions are concentrated among less clinically appropriate groups. In Chapter 3, along with co-authors Yiwei Chen, Min Yu, Jieming Zhong, Ruying Hu, Xiangyu Chen, Chunmei Wang, Kaixu Xie and Karen Eggleston, I investigate the effect of chronic disease management provided in primary health care (PHC) setting in rural China. Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management and PHC system. We provide evidence on China's efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% fewer inpatient admissions, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.
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: Jason Ung Huh
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Author: Morris L. Barer
Publisher: McGill-Queen's Press - MQUP
ISBN: 0773599479
Category : Medical
Languages : en
Pages :
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Book Description
For four decades Robert Evans has been Canada’s foremost health policy analyst and commentator, playing a leadership role in the development of both health economics and population health at home and internationally. An Undisciplined Economist collects Evans’ most important contributions and includes two new articles. The topics addressed range widely, from the peculiar structure of the health care industry to the social determinants of the health of entire populations to the misleading role that economists have sometimes played in health policy debates. Written with Evans' characteristic clarity, candour, and wit, these essays unabashedly expose health policy myths and the special interests that lie behind them. He refutes claims that public health insurance is unsustainable, that the health care costs of an aging population will bankrupt Canada, that user charges will make the health care system more efficient, and that health care is the most important determinant of a population’s health. An Undisciplined Economist is a valuable collection for those familiar with Evans’ work, a lucid introduction for those new to the fields of health economics, health policy, and population health, and a fitting tribute to an outstanding scholar.
Author: Ehren Schuttringer
Publisher:
ISBN: 9781321201086
Category : Electronic dissertations
Languages : en
Pages : 124
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Author:
Publisher: Newnes
ISBN: 0123756790
Category : Medical
Languages : en
Pages : 1663
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Book Description
The Encyclopedia of Health Economics offers students, researchers and policymakers objective and detailed empirical analysis and clear reviews of current theories and polices. It helps practitioners such as health care managers and planners by providing accessible overviews into the broad field of health economics, including the economics of designing health service finance and delivery and the economics of public and population health. This encyclopedia provides an organized overview of this diverse field, providing one trusted source for up-to-date research and analysis of this highly charged and fast-moving subject area. Features research-driven articles that are objective, better-crafted, and more detailed than is currently available in journals and handbooks Combines insights and scholarship across the breadth of health economics, where theory and empirical work increasingly come from non-economists Provides overviews of key policies, theories and programs in easy-to-understand language
Author: Colin D. Cannonier
Publisher:
ISBN:
Category :
Languages : en
Pages :
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