Three Essays On Access And Welfare In Health Care And Health Insurance Markets
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Three Essays On Access And Welfare In Health Care And Health Insurance Markets
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Author : Nathaniel Denison Mark
language : en
Publisher:
Release Date : 2021
Three Essays On Access And Welfare In Health Care And Health Insurance Markets written by Nathaniel Denison Mark and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2021 with categories.
We use a model of health plan choice and subsequent utilization to estimate household preferences in both markets and predict premiums and costs under a counterfactual pooled market. We find that integration mitigates adverse selection issues in the individual market, while decreasing government and employer expenditures on premium subsidies. Small group households benefit from lower premiums for low coverage plans in the merged market. However, they face higher premiums for high coverage plans and are constrained to a smaller set of insurance options. Thus, the effects of integration on small group households are heterogeneous.
Three Essays On Health Insurance And Health Care Consumption
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Author : Fei Liu
language : en
Publisher:
Release Date : 2007
Three Essays On Health Insurance And Health Care Consumption written by Fei Liu and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with categories.
The third essay investigates the switching behavior of non-elderly enrollees in U.S. managed care plans. Treatment effect analysis is used to examine the disaggregated expenditures of plan switchers and plan stayers prior to their decision to switch or stay. Propensity score matching methods are used to estimate the average treatment effects on the treated. The results, which are based on a national representative data set from the Medical Expenditure Panel Survey, indicate that switchers (from HMO to non-HMO) spend more on hospitalization. The other type of switchers (from non-HMO to HMO) spends less on prescribed medicine and office-based physician visits. The findings suggest that the non-HMO private managed care plans provide better coverage on hospitalization, office-based physician visits and prescribed medicine than the HMO plans.
Three Essays On Health Insurance Regulation And The Labor Market
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Author : James Bailey
language : en
Publisher:
Release Date : 2014
Three Essays On Health Insurance Regulation And The Labor Market written by James Bailey and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014 with categories.
This dissertation continues the tradition of identifying the unintended consequences of the US health insurance system. Its main contribution is to estimate the size of the distortions caused by the employer-based system and regulations intended to fix it, while using methods that are more novel and appropriate than those of previous work. Chapter 1 examines the effect of state-level health insurance mandates, which are regulations intended to expand access to health insurance. It finds that these regulations have the unintended consequence of increasing insurance premiums, and that these regulations have been responsible for 9-23% of premium increases since 1996. The main contribution of the chapter is that its results are more general than previous work, since it considers many more years of data, and it studies the employer-based plans that cover most Americans rather than the much less common individual plans. Whereas Chapter 1 estimates the effect of the average mandate on premiums, Chapter 2 focuses on a specific mandate, one that requires insurers to cover prostate cancer screenings. The focus on a single mandate allows a broader and more careful analysis that demonstrates how health policies spill over to affect the labor market. I find that the mandate has a significant negative effect on the labor market outcomes of the very group it was intended to help. The mandate expands the treatments health insurance covers for men over age 50, but by doing so it makes them more expensive to insure and employ. Employers respond to this added expense by lowering wages and hiring fewer men over age 50. According to the theoretical model put forward in the chapter, this suggests the mandate reduces total welfare. Chapter 3 shows that the employer-based health insurance system has deterred entrepreneurship. It takes advantage of the natural experiment provided by the Affordable Care Act's dependent coverage mandate, which de-linked insurance from employment for many 19-25 year olds. Difference-in-difference estimates show that the mandate increased self-employment among the treated group by 13-24%. Instrumental variables estimates show that those who actually received parental health insurance as a result of the mandate were drastically more likely to start their own business. This suggest that concerns over health insurance are a major barrier to entrepreneurship in the United States.
Essays In Health And Labor Economics
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Author : Ana Ines Rocca
language : en
Publisher:
Release Date : 2015
Essays In Health And Labor Economics written by Ana Ines Rocca and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2015 with categories.
In the United States, health insurance is often necessary for access to regular, affordable health care. With only eight of every hundred Americans buying private insurance plans on the individual market, the main sources for health insurance traditionally have been employers and the government. As new laws are being debated and introduced to reform an expensive health care industry in which nearly one-sixth of the population is uninsured, research is needed in order to evaluate the costs and benefits of these policy changes and to predict their success. To this end, in addition to understanding how likely individuals are to adopt new health insurance policies, we also should be interested in knowing how the demand for health insurance and changes in its accessibility will affect non-medical decisions. Specifically, labor market choices have been theorized to be directly related to decisions involving insurance coverage. If the availability of health insurance distorts a workers' job-related decisions, then the changing the landscape for how to access insurance may reverberate in employment outcomes. My dissertation focuses on understanding the factors that influence the demand for health insurance and the role that health insurance plays in an individual's decision to work, where to work, and how much to work. Specifically, I focus on the following three related questions: how does the demand for insurance affect labor market decisions such as when to exit unemployment? what drives insurance demand, and in particular, what motivators work best to increase demand for health coverage among the uninsured? and lastly, what are the supply-side employment responses to the provision of free or reduced-cost public health insurance? My first chapter explores how the demand for health insurance can change re-employment decisions among the unemployed, as well as the speed at which individuals return to work. Past research on this issue focuses on job-to-job switches and "job lock" but has yet to focus on individuals looking for work. This chapter uses data on laid-off individuals from the Medical Expenditure Panel Survey to compare the job search behavior and outcomes of individuals who differ in their demand for health insurance. I use three proxies for demand, based on spousal health and past insurance offer take-up decisions. Although each is potentially confounded by unobserved determinants of job search, I use a difference-in-differences and propensity score designs to isolate plausibly causal effects. I find consistent patterns across all three proxies (despite different potential omitted variables biases). Overall unemployment durations do not vary with demand for insurance, but this masks variation in the types of jobs taken. Individuals with higher demand for insurance have higher hazards for exiting unemployment into a job with insurance, but lower hazards for exiting to a job without insurance. This points to effects of insurance demand on both search effort and reservation wages, and to potentially important distorting effects of employer-linked health insurance. Whereas the first chapter takes variation in demand for insurance as a given, my second chapter digs deeper into the basis for this variation and whether it can be affected. In this chapter, I investigate the reasons the uninsured choose to forego insurance coverage and the impact of different messages on their insurance demand. Working with Enroll America, a large non-profit dedicated to decreasing the number of uninsured Americans, I conducted a stratified experiment to determine the best communication strategies to encourage participation in the healthcare exchanges. We test a combination of the following behavioral and information treatments: a risk treatment that emphasizes the average financial risk for someone without health insurance; a norms treatment that alerts our participants that staying uninsured will be against the law; a savings treatment that highlights the average savings available at the exchanges; a wording treatment where we refer to the Affordable Care Act (ACA) as "Obamacare"; and lastly, a cost-calculator treatment that allows individuals to explore the likely cost of insurance based on their own characteristics. Among the uninsured, we find that the cost-calculator treatment, the risk treatment, and the mandate are most effective in increasing intention to purchase insurance. The cost-calculator and the risk treatment increase informedness among this population, but the cost-calculator (when paired with the savings treatment) is the only treatment that increases willingness to pay for insurance. We use the information on willingness to pay to construct sub-group price elasticities of demand to compare to previous work interested in the demand for health insurance. Overall, the results of this chapter highlight the importance of informational campaigns to increase awareness of the costs and benefits of health coverage, particularly after large changes such as those implemented by the ACA. My third chapter continues by looking at the changes that have been introduced as a result of the ACA. Specifically, it explores whether expanding access to government-provided insurance affects individuals' decisions regarding employment and overall hours of work. Recent findings have suggested that increasing access to health insurance outside of employment has a sizable, negative impact on labor force participation. Along these lines, the Congressional Budget Office predicted that the expansion of Medicaid and private health insurance will cause a 1.5 to 2% reduction in hours worked in the first ten years. Comparing states by whether they chose to expand Medicaid under reforms introduced by the ACA, I look at changes in the probability a childless adult receives Medicaid, as well as changes in this group's employment likelihood and hours of work. Using household survey data from the CPS monthly survey and ASEC Supplement, I confirm a marked increase in the percent of childless adults insured by Medicaid but find no statistically significant changes in employment outcomes. I compare these results to other estimates of "employment lock" in recent literature. These results, though imprecise, align with the findings in Chapter 1 which suggest that overall employment is not drastically affected by insurance demand.
Three Essays On Public Health Insurance Quality Access And Cost Of Health Care
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Author : Tianyan Hu
language : en
Publisher:
Release Date : 2013
Three Essays On Public Health Insurance Quality Access And Cost Of Health Care written by Tianyan Hu and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with categories.
Medicaid and Medicare are two major public programs that help vulnerable groups of people to gain coverage of health care services. There are various ongoing debates on the Medicaid- and Medicare-related issues. Among those, some topics draw most of attentions.
Care Without Coverage
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Author : Institute of Medicine
language : en
Publisher: National Academies Press
Release Date : 2002-06-20
Care Without Coverage written by Institute of Medicine and has been published by National Academies Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2002-06-20 with Medical categories.
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Essays On Health Insurance Coverage And Food Assistance Programs
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Author : Daniela Zapata Sapiencia
language : en
Publisher:
Release Date : 2012
Essays On Health Insurance Coverage And Food Assistance Programs written by Daniela Zapata Sapiencia and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with Child health services categories.
"Empirical work shows that health insurance coverage improves children's health and that healthier children have better educational and labor market outcomes. This suggests that the benefits of higher insurance rates among children go beyond improvements in health. However, there are no investigations in the United States that track the long-term socioeconomic benefits of health insurance coverage during childhood. Using data from the Children of the National Longitudinal Survey of Youth to estimate family fixed effects models, I find evidence that health insurance coverage at ages 0-4 has a positive effect on test scores in mathematics, reading recognition, reading comprehension, and vocabulary at ages 5-14. The second essay in this dissertation, co-authored with Charles Courtemanche, investigates the effect of the Massachusetts health care reform on self-reported health. The main objective of this reform was to achieve universal health insurance coverage through a combination of insurance market reforms, mandates, and subsidies. This reform was later used as a model for the Patient Protection and Affordable Care Act (ACA). Using individual-level data from the Behavioral Risk Factor Surveillance System and a difference in differences estimation strategy, this essay provides evidence that this reform led to better overall self-assessed health. Several determinants of overall health, including physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity also improved. Public food assistance programs share the fundamental goal of helping needy and vulnerable people in the U.S. obtain access to nutritious foods that they might not otherwise be able to afford. These programs also have other objectives, such as improving recipients' health, furthering children's development and school performance. To investigate these broader impacts, the third chapter of this dissertation, co-authored with David Ribar, examines the relationship between participation in food assistance programs, family routines and time use. Results from fixed effects models estimated using longitudinal data from the Three-City Study indicate that SNAP participation is negatively associated with homework routines. WIC participation on the other hand, is positively associated with family routines in general and with dinner routines, homework routines, and family-time routines in particular."--Abstract from author supplied metadata.
Essays In Health Economics
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Author :
language : en
Publisher:
Release Date : 2014
Essays In Health Economics written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014 with categories.
This dissertation presents three essays in health economics. The first essay sheds light on the relationship between health insurance and access to care. The second essay considers the relationship between health and labor markets. The third essay explores one facet of health inequality.
Essays In Health Economics
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Author : Juan Pablo Atal Chomali
language : en
Publisher:
Release Date : 2016
Essays In Health Economics written by Juan Pablo Atal Chomali and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016 with categories.
These essays study how private incentives affect the functioning of three dimensions of health care markets: health insurance, prescription drugs, and the delivery of health care by physicians. In the first chapter, I study the workings of long term health insurance, a form of contracts with the potential to efficiently insure individuals against reclassification risk, but at the expense of other limitations like provider lock-in. I empirically investigate the workings of long-term guaranteed-renewable contracts, which are subject to this tradeoff. Individuals are shielded against premium increases and coverage denial as long as they stay with their initial contract, but those that become higher risk are subject to premium increases or coverage denials upon switching, potentially leaving them locked-in with their original network of providers. I provide the first empirical evidence on the importance of this phenomenon using administrative panel data from the universe of the private health insurance market in Chile, where competing insurers offer guaranteed-renewable plans. I fit a structural model to yearly plan choices, and am able to jointly estimate evolving preferences for different insurance companies and supply-side underwriting in the form of premium risk-rating and coverage denial. To quantify the welfare effects of lock-in, I compare simulated choices under the current rules to those in a counterfactual scenario with no underwriting. The results show that consumers would be willing to pay around 13 percent more in yearly premiums to avoid lock-in. Finally, I study a counterfactual scenario where guaranteed-renewable contracts are replaced with community-rated spot contracts, and I find only minor general-equilibrium effects on premiums and on the allocation of individuals across insurers. I argue that these small effects are the result of large levels of preference heterogeneity uncorrelated to risk. In the second chapter, David Silver and I study worker interactions among the medical staff in the emergency department. Using rich administrative case-level data from two hospital-based emergency departments, we start by documenting peer effects among physicians. We find that physicians are 1.5 percent faster when working with peers who are 10 percent faster. We devise a test for random patient-physician assignment and we provide a number of tests to discern the mechanisms underlying these spillovers. The evidence points to spillovers that are driven primarily by faster peers responding negatively to working with slower peers. Utilization of shared resources accounts for little of the spillover, and event-study evidence points to spillovers that come into effect as soon as slower peers begin their shifts. In the third chapter, José Ignacio Cuesta, Morten Sæthre and I study regulations to pharmaceutical laboratories in the form of bioequivalence (BE) requirements -- the most prevalent tool used in developed economies to ensure the effectiveness of generic drugs allowed in the market. The main goal is to empirically investigate how the market reacts to BE requirements, and the consequences in prices, market shares, and product availability for branded and generic drugs. In particular, this study is an early exploration of the experience of Chile, where BE requirements were adopted for 172 molecules, leading to the BE approval of 642 generic drugs between March 2009 and March 2015. We show that the introduction of the requirements lead to a significant increase in BE approvals and in the share of BE drugs in the market. However, prices and market shares of other competing drugs were not significantly affected during the period we analyze. Other outcomes, like number of products, and market concentration are also found to be unaffected.
Essays On The Economics Of Health Insurance Markets
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Author : Richard Domurat
language : en
Publisher:
Release Date : 2018
Essays On The Economics Of Health Insurance Markets written by Richard Domurat and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018 with categories.
This dissertation includes three chapters on the health insurance markets established by the Affordable Care Act (ACA), known as exchanges. Chapter 1 estimates the demand for each plan in the California exchange using a discrete choice model. The model incorporates heterogeneity in consumer preferences and in product characteristics, including hospital and primary care physician (PCP) networks. Endogeneity of prices is addressed using networking hospital costs as instruments, and prices for any given plan can vary across consumers within a market. Consumers are highly sensitive to prices, with market shares declining by 3%-5% for just a $1 increase in the premium. Demand also responds to hospital and PCP networks, but to a relatively small degree. Along the take-up margin, a $1 increase in premium subsidy increases take-up by 1.4%. Chapter 2 uses a structural model of demand and supply to examine how two insurance market regulations--community rating and risk adjustment--affect prices and enrollment in the ACA exchange in California. Without risk adjustment, community rating in the ACA would lead to a significant reduction in enrollment in desirable plans and in take-up overall. Risk adjustment under the ACA roughly restores relative shares across plans to what they would be without community rating; however, the reduction in take-up is not restored. An alternative risk adjustment method can increase enrollment by 3.0% and would have little impact on government spending. Chapter 3, written jointly with Isaac Menashe and Wesley Yin, examines the impact of information on insurance take-up in the ACA. We exploit experimental variation in the information mailed to 87,000 households in California's exchange to study the role of frictions in insurance take-up. We find that a basic reminder of the enrollment deadline raised enrollment by 1.4 pp (or 16 percent). Compared to the reminder alone, also reporting personalized subsidy benefits increases take-up among low-income individuals, but decreases take-up among higher-income individuals. This is despite reminder-only recipients eventually observing their subsidies before purchase. Finally, the letter interventions induced healthier individuals into the market, lowering aggregate spending risk by 5.9 percent, suggesting these interventions can improve both enrollment and average market risk.