What to expect when you are expecting: Are health care consumers forward-looking?
Publication date: September 2019Source: Journal of Health Economics, Volume 67Author(s): Audrey Guo, Jonathan ZhangAbstractA fundamental question in health insurance markets is how do health care consumers dynamically optimize their medical utilization under non-linear insurance contracts? Our paper tests the neoclassical prediction that a fully forward-looking agent only responds to their expected end-of-year price. Our unique identification strategy studies families during the year of childbirth who will likely satisfy their annual deductible, thereby knowing their expected end-of-year price. We find that during the year...
Source: Journal of Health Economics - July 28, 2019 Category: Health Management Source Type: research
What to Expect When You’re Expecting: Are Health Care Consumers Forward-Looking?
Publication date: Available online 17 July 2019Source: Journal of Health EconomicsAuthor(s): Audrey Guo, Jonathan ZhangAbstractA fundamental question in health insurance markets is how do health care consumers dynamically optimize their medical utilization under non-linear insurance contracts? Our paper tests the neoclassical prediction that a fully forward-looking agent only responds to their expected end-of-year price. Our unique identification strategy studies families during the year of childbirth who will likely satisfy their annual deductible, thereby knowing their expected end-of-year price. We find that during the ...
Source: Journal of Health Economics - July 19, 2019 Category: Health Management Source Type: research
The affordable care act and ambulance response times
This study contributes to the literature on the capacity challenges faced by health care providers after insurance expansions by examining the Affordable Care Act (ACA) and ambulance response times. Exploiting temporal and geographic variation in the implementation of the ACA as well as pre-treatment differences in uninsured rates, we estimate that the expansions of private and Medicaid coverage under the ACA combined to slow ambulance response times by an average of 24%. We conclude that, through extending coverage to individuals who, in its absence, would not have availed themselves of emergency medical services, the ACA...
Source: Journal of Health Economics - July 10, 2019 Category: Health Management Source Type: research
Health Care Reform, Adverse Selection and Health Insurance Choice
Publication date: Available online 8 July 2019Source: Journal of Health EconomicsAuthor(s): Cristian PardoAbstractThis paper builds and estimates a dynamic choice model to examine the impact on health insurance selection of Chile's GES health care reform. This program provides guarantees in coverage and benefits to several health conditions in the context of a market where public and private health insurers co-exist. Structural differences in premiums, benefits and out-of-pocket medical costs across systems may have caused adverse selection problems. Restrictions on pre-existing conditions in the private system mean that i...
Source: Journal of Health Economics - July 9, 2019 Category: Health Management Source Type: research
The Shattered “Iron Rice Bowl”: Intergenerational Effects of Chinese State-Owned Enterprise Reform
Publication date: Available online 8 July 2019Source: Journal of Health EconomicsAuthor(s): Nancy Kong, Lars Osberg, Weina ZhouAbstractReform of the Chinese State-Owned Enterprise (SOE) sector in the late 1990s triggered massive layoffs (34 million employees) and marked the end of the “Iron Rice Bowl” guarantee of employment security for the remaining 67 million workers. An expanding international literature has documented the adverse health impacts of economic insecurity on adults, but has typically neglected children. This paper uses the natural experiment of SOE reform to explore the causal relationship between incr...
Source: Journal of Health Economics - July 9, 2019 Category: Health Management Source Type: research
Disease Outbreaks, Healthcare Utilization, and On-Time Immunization in the First Year of Life
Publication date: Available online 6 July 2019Source: Journal of Health EconomicsAuthor(s): Jessamyn Schaller, Lisa Schulkind, Teny ShapiroAbstractThis paper examines the determinants of parental decisions about infant immunization. Using the exact timing of vaccination relative to birth, we estimate the effects of local pertussis outbreaks occurring in-utero and during the first two months of life on the likelihood of on-time initial immunization for pertussis and other diseases. We find that parents respond to changes in perceived disease risk: pertussis outbreaks within a state increase the rate of on-time receipt of th...
Source: Journal of Health Economics - July 8, 2019 Category: Health Management Source Type: research
Provider Responses to Online Price Transparency
Publication date: Available online 26 June 2019Source: Journal of Health EconomicsAuthor(s): Christopher WhaleyAbstractPrice transparency initiatives have recently emerged as a solution to the lack of health care price information available to consumers. This paper uses the staggered and nationwide diffusion of a leading internet-based price transparency platform to estimate the effects of price transparency on provider prices. I find a 1-4% reduction in provider prices for homogenous services, laboratory tests, but find no price response for differentiated services, office visits. Price responses are driven by active cons...
Source: Journal of Health Economics - June 27, 2019 Category: Health Management Source Type: research
Dynamic hospital competition under rationing by waiting times
Publication date: Available online 19 June 2019Source: Journal of Health EconomicsAuthor(s): Luís Sá, Luigi Siciliani, Odd Rune StraumeAbstractWe develop a dynamic model of hospital competition where (i) waiting times increase if demand exceeds supply; (ii) patients choose a hospital based in part on waiting times; and (iii) hospitals incur waiting time penalties. We show that, whereas policies based on penalties will lead to lower waiting times, policies that promote patient choice will instead lead to higher waiting times. These results are robust to different game-theoretic solution concepts, designs of the hospital p...
Source: Journal of Health Economics - June 19, 2019 Category: Health Management Source Type: research
Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health
Publication date: July 2019Source: Journal of Health Economics, Volume 66Author(s): Diane Alexander, Molly SchnellAbstractWe examine whether relaxing occupational licensing to allow nurse practitioners (NPs)—registered nurses with advanced degrees—to prescribe medication without physician oversight improves population mental health. Exploiting time-series variation in independent prescriptive authority for NPs from 1990 to 2014, we find that broadening prescriptive authority leads to improvements in self-reported mental health and decreases in mental health–related mortality. These improvements are concentrated in ar...
Source: Journal of Health Economics - June 19, 2019 Category: Health Management Source Type: research
How effective are pictorial warnings on tobacco products? New evidence on smoking behaviour using Australian panel data.
Publication date: Available online 15 June 2019Source: Journal of Health EconomicsAuthor(s): Daniel KuehnleAbstractStudies examining the introduction of pictorial warnings on cigarette packages provide inconclusive evidence due to small samples and methodological issues. We use individual-level panel data from Australia to examine the association between pictorial warnings and smoking behaviour – prevalence, quitting, initiating and relapsing. The pictorial warnings were accompanied by a reference to a smoking cessation helpline and supportive television commercials. Applying an event study framework, we show that the re...
Source: Journal of Health Economics - June 16, 2019 Category: Health Management Source Type: research
Does Children's Education Matter for Parents’ Health and Cognition? Evidence from China
Publication date: Available online 14 June 2019Source: Journal of Health EconomicsAuthor(s): Mingming MaAbstractIntergenerational transmission of human capital from parents to offspring is widely documented. However, whether there are upward spillovers from children to parents remains understudied. This paper uses data from the China Health and Retirement Longitudinal Study to estimate the causal impact of educational attainment of children on various health and cognition outcomes of older parents. Identification is achieved by using the exposure of children to the compulsory education law in China and its interaction with...
Source: Journal of Health Economics - June 14, 2019 Category: Health Management Source Type: research
Parallel imports, price controls, and innovation
Publication date: July 2019Source: Journal of Health Economics, Volume 66Author(s): Markus Reisinger, Lluís Saurí, Hans ZengerAbstractThe impact of parallel trade on innovation in R&D-intensive industries, such as pharmaceuticals, is a hotly debated question in antitrust and IP policy. The well-known argument that parallel trade dampens innovation by undermining firms’ ability to price discriminate has been challenged by recent literature. The argument is that with endogenous price controls, parallel trade increases innovation by reducing governments’ incentives to set particularly low price caps. In this paper, we s...
Source: Journal of Health Economics - June 13, 2019 Category: Health Management Source Type: research
Do Report Cards Predict Future Quality? The Case of Skilled Nursing Facilities
Publication date: Available online 24 May 2019Source: Journal of Health EconomicsAuthor(s): Momotazur RahmanAbstractReport cards on provider performance are intended to improve consumer decision-making and address information gaps in the market for quality. However, inadequate risk adjustment of report-card measures often biases comparisons across providers. We test whether going to a skilled nursing facility (SNF) with a higher star rating leads to better quality outcomes for a patient. We exploit variation over time in the distance from a patient’s residential ZIP code to SNFs with different ratings to estimate the cau...
Source: Journal of Health Economics - June 1, 2019 Category: Health Management Source Type: research
Data Transformations to Improve the Performance of Health Plan Payment Methods
We present a general economic model that incorporates the previously overlooked two-way relationship between health plan payment and insurer actions. We then demonstrate our systematic approach for data transformations in two Medicare applications: underprovision of care for individuals with chronic illnesses and health care disparities by geographic income levels. Empirically comparing our method to two other common approaches shows that the “side effects” of these approaches vary by context, and that data transformation is an effective tool for addressing misallocations in individual health insurance markets. (Source...
Source: Journal of Health Economics - May 26, 2019 Category: Health Management Source Type: research
Do Report Cards Predict Future Quality?The Case of Skilled Nursing Facilities
Publication date: Available online 24 May 2019Source: Journal of Health EconomicsAuthor(s): Momotazur RahmanAbstractReport cards on provider performance are intended to improve consumer decision-making and address information gaps in the market for quality. However, inadequate risk adjustment of report-card measures often biases comparisons across providers. We test whether going to a skilled nursing facility (SNF) with a higher star rating leads to better quality outcomes for a patient. We exploit variation over time in the distance from a patient’s residential ZIP code to SNFs with different ratings to estimate the cau...
Source: Journal of Health Economics - May 26, 2019 Category: Health Management Source Type: research
