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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
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
Donata Bessey
This research note analyzes the relationship between experimentally elicited, incentivized economic preference parameters, personality traits, and three health behaviors: smoking, drinking, and physical activity. While there is a strand of economic research that uses proxy measures of risk and time preference that are not derived from an incentivized experiment and personality traits at the same time, and a considerably smaller one that uses experimentally elicited measures of risk and time preference only, the innovation of my work is to use experimentally elicited, incentivized preference measures and personality traits at the same time to explain a range of health behaviors...
February 23, 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
Robert Nathenson, Michael R Richards
Direct-to-consumer advertising (DTCA) for prescription drugs is a relatively unique feature of the US health care system and a source of tens of billions of dollars in annual spending. It has also garnered the attention of researchers and policymakers interested in its implications for firm and consumer behavior. However, few economic studies have explored the DTCA response to public policies, especially those mandating coverage of these products. We use detailed advertising expenditure data to assess if pharmaceutical firms increase their marketing efforts after the implementation of relevant state and federal health insurance laws...
January 29, 2018: International Journal of Health Economics and Management
Thang Dang
In 1991, Vietnam implemented a compulsory primary schooling reform that provides this study a natural experiment to estimate the causal effect of education on health care utilization with a regression discontinuity design. This paper finds that education causes statistically significant impacts on health care utilization, although the signs of the impacts change with specific types of health care services examined. In particular, education increases the inpatient utilization of the public health sector, but it reduces the outpatient utilization of both the public and private health sectors...
January 10, 2018: International Journal of Health Economics and Management
Asankha Pallegedara
This article examines the effects of chronic non-communicable diseases (NCDs) on households' out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka...
January 10, 2018: International Journal of Health Economics and Management
Emily Gustafsson-Wright, Gosia Popławska, Zlata Tanović, Jacques van der Gaag
This paper analyzes the quantitative impact of an intervention that provides subsidized low-cost private health insurance together with health facility upgrades in Nigeria. The evaluation, which measures impact on healthcare utilization and spending, is based on a quasi-experimental design and utilizes three population-based household surveys over a 4-year period. After 4 years, the intervention increased healthcare use by 25.2 percentage points in the treatment area overall and by 17.7 percentage points among the insured...
December 8, 2017: International Journal of Health Economics and Management
Benjamin Ukert
This paper examines the short- and long-term effects of quitting smoking on alcohol consumption using the Lung Health Study, a randomized smoking cessation program. The paper estimates the relationship between smoking and alcohol consumption using several self-reported and objective smoking measures, while also implementing a two-stage least squares estimation strategy that utilizes the randomized smoking cessation program assignment as an instrument for smoking. The analysis leads to three salient findings...
December 2017: International Journal of Health Economics and Management
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