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International Journal of Health Economics and Management

Yan Zheng, Tomislav Vukina, Xiaoyong Zheng
We use a structural approach to separately estimate moral hazard and adverse selection effects in health care utilization using hospital invoices data. Our model explicitly accounts for the heterogeneity in the non-insurable transactions costs associated with hospital visits which increase the individuals' total cost of health care and dampen the moral hazard effect. A measure of moral hazard is derived as the difference between the observed and the counterfactual health care consumption. In the population of patients with non life-threatening diagnoses, our results indicate statistically significant and economically meaningful moral hazard...
July 14, 2018: International Journal of Health Economics and Management
Conor Keegan, Conor Teljeur, Brian Turner, Steve Thomas
Relatively little analysis has taken place internationally on the consumer-reported benefits and costs to switching insurer in multi-payer health insurance markets. Ideally, consumers should be willing to switch out of consideration for price and quality and switching should be able to take place without incurring significant switching costs. Costs to switching come in many forms and understanding the nature of these costs is necessary if policy interventions to improve market competition are to be successful...
May 10, 2018: International Journal of Health Economics and Management
Diego Proaño Falconi, Eduardo Bernabé
The aims of this study were to assess factors associated with catastrophic healthcare expenditure (CHE) and the burden of out-of-pocket (OOP) payments for specific healthcare services in Peru. We used data from 30,966 households that participated in the 2016 National Household Survey (Encuesta Nacional de Hogares, ENAHO). Participants reported household characteristics and expenditure on ten healthcare services. CHE was defined as healthcare spending equal to or higher than 40% of the household's capacity to pay...
May 9, 2018: International Journal of Health Economics and Management
Reo Takaku, Atsushi Yamaoka
Despite the huge attention on the long average hospital length of stay (LOS) in Japan, there are limited empirical studies on the impacts of the payment systems on LOS. In order to shed new light on this issue, we focus on the fact that reimbursement for hospital care is linked to the number of patient bed-days, where a "day" is defined as the period from one midnight to the next. This "midnight-to-midnight" definition may incentivize health care providers to manipulate hospital acceptance times in emergency patients, as patients admitted before midnight would have an additional day for reimbursement when compared with those admitted after midnight...
May 4, 2018: International Journal of Health Economics and Management
Dambar Uprety
Many studies have found that health outcomes decline when health professionals leave the country, but do such results remain consistent in gender- and income-disaggregated skilled migration? To help uncover explanations for such a pro-migration nature of health outcomes, the present study revisits this topic but allows for associations of skilled migration with mortality and life expectancy to differ between male and female, and between low- and high-income countries. Using a panel of 133 developing countries as source and 20 OECD countries as destination from 1980 to 2010 allowing the coefficient on emigration across different education levels to differ, the study finds the negative effect of high-skilled emigration on health outcomes...
April 30, 2018: International Journal of Health Economics and Management
Thomas M Selden, Zeynal Karaca, Sandra Decker
The past decade witnessed a dramatic increase in inpatient hospital payment rates for patients with private insurance relative to payment rates for those covered by Medicare. A natural question is whether the widening private-Medicare payment rate difference had implications for the hospital care received by patients just before and after turning 65-the age at which there is a substantial shift from private to Medicare coverage. Using a large discharge dataset covering the period 2001-2011, we tracked changes at age 65 in the following dimensions of hospital care: overall hospitalization rates, case mix, referral-sensitive surgeries, length of stay, full established charges, number of procedures, mortality, and composite measures of inpatient quality and patient safety...
April 25, 2018: International Journal of Health Economics and Management
Reed Olsen, Subhasree Basu Roy, Hui-Kuan Tseng
Previous researchers have found that Hispanic immigrants tend to have better health than could be reasonably explained by their socioeconomic status and other demographic variables. The main objective of this study is to re-investigate the Hispanic health paradox covering the period from 1992 to 2012. Main contributions of the paper include using a data set of older Americans from the Health and Retirement Study. More importantly, we use two new measures of health. Previous research on the paradox had primarily used mortality or morbidity to measure health...
April 23, 2018: International Journal of Health Economics and Management
Peter McHenry, Jennifer Mellor
Despite the importance of the nursing profession for healthcare delivery, costs, and quality, there is relatively little research on how provider payments to hospitals affect the labor market for nurses. This study deals with the hospital wage index (HWI) adjustment to Medicare hospital payments, an area-level adjustment intended to compensate hospitals in high-cost labor markets. Since the HWI adjustment is based on hospital-reported labor costs, some argue that it incentivizes hospitals in concentrated markets to pay higher wages to nurses and other workers (the "circularity" critique)...
June 2018: International Journal of Health Economics and Management
L F Andrade, T Rapp, C Sevilla-Dedieu
Diabetes may lead to severe complications. For this reason, disease prevention and improvement of medical follow-up represent major public health issues. The aim of this study was to measure the impact of adherence to French follow-up guidelines on hospitalization of people with diabetes. We used insurance claims data from the years 2010 to 2013 collected for 52,027 people aged over 18, affiliated to a French social security provider and treated for diabetes. We estimated panel data models to explore the association between adherence to guidelines and different measures of hospitalization, controlling for socioeconomic characteristics, diabetes treatment and density of medical supply...
June 2018: International Journal of Health Economics and Management
Mario Songane
Vaccines are very effective in providing individual and community (herd) immunity against a range of diseases. In addition to protection against a range of diseases, vaccines also have social and economic benefits. However, for vaccines to be effective, routine immunization programmes must be undertaken regularly to ensure individual and community protection. Nonetheless, in many countries in Africa, vaccination coverage is low because governments struggle to deliver vaccines to the most remote areas, thus contributing to constant outbreaks of various vaccine-preventable diseases...
June 2018: International Journal of Health Economics and Management
Victoria Perez
As the second largest item in the budget of every US state, Medicaid budget stability and financial transparency have significance for every state. This study is the first to test whether managed care enrollment reduces the variance of Medicaid spending, in contrast to the focus of the existing literature on spending levels. This variance bears directly on whether budget constrained states whether budget constrained states benefit from managed care in the form of stabilized spending, leading to improved budget predictability...
June 2018: International Journal of Health Economics and Management
David E Frisvold, Younsoo Jung
Expansions of public health insurance have the potential to reduce the uninsured rate, but also to reduce coverage through employer-sponsored insurance (ESI), reduce labor supply, and increase job mobility. In January 2014, twenty-five states expanded Medicaid as part of the Affordable Care Act to low-income parents and childless adults. Using data from the 2011-2015 March Current Population Survey Supplements, we compare the changes in insurance coverage and labor market outcomes over time of adults in states that expanded Medicaid and in states that did not...
June 2018: International Journal of Health Economics and Management
Margit Malmmose, Karoline Mortensen, Claus Holm
Maryland implemented one of the most aggressive payment innovations the nation has seen in several decades when it introduced global budgets in all its acute care hospitals in 2014. Prior to this, a pilot program, total patient revenue (TPR), was established for 8 rural hospitals in 2010. Using financial hospital report data from the Health Services Cost Review Commission from 2007 to 2013, we examined the hospitals' financial results including revenue, costs, and profit/loss margins to explore the impact of the adoption of the TPR pilot global budget program relative to the remaining hospitals in the state...
April 2, 2018: International Journal of Health Economics and Management
Junfang Xu, Jian Wang, Madeleine King, Ruiyun Liu, Fenghua Yu, Jinshui Xing, Lei Su, Mingshan Lu
Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China's on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China...
March 27, 2018: International Journal of Health Economics and Management
Elena Andreyeva, Benjamin Ukert
This study evaluates the effect of minimum wage on risky health behaviors, healthcare access, and self-reported health. We use data from the 1993-2015 Behavioral Risk Factor Surveillance System, and employ a difference-in-differences strategy that utilizes time variation in new minimum wage laws across U.S. states. Results suggest that the minimum wage increases the probability of being obese and decreases daily fruit and vegetable intake, but also decreases days with functional limitations while having no impact on healthcare access...
March 7, 2018: International Journal of Health Economics and Management
Min Chen
Reducing excess hospital readmissions has become a high policy priority to lower health care spending and improve quality. The Affordable Care Act (ACA) penalizes hospitals with higher-than-expected readmission rates. This study tracks patient-level admissions and readmissions to Florida hospitals from 2006 to 2014 to examine whether the ACA has reduced readmission effectively. We compare not only the change in readmissions in targeted conditions to that in non-targeted conditions, but also changes in sites of readmission over time and differences in outcomes based on destination of readmission...
March 2018: International Journal of Health Economics and Management
Kathleen Carey, Jean M Mitchell
In the U.S. health care sector, the economic logic of specialization as an organizing principle has come under active debate in recent years. An understudied case is that of ambulatory surgery centers (ASCs), which recently have become the dominant provider of specific surgical procedures. While the majority of ASCs focus on a single specialty, a growing number are diversifying to offer a wide range of surgical services. We take a multiple output cost function approach to an empirical investigation that compares production economies in single specialty ASCs with those in multispecialty ASCs...
March 2018: International Journal of Health Economics and Management
Shooshan Danagoulian
Despite substantial financial incentives provided by the Affordable Care Act and employers, employee enrollment in wellness programs is low. This paper studies enrollment in a wellness program offered along an employer-provided health insurance plan. Two factors are considered in the choice of health plan with wellness: the effect of peer choices and family health on plan choice. Using exclusively obtained data of health insurance plan choice and utilization, this paper compares similar plans and focuses on a subsample of new employees...
March 2018: International Journal of Health Economics and Management
Eugene Kouassi, Oluyele Akinkugbe, Noni Oratile Kutlo, J M Bosson Brou
This paper investigates the long run relationship between health care expenditure and economic growth, using panel data for 14 Southern African Development Community (SADC) member countries over the period 1995-2012. The non-stationarity and cointegration properties between health expenditure per capita and GDP per capita were examined, controlling for cross section dependence and heterogeneity between countries. Our results suggest that health expenditure and GDP per capita are non-stationary and cointegrated...
March 2018: International Journal of Health Economics and Management
Sarah S Stith
Organizational learning-by-doing implies that production outcomes improve with experience. Prior empirical research documents the existence of organizational learning-by-doing, but provides little insight into why some firms learn while others do not. Among the 124 U.S. liver transplant centers that opened between 1987 and 2009, this paper shows evidence of organizational learning-by-doing, but only shortly after entry. Significant heterogeneity exists with learning only evident among those firms entering early in the sample period when liver transplantation was an experimental medical procedure...
March 2018: International Journal of Health Economics and Management
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