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Journal of Health Economics

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https://www.readbyqxmd.com/read/28319791/premium-subsidies-the-mandate-and-medicaid-expansion-coverage-effects-of-the-affordable-care-act
#1
Molly Frean, Jonathan Gruber, Benjamin D Sommers
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014-2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange...
March 6, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28288356/the-effect-of-prices-on-nutrition-comparing-the-impact-of-product-and-nutrient-specific-taxes
#2
Matthew Harding, Michael Lovenheim
This paper provides an analysis of the role of prices in determining food purchases and nutrition using very detailed transaction-level observations for a large, nationally-representative sample of US consumers over the period 2002-2007. Using product-specific nutritional information, we develop a new method of partitioning the product space into relevant nutritional clusters that define a set of nutritionally-bundled goods, which parsimoniously characterize consumer choice sets. We then estimate a large utility-derived demand system over this joint product-nutrient space that allows us to calculate price and expenditure elasticities...
February 28, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28285141/mitigating-the-consequences-of-a-health-condition-the-role-of-intra-and-interhousehold-assistance
#3
Michael Dalton, Daniel LaFave
The behavior of noncoresident family members motivates much of the literature on consumption smoothing, risk-sharing, and informal networks, yet little is known empirically on the topic due to a lack of data simultaneously observing multiple households in an extended family. This study utilizes genealogically linked longitudinal data to examine how extended family networks insure against financial risks from severely limiting health conditions. We find that nonhealth consumption of unmarried households declines in response to worsening health, whereas married households smooth expenditures in a way that is consistent with full insurance...
February 20, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28242432/medicaid-family-spending-and-the-financial-implications-of-crowd-out
#4
Marcus Dillender
A primary purpose of health insurance is to protect families from medical expenditure risk. Despite this goal and despite the fact that research has found that Medicaid can crowd out private coverage, little is known about the effect of Medicaid on families' spending patterns. This paper implements a simulated instrumental variables strategy with data from the Consumer Expenditure Survey to estimate the effect of an additional family member becoming eligible for Medicaid on family-level health insurance coverage and spending...
February 16, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28273626/did-medicare-part-d-reduce-mortality
#5
Jason Huh, Julian Reif
We investigate the implementation of Medicare Part D and estimate that this prescription drug benefit program reduced elderly mortality by 2.2% annually. This was driven primarily by a reduction in cardiovascular mortality, the leading cause of death for the elderly. There was no effect on deaths due to cancer, a condition whose drug treatments are covered under Medicare Part B. We validate these results by demonstrating that the changes in drug utilization following the implementation of Medicare Part D match the mortality patterns we observe...
February 14, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28182999/employment-effects-of-active-labor-market-programs-for-sick-listed-workers
#6
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/28319792/safety-regulation-in-professional-football-empirical-evidence-of-intended-and-unintended-consequences
#7
Andrew Hanson, Nicholas A Jolly, Jeremy Peterson
In response to increasing public awareness and negative long-term health effects of concussions, the National Football League implemented the "Crown-of-the-Helmet Rule" (CHR). The CHR imposes penalties on players who initiate contact using the top of the helmet. This paper examines the intended effect of this policy and its potential for unintended consequences. We find evidence supporting the intended effect of the policy- a reduction in weekly concussion reports among defensive players by as much as 32% (34% for all head and neck injuries), but also evidence of an increase in weekly lower extremity injury reports for offensive players by as much as 34%...
January 29, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28235697/economic-conditions-illicit-drug-use-and-substance-use-disorders-in-the-united-states
#8
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
#9
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
#10
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
#11
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
#12
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/28318667/paying-medicare-advantage-plans-to-level-or-tilt-the-playing-field
#13
Jacob Glazer, Thomas G McGuire
Medicare beneficiaries are eligible for health insurance through the public option of traditional Medicare (TM) or may join a private Medicare Advantage (MA) plan. Both are highly subsidized but in different ways. Medicare pays for most of costs directly in TM, and subsidizes MA plans based on a "benchmark" for each beneficiary choosing a private plan. The level of this benchmark is arguably the most important policy decision Medicare makes about the MA program. Many analysts recommend equalizing Medicare's subsidy across the options - referred to in policy circles as a "level playing field...
December 29, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/28129914/is-the-rational-addiction-model-inherently-impossible-to-estimate
#14
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/28236720/do-hospital-mergers-reduce-costs
#15
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...
March 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28040620/the-long-term-health-impacts-of-medicaid-and-chip
#16
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
#17
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
#18
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
#19
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
#20
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
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