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Journal of Health Economics

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https://www.readbyqxmd.com/read/28807331/health-insurance-subsidies-and-deductible-choice-evidence-from-regional-variation-in-subsidy-schemes
#1
Cornel Kaufmann, Christian Schmid, Stefan Boes
The extent to which premium subsidies can influence health insurance choices is an open question. In this paper, we explore the regional variation in subsidy schemes in Switzerland, designed as either in-kind or cash transfers, to study their impact on the choice of health insurance deductibles. Using health survey data and a difference-in-differences methodology, we find that in-kind transfers increase the likelihood of choosing a low deductible plan by approximately 4 percentage points (or 7%). Our results indicate that the response to in-kind transfers is strongest among women, middle-aged and unmarried individuals, which we explain by differences in risk-taking behavior, health status, financial constraints, health insurance and financial literacy...
August 5, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28811119/family-planning-funding-cuts-and-teen-childbearing
#2
Analisa Packham
Publicly funded family planning clinics provide low-cost and free contraception to nearly 1.5 million teens each year. In recent years, several states have considered legislation to defund family planning services, although little is known about how these cuts affect teen pregnancy. This paper fills this knowledge gap by exploiting a policy change in Texas that reduced funding for family planning services by 67% and resulted in over 80 clinic closures. I estimate the effects of the funding cuts on teen health outcomes using a difference-in-differences approach that compares the changes in teen birth rates in Texas counties that lost family planning funding to changes in counties outside of Texas with publicly funded clinics...
August 3, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28811120/impact-of-caregiver-incentives-on-child-health-evidence-from-an-experiment-with-anganwadi-workers-in-india
#3
Prakarsh Singh, William A Masters
This paper tests the effectiveness of performance pay and bonuses among government childcare workers in India. In a controlled study of 160 ICDS centers serving over 4000 children, we randomly assign workers to either fixed bonuses or payments based on the nutritional status of children in their care, and also collect data from a control group receiving only standard salaries. In all three study arms mothers receive nutrition information. We find that performance pay reduces underweight prevalence by about 5 percentage points over 3 months, and height improves by about one centimeter...
August 1, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28802747/the-market-for-paid-sick-leave
#4
Simen Markussen, Knut Røed
In many countries, general practitioners (GPs) are assigned the task of controlling the validity of their own patients' insurance claims. At the same time, they operate in a market where patients are customers free to choose their GP. Are these roles compatible? Can we trust that the gatekeeping decisions are untainted by private economic interests? Based on administrative registers from Norway with records on sick pay certification and GP-patient relationships, we present evidence to the contrary: GPs are more lenient gatekeepers the more competitive is the physician market, and a reputation for lenient gatekeeping increases the demand for their services...
August 1, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28801131/health-care-demand-elasticities-by-type-of-service
#5
Randall P Ellis, Bruno Martins, Wenjia Zhu
We estimate within-year price elasticities of demand for detailed health care services using an instrumental variable strategy, in which individual monthly cost shares are instrumented by employer-year-plan-month average cost shares. A specification using backward myopic prices gives more plausible and stable results than using forward myopic prices. Using 171 million person-months spanning 73 employers from 2008 to 2014, we estimate that the overall demand elasticity by backward myopic consumers is -0.44, with higher elasticities of demand for pharmaceuticals (-0...
July 29, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28802746/is-it-who-you-are-or-where-you-live-residential-segregation-and-racial-gaps-in-childhood-asthma
#6
Diane Alexander, Janet Currie
Higher asthma rates are one of the more obvious ways that health inequalities between African American and other children are manifested beginning in early childhood. In 2010, black asthma rates were double non-black rates. Some but not all of this difference can be explained by factors such as a higher incidence of low birth weight (LBW) among blacks; however, even conditional on LBW, blacks have a higher incidence of asthma than others. Using a unique data set based on the health records of all children born in New Jersey between 2006 and 2010, we show that when we split the data by whether or not children live in a "black" zip code, this racial difference in the incidence of asthma among LBW children entirely disappears...
July 25, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28778349/competitive-effects-of-scope-of-practice-restrictions-public-health-or-public-harm
#7
Sara Markowitz, E Kathleen Adams, Mary Jane Lewitt, Anne L Dunlop
The demand for healthcare professionals is predicted to grow significantly over the next decade. Securing an adequate workforce is of primary importance to ensure the health and wellbeing of the population in an efficient manner. Occupational licensing laws and related restrictions on scope of practice (SOP) are features of the market for healthcare professionals and are also controversial. At issue is a balance between protecting the public health and removing anticompetitive barriers to entry and practice...
July 23, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28784289/do-health-insurers-innovate-evidence-from-the-anatomy-of-physician-payments
#8
Jeffrey Clemens, Joshua D Gottlieb, Tímea Laura Molnár
One of private health insurers' main roles in the United States is to negotiate physician payment rates on their beneficiaries' behalf. We show that these rates are often set in reference to a government benchmark, and ask how often private insurers customize their fee schedules away from this default. We exploit changes in Medicare's payments and dramatic bunching in markups over Medicare's rates to address this question. Although Medicare's rates are influential, 25 percent of physician services in our data, representing 45 percent of covered spending, deviate from the benchmark...
July 13, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28774725/endogenous-information-adverse-selection-and-prevention-implications-for-genetic-testing-policy
#9
Richard Peter, Andreas Richter, Paul Thistle
We examine public policy toward the use of genetic information by insurers. Individuals engage in unobservable primary prevention and have access to different prevention technologies. Thus, insurance markets are affected by moral hazard and adverse selection. Individuals can choose to take a genetic test to acquire information about their prevention technology. Information has positive decision-making value, that is, individuals may adjust their behavior based on the result of the test. However, testing also exposes individuals to uncertainty over the available insurance contract, so-called classification risk, which lowers the value of information...
July 13, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28778350/econometric-modelling-of-multiple-self-reports-of-health-states-the-switch-from-eq-5d-3l-to-eq-5d-5l-in-evaluating-drug-therapies-for-rheumatoid-arthritis
#10
Mónica Hernández-Alava, Stephen Pudney
EQ-5D is used in cost-effectiveness studies underlying many important health policy decisions. It comprises a survey instrument describing health states across five domains, and a system of utility values for each state. The original 3-level version of EQ-5D is being replaced with a more sensitive 5-level version but the consequences of this change are uncertain. We develop a multi-equation ordinal response model incorporating a copula specification with normal mixture marginals to analyse joint responses to EQ-5D-3L and EQ-5D-5L in a survey of people with rheumatic disease, and use it to generate mappings between the alternative descriptive systems...
July 4, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28743535/discharge-on-the-day-of-birth-parental-response-and-health-and-schooling-outcomes
#11
Hans Henrik Sievertsen, Miriam Wüst
Exploiting the Danish roll-out of same-day discharge policies after uncomplicated births, we find that treated newborns have a higher probability of hospital readmission in the first month after birth. While these short-run effects may indicate substitution of hospital stays with readmissions, we also find that-in the longer run-a same-day discharge decreases children's 9th grade GPA. This effect is driven by children and mothers, who prior to the policy change would have been least likely to experience a same-day discharge...
July 4, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28728808/wolves-in-sheep-s-clothing-is-non-profit-status-used-to-signal-quality
#12
Daniel B Jones, Carol Propper, Sarah Smith
Why do many firms in the healthcare sector adopt non-profit status? One argument is that non-profit status serves as a signal of quality when consumers are not well informed. A testable implication is that an increase in consumer information may lead to a reduction in the number of non-profits in a market. We test this idea empirically by exploiting an exogenous increase in consumer information in the US nursing home industry. We find that the information shock led to a reduction in the share of non-profit homes, driven by a combination of home closure and sector switching...
July 1, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28728807/the-impact-of-team-based-primary-care-on-health-care-services-utilization-and-costs-quebec-s-family-medicine-groups
#13
Erin Strumpf, Mehdi Ammi, Mamadou Diop, Julie Fiset-Laniel, Pierre Tousignant
We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec's Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not...
July 1, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28712437/the-long-term-effects-of-consumer-directed-health-plans-on-preventive-care-use
#14
Matthew D Eisenberg, Amelia M Haviland, Ateev Mehrotra, Peter J Huckfeldt, Neeraj Sood
"Consumer-Directed" Health Plans (CDHPs), those with high deductibles and personal medical accounts, have been shown to reduce health care spending. The impact of CDHPs on preventive care is unclear. On the one hand CDHPs might increase use of preventive care as such care is exempt from the deductible. However, CDHPs also decrease visits to physicians which might results in less screening. Prior research has found conflicting results. In this study, using data from 37 employers we examine the effects of CDHPs on the use of cancer screenings up to three years after the initial CDHP offering with ITT and LATE approaches...
June 27, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28743536/vitamin-panacea-is-advertising-fueling-demand-for-products-with-uncertain-scientific-benefit
#15
Matthew D Eisenberg, Rosemary J Avery, Jonathan H Cantor
This study examines the effect of advertising on demand for vitamins-products with spiraling sales despite little evidence of efficacy. We merge seven years (2003-2009) of advertising data from Kantar Media with the Simmons National Consumer Survey to estimate individual-level vitamin print and television ad exposure effects. Identification relies on exploiting exogenous variation in year-to-year advertising exposure by controlling for each individual's unique media consumption. We find that increasing advertising exposure from zero to the mean number of ads increases the probability of consumption by 1...
June 17, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28655489/the-spillover-effects-of-health-insurance-benefit-mandates-on-public-insurance-coverage-evidence-from-veterans
#16
Xiaoxue Li, Jinqi Ye
This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance...
June 13, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28619488/financial-risk-protection-from-social-health-insurance
#17
Kayleigh Barnes, Arnab Mukherji, Patrick Mullen, Neeraj Sood
This paper estimates the impact of social health insurance on financial risk by utilizing data from a natural experiment created by the phased roll-out of a social health insurance program for the poor in India. We estimate the distributional impact of insurance on of out-of-pocket costs and incorporate these results with a stylized expected utility model to compute associated welfare effects. We adjust the standard model, accounting for conditions of developing countries by incorporating consumption floors, informal borrowing, and asset selling which allow us to separate the value of financial risk reduction from consumption smoothing and asset protection...
June 7, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28602394/reputational-concerns-with-altruistic-providers
#18
Pau Olivella, Luigi Siciliani
We study a model of reputational concerns when doctors differ in their degree of altruism and they can signal their altruism by their (observable) quality. When reputational concerns are high, following the introduction or enhancement of public reporting, the less altruistic (bad) doctor mimics the more altruistic (good) doctor. Otherwise, either a separating or a semi-separating equilibrium arises: the bad doctor mimics the good doctor with probability less than one. Pay-for-performance incentive schemes are unlikely to induce crowding out, unless some dimensions of quality are unobservable...
June 1, 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28641741/editorial-changes
#19
EDITORIAL
John Cawley, Martin Chalkley, Michael Chernew, Maarten Lindeboom, Ellen Meara, Nigel Rice, Luigi Siciliani, Andrew Street
No abstract text is available yet for this article.
July 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/28558295/the-effect-of-spending-cuts-on-teen-pregnancy
#20
David Paton, Liam Wright
In recent years, English local authorities have been forced to make significant cuts to devolved expenditure. In this paper, we examine the impact of reductions in local expenditure on one particular public health target: reducing rates of teen pregnancy. Contrary to predictions made at the time of the cuts, panel data estimates provide no evidence that areas which reduced expenditure the most have experienced relative increases in teenage pregnancy rates. Rather, expenditure cuts are associated with small reductions in teen pregnancy rates, a result which is robust to a number of alternative specifications and tests for causality...
July 2017: Journal of Health Economics
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