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Journal of Health Economics

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https://www.readbyqxmd.com/read/28236720/do-hospital-mergers-reduce-costs
#1
Matt Schmitt
Proponents of hospital consolidation claim that mergers lead to significant cost savings, but there is little systematic evidence backing these claims. For a large sample of hospital mergers between 2000 and 2010, I estimate difference-in-differences models that compare cost trends at acquired hospitals to cost trends at hospitals whose ownership did not change. I find evidence of economically and statistically significant cost reductions at acquired hospitals. On average, acquired hospitals realize cost savings between 4 and 7 percent in the years following the acquisition...
February 7, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28182999/employment-effects-of-active-labor-market-programs-for-sick-listed-workers
#2
Anders Holm, Jan Høgelund, Mette Gørtz, Kristin Storck Rasmussen, Helle Sofie Bøje Houlberg
We use register data of 88,948 sick-listed workers in Denmark over the period 2008-2011 to investigate the effect of active labor market programs on the duration until returning to non-subsidized employment and the duration of this employment. To identify causal treatment effects, we exploit over-time variation in the use of active labor market programs in 98 job centers and time-to- event. We find that ordinary education and subsidized job training have significant positive employment effects. Subsidized job training has a large, positive effect on the transition into employment but no effect on the subsequent employment duration...
January 30, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28235697/economic-conditions-illicit-drug-use-and-substance-use-disorders-in-the-united-states
#3
Christopher S Carpenter, Chandler B McClellan, Daniel I Rees
We provide the first analysis of the relationship between economic conditions and the use of illicit drugs other than marijuana. Drawing on US data from 2002 to 2015, we find mixed evidence on the cyclicality of illicit drug use. However, we find robust evidence that economic downturns lead to increases in the intensity of prescription pain reliever use as well as increases in clinically relevant substance use disorders involving opioids. These effects are concentrated among working-age white males with low educational attainment...
January 20, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28157587/health-and-work-in-the-family-evidence-from-spouses-cancer-diagnoses
#4
Sung-Hee Jeon, R Vincent Pohl
Using Canadian administrative data from multiple sources, we provide the first nationally representative estimates for the effect of spouses' cancer diagnoses on individuals' employment and earnings and on family income. Our identification strategy exploits unexpected health shocks and combines matching with individual fixed effects in a generalized difference-in-differences framework to control for observable and unobservable heterogeneity. While the effect of spousal health shocks on labor supply is theoretically ambiguous, we find strong evidence for a decline in employment and earnings of individuals whose spouses are diagnosed with cancer...
January 20, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28183000/effectiveness-of-vaccination-recommendations-versus-mandates-evidence-from-the-hepatitis-a-vaccine
#5
Emily C Lawler
I provide novel evidence on the effectiveness of two vaccination policies - simple non-binding recommendations to vaccinate versus mandates requiring vaccination prior to childcare or kindergarten attendance - in the context of the only disease whose institutional features permit a credible examination of both: hepatitis A. Using provider-verified immunization data I find that recommendations significantly increased hepatitis A vaccination rates among young children by at least 20 percentage points, while mandates increase rates by another 8 percentage points...
January 18, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28182998/how-vertical-integration-affects-the-quantity-and-cost-of-care-for-medicare-beneficiaries
#6
Thomas G Koch, Brett W Wendling, Nathan E Wilson
Health systems are employing physicians in growing numbers. The implications of this trend are poorly understood and controversial. We use rich data from the Centers for Medicare and Medicaid Services to examine the effects of a set of physician acquisitions by hospital systems on outpatient utilization and spending. We find that financial integration systematically produces economically large changes in the acquired physicians' behavior, but has less consistent effects at the acquiring system level.
January 17, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28073062/effects-of-payment-reform-in-more-versus-less-competitive-markets
#7
Neeraj Sood, Abby Alpert, Kayleigh Barnes, Peter Huckfeldt, José J Escarce
Policymakers are increasingly interested in reducing healthcare costs and inefficiencies through innovative payment strategies. These strategies may have heterogeneous impacts across geographic areas, potentially reducing or exacerbating geographic variation in healthcare spending. In this paper, we exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market...
December 30, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/28129914/is-the-rational-addiction-model-inherently-impossible-to-estimate
#8
Audrey Laporte, Adrian Rohit Dass, Brian S Ferguson
The Rational Addiction (RA) model is increasingly often estimated using individual level panel data with mixed results; in particular, with regard to the implied rate of time discount. This paper suggests that the odd values of the rate of discount frequently found in the literature may in fact be a consequence of the saddle-point dynamics associated with individual level inter-temporal optimization problems. We report the results of Monte Carlo experiments estimating RA-type difference equations that seem to suggest the possibility that the presence of both a stable and an unstable root in the dynamic process may create serious problems for the estimation of RA equations...
December 28, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/28040620/the-long-term-health-impacts-of-medicaid-and-chip
#9
Owen Thompson
This paper estimates the effect of US public health insurance programs for children on health. Previous work in this area has typically focused on the relationship between current program eligibility and current health. But because health is a stock variable which reflects the cumulative influence of health inputs, it would be preferable to estimate the impact of total program eligibility during childhood on longer-term health outcomes. I provide such estimates by using longitudinal data to construct Medicaid and CHIP eligibility measures that are observed from birth through age 18 and estimating the effect of cumulative program exposure on a variety of health outcomes observed in early adulthood...
December 23, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27992772/the-role-of-imperfect-surrogate-endpoint-information-in-drug-approval-and-reimbursement-decisions
#10
Katalin Bognar, John A Romley, Jay P Bae, James Murray, Jacquelyn W Chou, Darius N Lakdawalla
Approval of new drugs is increasingly reliant on "surrogate endpoints," which correlate with but imperfectly predict clinical benefits. Proponents argue surrogate endpoints allow for faster approval, but critics charge they provide inadequate evidence. We develop an economic framework that addresses the value of improvement in the predictive power, or "quality," of surrogate endpoints, and clarifies how quality can influence decisions by regulators, payers, and manufacturers. For example, the framework shows how lower-quality surrogates lead to greater misalignment of incentives between payers and regulators, resulting in more drugs that are approved for use but not covered by payers...
December 11, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/28040621/non-separable-time-preferences-novelty-consumption-and-body-weight-theory-and-evidence-from-the-east-german-transition-to-capitalism
#11
Davide Dragone, Nicolas R Ziebarth
This paper develops a dynamic model to illustrate how diet and body weight change when novel food products become available to consumers. We propose a microfounded test to empirically discriminate between habit and taste formation in intertemporal preferences. Moreover, we show that 'novelty consumption' and endogenous preferences can explain the persistent correlation between economic development and obesity. By empirically studying the German reunification, we find that East Germans consumed more novel Western food and gained more weight than West Germans when a larger variety of food products became readily accessible after the fall of the Wall...
December 9, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/28012299/claims-shifting-the-problem-of-parallel-reimbursement-regimes
#12
Olesya Fomenko, Jonathan Gruber
Parallel reimbursement regimes, under which providers have some discretion over which payer gets billed for patient treatment, are a common feature of health care markets. In the U.S., the largest such system is under Workers' Compensation (WC), where the treatment workers with injuries that are not definitively tied to a work accident may be billed either under group health insurance plans or under WC. We document that there is significant reclassification of injuries from group health plans into WC, or "claims shifting", when the financial incentives to do so are strongest...
December 9, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27814484/a-soft-pillow-for-hard-times-economic-insecurity-food-intake-and-body-weight-in-russia
#13
Matthias Staudigel
This study investigates causal effects of economic insecurity on subjective anxiety, food intake, and weight outcomes. A review of psychological and nutrition studies highlights the complexity of processes at work on each stage of this causal chain. Econometric analyses trace the effects along the hypothesized pathway using detailed household panel data from the Russia Longitudinal Monitoring Survey from 1994 to 2005. Economic insecurity measures serve as key explanatory variables in regressions and are instrumented by exogenous regional indicators...
December 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27814483/do-working-conditions-at-older-ages-shape-the-health-gradient
#14
Lauren L Schmitz
This study examines whether working conditions at the end of workers' careers impact health and contribute to health disparities across occupations. A dynamic panel correlated random effects model is used in conjunction with a rich data set that combines information from the Health and Retirement Study (HRS), expert ratings of job demands from the Occupational Information Network (O*NET), and mid-career earnings records from the Social Security Administration's (SSA) Master Earnings File (MEF). Results reveal a strong relationship between positive aspects of the psychosocial work environment and improved self-reported health status, blood pressure, and cognitive function...
December 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27792903/doctor-patient-differences-in-risk-and-time-preferences-a-field-experiment
#15
Matteo M Galizzi, Marisa Miraldo, Charitini Stavropoulou, Marjon van der Pol
We conduct a framed field experiment among patients and doctors to test whether the two groups have similar risk and time preferences. We elicit risk and time preferences using multiple price list tests and their adaptations to the healthcare context. Risk and time preferences are compared in terms of switching points in the tests and the structurally estimated behavioural parameters. We find that doctors and patients significantly differ in their time preferences: doctors discount future outcomes less heavily than patients...
December 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27765280/the-design-of-long-term-care-insurance-contracts
#16
Helmuth Cremer, Jean-Marie Lozachmeur, Pierre Pestieau
This paper studies the design of long term care (LTC) insurance contracts in the presence of ex post moral hazard. While this problem bears some similarity with the study of health insurance (Blomqvist, 1997) the significance of informal LTC affects the problem in several crucial ways. It introduces the potential crowding out of informal care by market care financed through insurance coverage. Furthermore, the information structure becomes more intricate. Informal care is not publicly observable and, unlike the insurer, caregivers know the true needs of their relatives...
December 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27744236/does-the-extension-of-primary-care-practice-opening-hours-reduce-the-use-of-emergency-services
#17
Matteo Lippi Bruni, Irene Mammi, Cristina Ugolini
Overcrowding in emergency departments generates potential inefficiencies. Using regional administrative data, we investigate the impact that an increase in the accessibility of primary care has on emergency visits in Italy. We consider two measures of avoidable emergency visits recorded at list level for each General Practitioner. We test whether extending practices' opening hours to up to 12 hours/day reduces the inappropriate utilization of emergency services. Since subscribing to the extension program is voluntary, we account for the potential endogeneity of participation in a count model for emergency admissions in two ways: first, we use a two-stage residual inclusion approach...
December 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27736705/the-mental-health-parity-and-addiction-equity-act-evaluation-study-impact-on-specialty-behavioral-health-utilization-and-expenditures-among-carve-out-enrollees
#18
Susan L Ettner, Jessica M Harwood, Amber Thalmayer, Michael K Ong, Haiyong Xu, Michael J Bresolin, Kenneth B Wells, Chi-Hong Tseng, Francisca Azocar
Interrupted time series with and without controls was used to evaluate whether the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and its Interim Final Rule increased the probability of specialty behavioral health treatment and levels of utilization and expenditures among patients receiving treatment. Linked insurance claims, eligibility, plan and employer data from 2008 to 2013 were used to estimate segmented regression analyses, allowing for level and slope changes during the transition (2010) and post-MHPAEA (2011-2013) periods...
December 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27723470/the-effect-of-college-education-on-mortality
#19
Kasey Buckles, Andreas Hagemann, Ofer Malamud, Melinda Morrill, Abigail Wozniak
We exploit exogenous variation in years of completed college induced by draft-avoidance behavior during the Vietnam War to examine the impact of college on adult mortality. Our estimates imply that increasing college attainment from the level of the state at the 25th percentile of the education distribution to that of the state at the 75th percentile would decrease cumulative mortality for cohorts in our sample by 8 to 10 percent relative to the mean. Most of the reduction in mortality is from deaths due to cancer and heart disease...
September 3, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/27697699/the-effect-of-narrow-provider-networks-on-health-care-use
#20
Alicia Atwood, Anthony T Lo Sasso
Network design is an often overlooked aspect of health insurance contracts. Recent policy factors have resulted in narrower provider networks. We provide plausibly causal evidence on the effect of narrow network plans offered by a large national health insurance carrier in a major metropolitan market. Our econometric design exploits the fact that some firms offer a narrow network plan to their employees and some do not. Our results show that narrow network health plans lead to reductions in health care utilization and spending...
December 2016: Journal of Health Economics
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