Health Economics Commons^™

Does A Ban On Informal Health Providers Save Lives? Evidence From Malawi, Edward Okeke, Susan Godlonton

Edward Okeke

Does Retirement Impact Health Care Utilization?, Norma Coe, Gema Zamarro

Gema Zamarro

How Does Retirement Impact Health Behaviors? An International Comparison, Norma Coe, Gema Zamarro

Gema Zamarro

Prices And Social Behavior: Evidence From Adult Smoking In Canadian Aboriginal Communities, Jesse A. Matheson

Jesse A Matheson

Cultural Competency: Across Cultures Between Physicians And Patients, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.

A Culture Of One. Every Healthcare Encounter Is A Cultural Encounter, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.

Access To Hospital Interpreter Services For Limited English Proficient Patients In New Jersey: A Statewide Evaluation, Glenn Flores, Sylvia Torres, Linda Holmes, Debbie Salas-Lopez, Mara Youdelman, Sandra Tomany-Korman

Debbie Salas-Lopez MD, MPH

CONTEXT/OBJECTIVES: We surveyed New Jersey (NJ) hospitals to assess current language services and identify policy recommendations on meeting limited English proficiency (LEP) patients' needs.

METHODS: Survey with 37 questions regarding hospital/patient features, interpreter services, and resources/policies needed to provide quality interpreter services.

RESULTS: Sixty-seven hospitals responded (55% response rate). Most NJ hospitals have no interpreter services department, 80% provide no staff training on working with interpreters, 31% lack multilingual signs, and 19% offer no written translation services. Only 3% of hospitals have full-time interpreters, a ratio of 1 interpreter:240,748 LEP NJ residents. Most hospitals stated third-party reimbursement for interpreters would …

Effects Of Medicare Payment Reform: Evidence From The Home Health Interim And Prospective Payment Systems, Peter Huckfeldt, Neeraj Sood, Jose Escarce, David Grabowski, Joseph Newhouse

Peter J. Huckfeldt

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service towards episode-based payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.

Brain Drain: Do Economic Conditions “Push” Doctors Out Of Developing Countries?, Edward Okeke

Edward Okeke

Health worker migration is an issue of first order concern in global health policy circles and continues to be the subject of much policy debate. In this paper, we contribute to the discussion by studying the impact of economic conditions on the migration of physicians from developing countries. To our knowledge, this is one of the first papers to do so. A major contribution of this paper is the introduction of a new panel dataset on migration to the US and the UK from 31 sub-Saharan Africa countries. The data spans the period 1975-2004. Using this data, we estimate the …

The Effect Of Violence On Birth Outcomes: Evidence From Homicides In Rural Brazil, Martin Koppensteiner, Marco Manacorda

Martin Foureaux Koppensteiner

This paper uses microdata from Brazilian vital statistics natality and mortality data between 2000 and 2010 to estimate the impact of in-utero exposure to local violence—measured by homicide rates—on birth outcomes. Focusing on small communities, where it is more plausible that local homicide rates reflect actual exposure to violence, the analysis shows that exposure to violence during pregnancy leads to deterioration in birth outcomes: one extra homicide during the first trimester of pregnancy increases the probability of low birthweight by around 6 percent. Results are particularly pronounced among children of poorly educated mothers, implying that violence compounds the disadvantage that …

Price-Shopping In Consumer Directed Health Plans, Neeraj Sood, Zach Wagner, Peter Huckfeldt, Amelia Haviland

Peter J. Huckfeldt

No abstract provided.

The Effect Of Prospective Payment On Admission And Treatment Policy: Evidence From Inpatient Rehabilitation Facilities, Neeraj Sood, Peter Huckfeldt, David Grabowski, Joe Newhouse, Jose Escarce

Peter J. Huckfeldt

We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the number of patients admitted, admitting different types of patients, or changing the intensity of care. We use Medicare claims data to separately estimate each type of provider response. We also examine changes in patient outcomes and spillover effects on other post-acute care providers. We find that costs of care initially fell following the PPS, which we attribute to changes in treatment decisions rather than the characteristics of …

Further Evidence On The Internal Validity Of The Early Legal Access Research Design, Brad Hershbein, Martha Bailey, Melanie Guldi

Brad J. Hershbein

Recent Evidence On The Broad Benefits Of Reproductive Health Policy, Brad Hershbein, Martha Bailey, Melanie Guldi

Brad J. Hershbein

The Price Sensitivity Of Medicare Beneficiaries: A Regression Discontinuity Approach., Thomas Buchmueller, Kyle Grazier, Richard Hirth, Edward Okeke

Edward Okeke

We use 4 years of data from the retiree health benefits program of the University of Michigan to estimate the effect of price on the health plan choices of Medicare beneficiaries. During the period of our analysis, changes in the University's premium contribution rules led to substantial price changes. A key feature of this ‘natural experiment’ is that individuals who had retired before a certain date were exempted from having to pay any premium contributions. This ‘grandfathering’ creates quasi-experimental variation that is ideal for estimating the effect of price. Using regression discontinuity methods, we compare the plan choices of individuals …

Medicare Payment Reform And Provider Entry And Exit, Peter Huckfeldt, Neeraj Sood, John Romley, Alessandro Malchiodi, Jose Escarce

Peter J. Huckfeldt

Objective. To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services …

Quantifying The Value Of Personalized Medicines: Evidence From Cox-2 Inhibitors, Neeraj Sood, Tomas Philipson, Peter Huckfeldt

Peter J. Huckfeldt

No abstract provided.

What Is The Price Of Prevention? New Evidence From A Field Experiment., Edward Okeke, Akinfolarin Adepiti, Kayode Ajenifuja

Edward Okeke

Price Elasticity Of Expenditure Across Health Care Services, Fabian Duarte

Fabian Duarte

Policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures. Estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Using unique individual-level data compiled from administrative records from the Chilean private health insurance market, I estimate the price elasticity of expenditures across a variety of health care services. I find elasticities that range between zero for the most acute service (appendectomy) and −2.08 for the most elective (psychologist visit). Moreover, the results show that at least one third of …

Management And Employee Agreement On Reports Of Organizational Policies And Practices Important In Return To Work Following Carpal Tunnel Surgery, Benjamin Amick, H. Hunt, Jeffrey Katz, Rochelle Habeck, Janet Ossmann, Gopika Ramamurthy, Valerie Soucie

H. Allan Hunt

No abstract provided.

Work Incentives And The Food Stamp Program, Hilary Hoynes, Diane Schanzenbach

Diane Whitmore Schanzenbach

Labor supply theory makes strong predictions about how the introduction or expansion of a social welfare program impacts work effort. Although there is a large literature on the work incentive effects of AFDC and the EITC, relatively little is known about the work incentive effects of the Food Stamp Program and none of the existing literature is based on quasi-experimental methods. We use the cross-county introduction of the program in the 1960s and 1970s to estimate the impact of the program on the extensive and intensive margins of labor supply, earnings, and family cash income. Consistent with theory, we find …

The Opt-In Revolution? Contraception And The Gender Gap In Wages, Brad Hershbein, Martha Bailey, Amalia Miller

Brad J. Hershbein

How Does Your Kindergarten Classroom Affect Your Earnings? Evidence From Project Star, Raj Chetty, John Friedman, Nathaniel Hilger, Emmanuel Saez, Diane Schanzenbach, Danny Yagan

Diane Whitmore Schanzenbach

In Project STAR, 11,571 students in Tennessee and their teachers were randomly assigned to classrooms within their schools from kindergarten to third grade. This article evaluates the long-term impacts of STAR by linking the experimental data to administrative records. We first demonstrate that kindergarten test scores are highly correlated with outcomes such as earnings at age 27, college attendance, home ownership, and retirement savings. We then document four sets of experimental impacts. First, students in small classes are significantly more likely to attend college and exhibit improvements on other outcomes. Class size does not have a significant effect on earnings …

Is Being In School Better? The Impact Of School On Children's Bmi When Starting Age Is Endogenous, Patricia Anderson, Kristin Butcher, Elizabeth Cascio, Diane Schanzenbach

Diane Whitmore Schanzenbach

In this paper, we investigate the impact of attending school on body weight and obesity using a regression-discontinuity design. As is the case with academic outcomes, school exposure is related to unobserved determinants of weight outcomes because some families choose to have their child start school late (or early). If one does not account for this endogeneity, it appears that an additional year of school exposure results in a greater BMI and a higher probability of being overweight or obese. When we compare the weight outcomes of similar age children with one versus two years of school exposure due to …

Grossman's Missing Health Threshold, Titus Galama, Arie Kapteyn

Titus Galama

We present a generalized solution to Grossman’s model of health capital (1972), relaxing the widely used assumption that individuals can adjust their health stock instantaneously to an “optimal” level without adjustment costs. The Grossman model then predicts the existence of a health threshold above which individuals do not demand medical care. Our generalized solution addresses a significant criticism: the model’s prediction that health and medical care are positively related is consistently rejected by the data. We suggest structural- and reduced-form equations to test our generalized solution and contrast the predictions of the model with the empirical literature.

A Theory Of Socioeconomic Disparities In Health, Titus Galama

Titus Galama

Detailed understanding of the mechanisms responsible for the substantial socioeconomic disparities in health is necessary to design policies effective in reducing those disparities. This requires a unifying theory of socioeconomic status and health, which is currently absent. This thesis in economics aims to develop, in several steps, a theoretical framework of disparities in health by socioeconomic status over the life cycle, using economic principles and founded in health capital theory. The first part of this thesis addresses several serious technical issues with life-cycle models of health, medical care, and socioeconomic status. The second part presents the theoretical framework.

Inside The War On Poverty: The Impact Of Food Stamps On Birth Outcomes, Douglas Almond, Hilary Hoynes, Diane Schanzenbach

Diane Whitmore Schanzenbach

This paper evaluates the health impacts of a signature initiative of the War on Poverty: the introduction of the modern Food Stamp Program (FSP). Using variation in the month FSP began operating in each U.S. county, we find that pregnancies exposed to FSP three months prior to birth yielded deliveries with increased birth weight, with the largest gains at the lowest birth weights. We also find small but statistically insignificant improvements in neonatal mortality. We conclude that the sizable increase in income from FSP improved birth outcomes for both whites and African Americans, with larger impacts for African American mothers.

Who Would Be Affected By Soda Taxes?, Diane Schanzenbach, Leslie Mcgranahan

Diane Whitmore Schanzenbach

In 2009–10, 17 states considered expanding taxation on sugar-sweetened beverages (SSBs) as a potential source of funds and a means to curb obesity. This article examines the various types of soda tax proposals, the underlying economic theory, and the anticipated impact of the proposed taxes on different population groups.

Adequate (Or Adipose?) Yearly Progress: Assessing The Effect Of "No Child Left Behind" On Children's Obesity, Patricia Anderson, Kristin Butcher, Diane Schanzenbach

Diane Whitmore Schanzenbach

This paper investigates how accountability pressures under No Child Left Behind (NCLB) may affect children’s rate of overweight. Schools facing increased pressures to produce academic outcomes may reallocate their efforts in ways that have unintended consequences for children’s health. For example, schools may cut back on recess and physical education in favor of increasing time on tested subjects. To examine the impact of school accountability programs, we create a unique panel data set of schools in Arkansas that allows us to test the impact of NCLB rules on students’ weight outcomes. Our main approach is to consider schools to be …

Inequalities In Mortality In The Us And Denmark: More Alike Than Different. A Commentary On Hoffman., Titus Galama, Mauricio Avendano

Titus Galama

No abstract provided.