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Journal of Health Economics

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https://www.readbyqxmd.com/read/30007261/quality-disclosure-and-the-timing-of-insurers-adjustments-evidence-from-medicare-advantage
#1
Ian M McCarthy
Mandatory quality disclosure often includes a period over which the quality of new entrants is unreported. This provides the opportunity for forward-looking firms to adjust product characteristics in advance of disclosure. Using comprehensive data on Medicare Advantage (MA) from 2007 to 2015, I exploit the design of the MA Star Rating program to examine the presence of forward-looking behavior among insurers. I find that high-quality insurers reduce prices leading up to quality disclosure, while low-quality insurers increase prices in advance of quality disclosure...
June 30, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/30007260/price-competition-in-pharmaceuticals-evidence-from-1303-swedish-markets
#2
David Granlund, Mats A Bergman
We study the short- and long-term price effects of the number of competing firms, using panel-data on 1303 distinct pharmaceutical markets for 78 months within a reference-price system. We use actual transaction prices in an institutional setting with little scope for non-price competition and where simultaneity problems can be addressed effectively. In the long term, the price of generics is found to decrease by 81% when the number of firms selling generics with the same strength, form and similar package size is increased from 1 to 10...
June 30, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29990675/the-role-of-health-insurance-on-treatment-for-opioid-use-disorders-evidence-from-the-affordable-care-act-medicaid-expansion
#3
Angélica Meinhofer, Allison E Witman
We estimate the effect of health insurance coverage on opioid use disorder treatment utilization and availability by exploiting cross-state variation in effective dates of Medicaid expansions under the Affordable Care Act. Using a difference-in-differences design, we find that aggregate opioid admissions to specialty treatment facilities increased 18% in expansion states, most of which involved outpatient medication-assisted treatment (MAT). Opioid admissions from Medicaid beneficiaries increased 113% without crowding out admissions from individuals with other health insurance...
June 30, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29957473/choice-in-the-presence-of-experts-the-role-of-general-practitioners-in-patients-hospital-choice
#4
Walter Beckert
This paper considers the micro-econometric analysis of patients' hospital choice for elective medical procedures when their choice set is pre-selected by a general practitioner (GP). GPs have a dual role with regard to elective referrals in the English NHS, advising patients and at the same time taking account of the financial implications of referral decisions on local health budgets. The paper proposes a two-stage choice model that encompasses both patient and GP level optimization. It demonstrates that estimators that do not take account of strategic pre-selection of choice sets may be biased and inconsistent...
June 25, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/30007212/adoption-and-learning-across-hospitals-the-case-of-a-revenue-generating-practice
#5
Adam Sacarny
Performance-raising practices tend to diffuse slowly in the health care sector. To understand how incentives drive adoption, I study a practice that generates revenue for hospitals: submitting detailed documentation about patients. After a 2008 reform, hospitals could raise their Medicare revenue over 2% by always specifying a patient's type of heart failure. Hospitals only captured around half of this revenue, indicating that large frictions impeded takeup. Exploiting the fact that many doctors practice at multiple hospitals, I find that four-fifths of the dispersion in adoption reflects differences in the ability of hospitals to extract documentation from physicians...
June 19, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29936292/effects-of-medicare-coverage-for-the-chronically-ill-on-health-insurance-utilization-and-mortality-evidence-from-coverage-expansions-affecting-people-with-end-stage-renal-disease
#6
Martin S Andersen
I study the effect of the 1973 expansions of Medicare coverage among individuals with end-stage renal disease (ESRD) on insurance coverage, health care utilization, and mortality. I find that the expansions increased insurance coverage by between 22 and 30 percentage points, in models that include trends in age, with the increase explained by Medicare coverage, and increased physician visits by 25-35 percent. These expansions also decreased mortality due to kidney disease in the under 65 population by between 0...
June 18, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29940410/narrow-provider-networks-and-willingness-to-pay-for-continuity-of-care-and-network-breadth
#7
Lucas Higuera, Caroline S Carlin, Bryan Dowd
Tiered and narrow provider networks are mechanisms implemented by health plans to reduce health care costs. The benefits of narrow networks for consumers usually come in the form of lower premiums in exchange for access to fewer providers. Narrow networks may disrupt continuity of care and access to usual sources of care. We examine choices of health plans in a private health insurance exchange where consumers choose among one broad network and four narrow network plans. Using a discrete choice model with repeated choices, we estimate the willingness to pay for a health plan that covers consumers' usual sources of care...
June 15, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29960097/roads-and-the-spread-of-hiv-in-africa
#8
Elodie Djemai
I here use GIS and HIV data from five African countries to estimate the effect of road proximity on HIV infection. I find a negative effect of the distance to the nearest paved road on the probability of being infected with HIV: a one standard-deviation fall in this distance (approximately 2.4 km) increases the probability of infection by 0.6-2.0 percentage points. Using slope as an instrument for road distance continues to produce a negative and significant estimated coefficient. However this relationship may also reflect selection and reverse causality in individual choice of location, and I extensively discuss the role of migration...
June 7, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29906764/end-of-life-healthcare-expenditure-testing-economic-explanations-using-a-discrete-choice-experiment
#9
Barbara Fischer, Harry Telser, Peter Zweifel
Healthcare expenditure (HCE) spent during an individual's last year of life accounts for a high share of lifetime HCE. This finding is puzzling because an investment in health is unlikely to have a sufficiently long payback period. However, Becker et al. (2007) and Philipson et al. (2010) have advanced a theory designed to explain high willingness to pay (WTP) for an extension of life close to its end. Their testable implications are complemented by the concept of 'pain of risk bearing' introduced by Eeckhoudt and Schlesinger (2006)...
June 7, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29913308/basic-versus-supplementary-health-insurance-access-to-care-and-the-role-of-cost-effectiveness
#10
Jan Boone
In a model where patients face budget constraints that make some treatments unaffordable without health insurance, we ask which treatments should be covered by universal basic insurance and which by private voluntary insurance. We argue that next to cost effectiveness, prevalence is important if the government wants to maximize the welfare gain that it gets from its health budget. Conditions are derived under which basic insurance should cover treatments that are mainly used by high risk agents with low income...
May 31, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29909201/blowing-up-money-the-earnings-penalty-of-smoking-in-the-1970s-and-the-21st-century
#11
Elisabeth Lång, Paul Nystedt
We analyze the earnings penalty of smoking among Swedish twins in two social contexts: the 1970s, when smoking was common and widely accepted and when there were relatively few tobacco laws aiming to reduce smoking; and the 2000s, when smoking had become more expensive, stigmatizing and less common, and when tobacco laws and regulations had intensified. The results show that the short-term earnings penalty of smoking was much higher in the 21st century than in the 1970s for men. For women, smokers had on average higher annual earnings compared to nonsmokers in the 1970s, but lower annual earnings in the 2000s...
May 31, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29990674/health-care-in-a-multi-payer-system-spillovers-of-health-care-service-demand-among-adults-under-65-on-utilization-and-outcomes-in-medicare
#12
Sherry Glied, Kai Hong
This paper examines, theoretically and empirically, how changes in the demand for health insurance and medical services in the non-Medicare population - coverage eligibility changes for parents and the firm size composition of employment - spill over and affect health insurance coverage and how these factors affect per beneficiary Medicare spending. We find that factors that increase coverage and hence demand for medical services in the non-Medicare population generate contemporaneous decreases in per beneficiary Medicare spending and utilization, particularly for high variation services...
May 30, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29775799/exploding-asthma-and-adhd-caseloads-the-role-of-medicaid-managed-care
#13
Anna Chorniy, Janet Currie, Lyudmyla Sonchak
In the U.S., nearly 11% of school-age children have been diagnosed with ADHD, and approximately 10% of children suffer from asthma. In the last decade, the number of children diagnosed with these conditions has inexplicably been on the rise. This increase has been concentrated in the Medicaid caseload nationwide. One of the most striking changes in Medicaid has been the transition from fee-for-service (FFS) reimbursement to Medicaid managed care (MMC), which had taken place in 80% of states by 2016. Using Medicaid claims from South Carolina, we show that this change contributed to the increase in asthma and ADHD caseloads...
May 7, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29753197/violence-selection-and-infant-mortality-in-congo
#14
Olivier Dagnelie, Giacomo Davide De Luca, Jean-François Maystadt
This paper documents the effects of the recent civil war in the Democratic Republic of Congo on mortality both in utero and during the first year of life. It instruments for conflict intensity using a mineral price index, which exploits the exogenous variation in the potential value of mineral resources generated by changes in world mineral prices to predict the geographic distribution of the conflict. Using estimates of civil war exposure on mortality across male and female newborn to assess their relative health, it provides evidence of culling effect (in utero selection) as a consequence of in utero shocks...
May 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29727744/the-effect-of-hospital-acquisitions-of-physician-practices-on-prices-and-spending
#15
Cory Capps, David Dranove, Christopher Ody
During the past decade, U.S. hospitals have acquired a large number of physician practices. For example, from 2007 to 2013, hospitals acquired nearly 10% of the practices in our sample. We find that the prices for the services provided by acquired physicians increase by an average of 14.1% post-acquisition. Nearly half of this increase is attributable to the exploitation of payment rules. Price increases are larger when the acquiring hospital has a larger share of its inpatient market. We find that integration of primary care physicians increases enrollee spending by 4...
May 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29723696/can-natural-gas-save-lives-evidence-from-the-deployment-of-a-fuel-delivery-system-in-a-developing-country
#16
Resul Cesur, Erdal Tekin, Aydogan Ulker
There has been a widespread displacement of coal by natural gas as space heating and cooking technology in Turkey in the last two decades, triggered by the deployment of natural gas networks. We examine the impact of this development on mortality among adults and the elderly by exploiting the variation in the timing of the deployment and the intensity of expansion of gas networks across provinces using data from 2001 to 2016. The results indicate that the expansion of natural gas has caused significant reductions in mortality among both adults and the elderly...
May 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29723695/patient-cost-sharing-socioeconomic-status-and-children-s-health-care-utilization
#17
Anton Nilsson, Alexander Paul
This paper estimates the effect of cost-sharing on the demand for children's and adolescents' use of medical care. We use a large population-wide registry dataset including detailed information on contacts with the health care system as well as family income. Two different estimation strategies are used: regression discontinuity design exploiting age thresholds above which fees are charged, and difference-in-differences models exploiting policy changes. We also estimate combined regression discontinuity difference-in-differences models that take into account discontinuities around age thresholds caused by factors other than cost-sharing...
May 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29709710/are-coresidence-and-nursing-homes-substitutes-evidence-from-medicaid-spend-down-provisions
#18
Corina Mommaerts
This paper measures the extent to which the price of nursing home care affects a potential substitute living arrangement: coresidence with adult children. Exploiting variation in state Medicaid income "spend-down" provisions over time, I find that living in a state with a spend-down provision decreases the prevalence of coresidence with adult children by 1-4 percentage points for single elderly individuals, with a corresponding increase in the use of nursing home care. These findings suggest that changes in Medicaid eligibility for long-term care benefits could have large impacts on living arrangements, care utilization patterns, and Medicaid expenditures...
May 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29673900/the-economics-of-patient-centered-care
#19
Guy David, Philip A Saynisch, Aaron Smith-McLallen
The Patient-Centered Medical Home (PCMH) is a widely-implemented model for improving primary care, emphasizing care coordination, information technology, and process improvements. However, its treatment as an undifferentiated intervention in policy evaluation obscures meaningful variation in implementation. This heterogeneity leads to contracting inefficiencies between insurers and practices and may account for mixed evidence on its success. Using a novel dataset we group practices into meaningful implementation clusters and then link these clusters with detailed patient claims data...
May 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29673899/it-s-about-time-cesarean-sections-and-neonatal-health
#20
Ana María Costa-Ramón, Ana Rodríguez-González, Miquel Serra-Burriel, Carlos Campillo-Artero
Cesarean sections have been associated in the literature with poorer newborn health, particularly with a higher incidence of respiratory morbidity. Most studies suffer, however, from potential omitted variable bias, as they are based on simple comparisons of mothers who give birth vaginally and those who give birth by cesarean section. We try to overcome this limitation and provide credible causal evidence by using variation in the probability of having a c-section that is arguably unrelated to maternal and fetal characteristics: variation by time of day...
May 2018: Journal of Health Economics
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