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Journal of Health Economics

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...
October 8, 2016: Journal of Health Economics
Martin Chalkley, Helmuth Cremer, Luigi Siciliani
No abstract text is available yet for this article.
September 30, 2016: Journal of Health Economics
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...
September 30, 2016: Journal of Health Economics
Line Bjørnskov Pedersen, Stephane Hess, Trine Kjær
This study uses a best-worst scaling experiment to test whether general practitioners (GPs) act as perfect agents for the patients in the consultation; and if not, whether this is due to asymmetric information and/or other motivations than user orientation. Survey data were collected from 775 GPs and 1379 Danish citizens eliciting preferences for a consultation. Sequential models allowing for within-person preference heterogeneity and heteroskedasticity between best and worst choices were estimated. We show that GPs do not always act as perfect agents and that this non-alignment stems from GPs being both unable and unwilling to do so...
September 28, 2016: Journal of Health Economics
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...
September 27, 2016: Journal of Health Economics
Pierre Pestieau, Gregory Ponthiere
Due to the aging process, the provision of long-term care (LTC) to the dependent elderly has become a major challenge of our epoch. But our societies are also characterized, since the 1970s, by a postponement of births, which, by raising the intergenerational age gap, can affect the provision of LTC by children. In order to examine the impact of those demographic trends on the optimal policy, we develop a four-period OLG model where individuals, who receive children's informal LTC at the old age, must choose, when being young, how to allocate births along their life cycle...
September 22, 2016: Journal of Health Economics
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...
September 21, 2016: Journal of Health Economics
Keith M Marzilli Ericson, Amanda Starc
This paper examines the effect of choice architecture on Massachusetts' Health Insurance Exchange. A policy change standardized cost-sharing parameters of plans across insurers and altered information presentation. Post-change, consumers chose more generous plans and different brands, but were not more price-sensitive. We use a discrete choice model that allows the policy to affect how attributes are valued to decompose the policy's effects into a valuation effect and a product availability effect. The brand shifts are largely explained by the availability effect and the generosity shift by the valuation effect...
September 21, 2016: Journal of Health Economics
Vincent Réquillart, Louis-Georges Soler, Yu Zang
The goal of this paper is to better understand firms' strategic reactions to nutritional policies targeting food quality improvements and to derive optimal policies. We propose a model of product differentiation, taking into account the taste and health characteristics of products. We study how two firms react to alternative policies: an MQS policy, linear taxation of the two goods on the market, and taxation of the low-quality good. The MQS and the taxation of the low-quality product are the preferred options by a social planner...
September 14, 2016: Journal of Health Economics
Ian M McCarthy
Researchers are often interested in composite measures such as overall ratings, indices of physical or mental health, or health-related quality-of-life (HRQoL) outcomes. Such measures are typically composed of two or more underlying discrete variables. In this paper, I investigate conditions where the estimated treatment effect based solely on the composite outcome is biased under non-random treatment assignment, which I refer to as composite bias. I then compare the magnitude of this bias across a variety of estimators, including ordinary least squares, propensity score estimators, and an alternative two-stage approach that first estimates treatment effects on the underlying outcomes and then combines these effects into an overall effect on the composite outcome of interest...
September 13, 2016: Journal of Health Economics
Sanders D Korenman, Dahlia K Remler
We develop and implement what we believe is the first conceptually valid health-inclusive poverty measure (HIPM) - a measure that includes health care or insurance in the poverty needs threshold and health insurance benefits in family resources - and we discuss its limitations. Building on the Census Bureau's Supplemental Poverty Measure, we construct a pilot HIPM for the under-65 population under ACA-like health reform in Massachusetts. This pilot demonstrates the practicality, face validity and value of a HIPM...
September 8, 2016: Journal of Health Economics
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
Sean Shenghsiu Huang, Richard A Hirth
We use the rollout of the five-star rating of nursing homes to study how private-pay prices respond to quality rating. We find that star rating increases the price differential between top- and bottom-ranked facilities. On average, prices of top-ranked facilities increased by 4.8 to 6.0 percent more than the prices of bottom-ranked facilities. We find stronger price effects in markets that are less concentrated where consumers may have more choices of alternative nursing homes. Our results suggest that with simplified design and when markets are less concentrated, consumers are more responsive to quality reporting...
September 3, 2016: Journal of Health Economics
Momotazur Rahman, Edward C Norton, David C Grabowski
As hospitals are increasingly held accountable for patients' post-discharge outcomes under new payment models, hospitals may choose to acquire skilled nursing facilities (SNFs) to better manage these outcomes. This raises the question of whether patients discharged to hospital-based SNFs have better outcomes. In unadjusted comparisons, hospital-based SNF patients have much lower Medicare utilization in the 180 days following discharge relative to freestanding SNF patients. We solved the problem of differential selection into hospital-based and freestanding SNFs by using differential distance from home to the nearest hospital with a SNF relative to the distance from home to the nearest hospital without a SNF as an instrument...
September 3, 2016: Journal of Health Economics
Laurence C Baker, M Kate Bundorf, Daniel P Kessler
In this paper, we estimate how hospital ownership of physicians' practices affects their patients' hospital choices. We match data on the hospital admissions of Medicare beneficiaries, including the identity of their physician, with data on the identity of the owner of their physician's practice. We find that a hospital's ownership of a physician dramatically increases the probability that the physician's patients will choose the owning hospital. We also find that patients are more likely to choose a high-cost, low-quality hospital when their physician is owned by that hospital...
September 3, 2016: Journal of Health Economics
Christoph M Rheinberger, Daniel Herrera-Araujo, James K Hammitt
We present an integrated valuation model for diseases that are life-threatening. The model extends the standard one-period value-per-statistical-life model to three health prospects: healthy, ill, and dead. We derive willingness-to-pay values for prevention efforts that reduce a disease's incidence rate as well as for treatments that lower the corresponding health deterioration and mortality rates. We find that the demand value of prevention always exceeds that of treatment. People often overweight small risks and underweight large ones...
August 29, 2016: Journal of Health Economics
Kristian Bolin, Björn Lindgren
A number of behaviours influence health in a non-monotonic way. Physical activity and alcohol consumption, for instance, may be beneficial to one's health in moderate but detrimental in large quantities. We develop a demand-for-health framework that incorporates the feature of a physiologically optimal level. An individual may still choose a physiologically non-optimal level, because of the trade-off in his or her preferences for health versus other utility-affecting commodities. However, any deviation above or below the physiologically optimal level will be punished with respect to health...
August 26, 2016: Journal of Health Economics
Nils Gutacker, Luigi Siciliani, Giuseppe Moscelli, Hugh Gravelle
The implications of hospital quality competition depend on what type of quality affects choice of hospital. Previous studies of quality and choice of hospitals have used crude measures of quality such as mortality and readmission rates rather than measures of the health gain from specific treatments. We estimate multinomial logit models of hospital choice by patients undergoing hip replacement surgery in the English NHS to test whether hospital demand responds to quality as measured by detailed patient reports of health before and after hip replacement...
August 22, 2016: Journal of Health Economics
Michèle Belot, Jonathan James, Patrick Nolen
We conduct a field experiment in 31 primary schools in England to test the effectiveness of different temporary incentives on increasing choice and consumption of fruit and vegetables at lunchtime. In each treatment, pupils received a sticker for choosing a fruit or vegetable at lunch. They were eligible for an additional reward at the end of the week depending on the number of stickers accumulated, either individually (individual scheme) or in comparison to others (competition). Overall, we find no significant effect of the individual scheme, but positive effects of competition...
August 10, 2016: Journal of Health Economics
Dorte Gyrd-Hansen, Trine Kjær, Jytte Seested Nielsen
This paper examines public valuations of mortality risk reductions. We set up a theoretical framework that allows for altruistic preferences, and subsequently test theoretical predictions through the design of a discrete choice experiment. By varying the tax scenario (uniform versus individual tax), the experimental design allows us to verify whether pure altruistic preferences are present and the underlying causes. We find evidence of negative pure altruism. Under a coercive uniform tax system respondents lower their willingness to pay possibly to ensure that they are not forcing others to pay at a level that corresponds to their own - higher - valuations...
September 2016: Journal of Health Economics
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