Health Economics Commons^™

Three Essays On The Health Insurance Coverage Of Young Adults, David M. Yaskewich

Theses and Dissertations--Economics

This dissertation examines the health insurance status of young adults during the transition to adulthood. In a series of three essays, I analyze what happens as young adults reach important milestones and the effects of public policies. The first essay is a descriptive study on how insurance status changes after reaching age 19 and graduating from college. The likelihood of becoming uninsured rises sharply once turning age 19 and then peaks at age 23. While the proportion uninsured also increases following college graduation, this increase disappears after one year. The second essay analyzes the effect of a dependent age law …

Marketing Pharmaceuticals: A Constitutional Right To Sell Prescriber-Identified Data?, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Pharmaceutical companies have strong economic interests in influencing physician-prescribing behaviors. They advertise direct-to-the-consumer and to the physician. Beyond general marketing, manufacturers promote their drugs to physicians through “detailing”—sales representatives (“detailers”) visiting medical offices to persuade physicians to prescribe their products.

By law, pharmacies receive specific information with every prescription, including the physician’s name, the drug, and the dose. Pharmacies sell these records to Prescription Drug Intermediaries (data miners), who use advanced computing to analyze prescriber-identified information (which physicians prescribe what drugs, in what dose, and with what prescribing patterns). Data miners, in turn, lease sophisticated reports to pharmaceutical companies to …

A System Dynamics Model For Simulating Ambulatory Health Care Demands, Rafael Diaz, Joshua G. Behr, Mandar Tulpule

VMASC Publications

Introduction: This article demonstrates the utility of the system dynamics approach to model and simulate US demand for ambulatory health care service both for the general population and for specific cohort subpopulations over the 5-year period, from 2003 to 2008. A system dynamics approach that is shown to meaningfully project demand for services has implications for health resource planning and for generating knowledge that is critical to assessing interventions.

Methods: The study uses a cohort-component method in combination with structural modeling to simulate ambulatory health care utilization. Data are drawn from the National Ambulatory Medical Care Survey and the National …

Formal And Informal Care: An Empirical Bayesian Analysis Using The Two-Part Model, Juan Du

Economics Faculty Publications

Informal care provided to the elderly by their children is proposed as a less expensive alternative to institutional long-term care. This paper explores how the elderly's consumption of medical care changes in response to changes in the informal care they receive from their children. Many earlier studies have ignored both the endogeneity of informal care and the complicated nature of health care utilization data. This paper develops a two-part model with informal care treated as an endogenous regressor and imposes exclusion restrictions on the selection process. The model is fitted using the Bayesian Markov Chain Monte Carlo (MCMC) methods, in …

The Health And Wealth Of A Nation: Employer-Based Health Insurance And The Affordable Care Act, Nan L. Maxwell

Upjohn Press

This research examines the behaviors of firms with respect to their provision of health care prior to the Affordable Care Act (ACA) deliberations and uses those behaviors to assess changes in employer-sponsored health insurance that might occur once the ACA is fully implemented.

Differential Effects Of Tort Reform Across Medical Specialties, William C. Dodds

CMC Senior Theses

This paper utilizes data on physician malpractice insurance premiums and state tort law to analyze how physicians in various medical specialties are differentially affected by caps on noneconomic damages. As higher premiums put pressure on legislators to enact damage caps, I instrument caps on noneconomic damages with enactment of tort reform measures that do not affect malpractice premiums to uncover the effect of caps on noneconomic damages on such premiums. I find evidence to support that, in terms of dollars saved, physicians in high risk specialties benefit more from noneconomic damage caps than physicians in low risk specialties. However, in …

Driving Qi With Research: Findings From Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are increasingly experimenting with quality improvement (QI) strategies designed to enhance the effectiveness and efficiency of their efforts. Does QI work in public health, and if so for whom and under what circumstances? What QI strategies work best for which types of public health process failures, and at what cost? Research underway through the Public Health Practice-Based Research Networks (PBRN) Program is examining these types of questions to build an evidence base for public health QI.

The Science Of Public Health Delivery: Evidence, Uncertainties & Research Needs, Glen P. Mays

Health Management and Policy Presentations

Policy initiatives to reform the nation's health system increasingly recognize the need to incorporate public health and prevention strategies. The nation's delivery system for public health, however, varies widely across states and communities in its structure, authority, and capabilities. This session examines research from the growing field of public health services and systems research to identify directions for improving public health delivery.

Estimating The Value Of Public Health Services & Systems: Evidence, Uncertainties, And Research Needs, Glen P. Mays

Health Management and Policy Presentations

The Affordable Care Act authorized the largest expansion in federal funding for public health services and delivery systems in decades. These provisions, designed to support programs and services that promote health and prevent disease and injury on a population-wide basis, remain controversial because of uncertainties regarding their effectiveness in improving health and constraining medical cost growth. This session examines a series of recent studies to shed light on the health and economic value of spending on public health.

Disparities Research In Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are well positioned within the health system to play key roles in addressing oral health issues on a population-wide basis, However, current evidence reveals wide geographic variation in the delivery of public health interventions for oral health promotion. This session explores the factors contributing to this variation, and it highlights studies underway through the Public Health Practice-Based Research Networks (PBRNs) to produce more and better evidence about public health delivery and impact.

Poor Women With Sexually Transmitted Infections: Providers’ Perspectives On Diagnoses, Genevieve R. Cox

Sociology

This article presents results from a study of health care providers, mainly nurses and nurse practitioners, who routinely diagnose sexually transmitted diseases (STDs) in rural low-income populations in West Virginia (WV). A qualitative analysis of eighteen semi-structured interviews reveals that providers who consistently work with low-income populations believe patients undergo a negative change in self-image in response to a chronic STD diagnosis. Providers express concerns about a number of issues related to low-income, rural women’s access to sexual health care and see the need for more sexuality education, more funding for free and reduced cost clinics, and more available health …

Review Of Food Justice. By Robert Gottlieb And Anupama Joshi., Toby Ten Eyck

Great Plains Research: A Journal of Natural and Social Sciences (through 2013)

It is a story about food we have heard before-big is bad; small, local, and organic is better; and if you can link small, local, and organic to students, that is best of all. Part of the problem is that the usual suspects-WalMart, McDonalds, PepsiCo, etc.-have so many more resources than the usual cast of small-is-good heroes eking out a living from the earth and hard work: organic farmers , migrant workers, CSA founders and operators, and similar supporters. Gottlieb and Joshi provide some hope by pointing to a few small victories among the heroes, but it is a fight …

Hiv And Concurrent Sexual Partnerships: Modelling The Role Of Coital Dilution, Larry Sawers, Alan G. Isaac, Eileen Stillwaggon

Economics Faculty Publications

Background: The concurrency hypothesis asserts that high prevalence of overlapping sexual partnerships explains extraordinarily high HIV levels in sub-Saharan Africa. Earlier simulation models show that the network effect of concurrency can increase HIV incidence, but those models do not account for the coital dilution effect (nonprimary partnerships have lower coital frequency than primary partnerships).

Methods: We modify the model of Eaton et al (AIDS and Behavior, September 2010) to incorporate coital dilution by assigning lower coital frequencies to non-primary partnerships. We parameterize coital dilution based on the empirical work of Morris et al (PLoS ONE, December …

Why The Master? Human Capital Development For Practicing U.S. Cycling Coaches, Daniel Larson, Joel Maxcy

Faculty Articles

The economic structure of the industry of cycling coaches has yet to be the subject of any apparent published inquiry. This study describes the basic characteristics of practicing cycling coaches and presents economic models of the determinants of commercial success for individual coaches. Data were collected through an independent survey of current and former U.S.A. Cycling (USAC) coaches in 2010 (N = 386). Results of ordinary least squares and negative-binomial regression models suggest that coaching and competitive experience are associated with larger clienteles, but formal human capital investments do not generally add to a coach's ability to garner more clients. …

Quenching Thirst Through Policy And Planning, Knowledge@Smu

Knowledge@SMU

Water is fundamental to human survival. Yet, for many people in the world, clean water may not necessarily come as easy as simply turning the tap. It is estimated that some 20 percent of the world's population do not have access to water – a reality not perpetuated by a lack of water, but rather, ineffective policies and politicians. Speaking at a SMU Social Sciences seminar, Eduardo Araral shares the story of how a city overcame the odds to supply clean water to its masses.

Comment On Hoerger: Early Pilots Of Medicare Auctions Brings No Solace To Auction Experts, Peter Cramton, Brett E. Katzman

Faculty Articles

Peter Cramton and Brett Katzman stick to their guns: Medicare auctions remain fatally flawed and must be fixed. They argue that contrary to Hoerger's comment, no comfort can be drawn from the fact that the market was able to withstand price reductions in early pilots.

The Effect Of Employer Health Insurance Offering On The Growth And Survival Of Small Business, Adela Luque, C. J. Krizan, Alice Zawacki

Upjohn Institute Technical Reports

No abstract provided.

The Efficiency Of A Group-Specific Mandated Benefit Revisited: The Effect Of Infertility Mandates, Joanna N. Lahey

Upjohn Institute Working Papers

This paper examines the labor market effects of state health insurance mandates that increase the cost of employing a demographically identifiable group. State mandates requiring that health insurance plans cover infertility treatment raise the relative cost of insuring older women of child-bearing age. Empirically, wages in this group are unaffected, but their total labor input decreases. Workers do not value infertility mandates at cost, and so will not take wage cuts in exchange, leading employers to decrease their demand for this affected and identifiable group. Differences in the empirical effects of mandates found in the literature are explained by a …

The Role Of Sorghum In Food Security In Central America, Lloyd W. Rooney

INTSORMIL Presentations

Discusses the qualities of sorghum that make it suitable for human consumption, with a focus on its use in Central America.

The Pragmatist’S Guide To Comparative Effectiveness Research, Amitabh Chandra, Anupam B. Jena, Jonathan Skinner

Dartmouth Scholarship

No abstract provided.

Employer-Provided Health Insurance And Labor Supply Of Married Women, Merve Cebi

Upjohn Institute Working Papers

This work presents new evidence on the effect of husbands’ health insurance on wives’ labor supply. Previous cross-sectional studies have estimated a significant negative effect of spousal coverage on wives’ labor supply. However, these estimates potentially suffer from bias due to the simultaneity of wives’ labor supply and the health insurance status of their husbands. This paper attempts to obtain consistent estimates by using several panel data methods. In particular, the likely correlation between unobserved personal characteristics of husbands and wives—such as preferences for work—and potential joint job choice decisions can be controlled by using panel data on intact marriages. …

Being Surveyed Can Change Later Behavior And Related Parameter Estimates, Alix Peterson Zwane, Jonathan Zinman, Eric Van Dusen, William Pariente

Dartmouth Scholarship

Does completing a household survey change the later behavior of those surveyed? In three field studies of health and two of microlending, we randomly assigned subjects to be surveyed about health and/or household finances and then measured subsequent use of a related product with data that does not rely on subjects' self-reports. In the three health experiments, we find that being surveyed increases use of water treatment products and take-up of medical insurance. Frequent surveys on reported diarrhea also led to biased estimates of the impact of improved source water quality. In two microlending studies, we do not find an …

Specialty Service Lines In The United States Hospital System: Old Wine, New Bottles, Michael Sajovetz

Electronic Theses and Dissertations

The emergence of specialty service lines in the United States health care system presents many significant questions regarding the access to, provision of, and financing of healthcare. In general terms, specialty service lines represent the newest development in several important trends in the American hospital system and reflect important trends in the wider economy. Many claims have been made regarding the effect of physician-owned specialty hospitals, from their exemption from self-referral prohibitions, their diversion of services away from general hospitals that use high profit margins to subsidize the "safety net," and concerns regarding the over-provision of technologically complex treatments in …

The Economics Of Health 2011-12, Department Of Economics

Werner Sichel Lecture Series

The 2011-12 Werner Sichel Lecture Series features six nationally recognized economists & medical specialists whose presentations will focus on the economics of health.The Sichel Series is directed by Professor Donald Meyer, and is cosponsored by the W. E. Upjohn Institute for Employment Research, College of Arts and Sciences, and the Medical Humanities Workgroup of WMU. It is named for longtime WMU economics professor, Dr. Werner Sichel, who retired in 2004.

Does The Provision Of Healthcare Vary With Race? Evidence From Health Shocks To Patients Far From Home, Ajay Sridhar

CMC Senior Theses

A vast literature acknowledges that minority groups, particularly African-Americans, receive less, and lower-quality treatment than Caucasians in U.S. health facilities. It remains an open question as to how much of this disparity is a result of poverty, and how much, a result of more overt discrimination. Former empirical studies are far from conclusive given the endogeneity of hospital quality, as minorities are overrepresented in areas served by poor health facilities. To remedy this endogeneity issue, we observe visitors to the state of Florida, as well as travelers within Florida. When an individual experiences a health shock far from home, her …

A Cross-Sectional Study Of Infant Mortality Rates Between Countries, Katelyn E. May

Undergraduate Theses and Capstone Projects

The health status of nations has been and continues to be under debate. Although the variables that comprise such a status have not been solidified, one variable that is closely studied and is thought to have an effect on the idea of health status is infant mortality. A country’s Infant Mortality Rate (IMR) is treated as an indicator of its health status as well as socioeconomic status. This research attempts to study the variables which are hypothesized to be significant in relation to IMR, and to find which ones truly have an effect. Data on eight independent variables were collected …

Money And Its Effects On Life, Behaviour And Happiness, Knowledge@Smu

Knowledge@SMU

Happiness cannot be bought, some people might argue. Yet, money certainly allows people to buy things and experiences that can ultimately bring joy and happiness. Results from this year's Gallup World Poll, for instance, ranked Denmark, Finland, Norway, Sweden and the Netherlands – all wealthy countries – as the top five for happiest inhabitants. A recent SMU Social Sciences Capstone Seminar also pointed out that wealthier countries have cleaner water, better infrastructure, fewer diseases, and higher IQs. Could the old adage, that money is the root of all evil, be out of touch with the realities of our capitalist, consumerist …

Micro-Level Estimation Of Child Undernutrition Indicators In Cambodia, Tomoki Fujii

Research Collection School Of Economics

One major limitation to addressing child undernutrition is a lack of the information required to target resources. This article extends the small-area estimation technique of Elbers, Lanjouw, and Lanjouw (2002, 2003) to jointly estimate multiple equations while allowing for individual-specific random errors across equations (in addition to cluster- and household-specific random errors). Estimates of the prevalence of stunting and underweight for children under age 5 in Cambodia from 17 Demographic and Health Survey strata are disaggregated into 1,594 communes by combining the Demographic and Health Survey data. The estimates are consistent with the surveyonly estimates at the aggregate and primary …

Accidental Leaders No More: Challenges Facing Healthcare Leaders Of Today And Tomorrow, Knowledge@Smu

Knowledge@SMU

Singapore’s ageing population means healthcare costs are going up at faster than ever. The heavier workload and growing business opportunities within this essential industry also means that on-going tensions between the public and private sectors are unlikely to go away anytime soon. Yet, at the same time, the industry faces multi-dimensional challenges, like rapidly-changing technology and fierce competition for talent. How can healthcare organisations prepare themselves for the challenges ahead? For a start, they could use a pipeline of formally-trained leaders.

Reducing Healthcare Costs Requires Good Market Design, Peter Cramton, Brett E. Katzman

Faculty Articles

Healthcare costs are no doubt too high, and Congress has been pushing for 13 years to harness market forces in Medicare procurement. But despite all this time, we are on the precipice of adopting a very poor market design, according to Peter Cramton of University of Maryland and Brett Katzman of Kennesaw State University.