Health Economics Commons^™

Early Effects Of The Affordable Care Act On Health Care Access, Risky Health Behaviors, And Self-Assessed Health, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Institute for the Study of Free Enterprise Working Papers

The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre-ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both …

A Cross-Sectional Exploration Of Household Financial Reactions And Homebuyer Awareness Of Registered Sex Offenders In A Rural, Suburban, And Urban County., John Charles Navarro

Electronic Theses and Dissertations

As stigmatized persons, registered sex offenders betoken instability in communities. Depressed home sale values are associated with the presence of registered sex offenders even though the public is largely unaware of the presence of registered sex offenders. Using a spatial multilevel approach, the current study examines the role registered sex offenders influence sale values of homes sold in 2015 for three U.S. counties (rural, suburban, and urban) located in Illinois and Kentucky within the social disorganization framework. Homebuyers were surveyed to examine whether awareness of local registered sex offenders and the homebuyer’s community type operate as moderators between home selling …

Pregnancy Medicaid Expansions And Fertility: Differentiating Between The Intensive And Extensive Margins, Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo

Center for Policy Research

The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987-1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, …

Socioeconomic Status, Air Quality And Geographic Variation In Emergency Room Visits For Acute Bronchitis On The California Central Coast, Sean Lang-Brown, Heather W. Starnes, Gary B. Hughes

Symposium

IMPORTANCE: Analysis of geospatial variation in acute bronchitis due to socioeconomic and environmental factors can allow the efficient delivery of resources to populations most at risk.

OBJECTIVE: We sought to determine if small scale variation in socioeconomic factors and emergency room (ER) visits for acute bronchitis are associated in small cities or rural communities. We also modeled the effects of air quality on daily rates of ER visits for acute bronchitis in the context of socioeconomic factors to investigate modifying relationships.

DESIGN, SETTING, AND PARTICIPANTS: We examined ER visits for acute bronchitis in San Luis Obispo and Santa Barbara counties …

Burden Of Atopic Dermatitis In The United States: Analysis Of Healthcare Claims Data In The Commercial, Medicare, And Medi-Cal Databases, Sulena Shrestha, Raymond Miao, Li Wang, Jingdong Chao, Huseyin Yuce, Wenhui Wei

Publications and Research

Comparative data on the burden of atopic dermatitis (AD) in adults relative to the general population are limited. We performed a large-scale evaluation of the burden of disease among US adults with AD relative to matched non-AD controls, encompassing comorbidities, healthcare resource utilization (HCRU), and costs, using healthcare claims data. The impact of AD disease severity on these outcomes was also evaluated.

Congenital Toxoplasmosis In Austria: Prenatal Screening For Prevention Is Cost-Saving, Andrea-Romana Prusa, David C. Kasper, Larry Sawers, Evelyn Walter, Michael Hayde, Eileen Stillwaggon

Economics Faculty Publications

Background:

Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario.

Methodology/Principal Findings:

We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric …

Determinan Harapan Peserta Jaminan Kesehatan Nasional Terhadap Layanan Di Klinik Pratama Kota Depok Periode Mei Tahun 2016, Baiq Qurrata Aini, Rita Damayanti

Jurnal Ekonomi Kesehatan Indonesia

The score of JKN member’s satisfaction in primary clinic in 2014 reached as high as 80%, which means that it achieved the target of Jaminan Kesehatan Nasional’s (JKN) Road Map. However, there were still many complaints coming from the BPJS customer as shown in YLKI report and in Kemenpan official website regarding unfulfillment of their expectations. This study aimed to obtain information about the determinant of member’s expectation to the service of primary clinic in Depok (May 2016). This study combined qualitative and quantitative study by sequential exploratory, which was started by qualitative study to explore the phenomena and then …

Analisis Perhitungan Kapitasi Pada Fasilitas Kesehatan Tingkat Pertama Yang Bekerja Sama Dengan Bpjs Kesehatan Kcu Kota Bogor Tahun 2015, Ayu Novia Kurnia, Atik Nurwahyuni

Jurnal Ekonomi Kesehatan Indonesia

Based on PMK No. 69 in 2013, capitation is set at the same tariff for all age groups and only distinguished for each primary health care. Capitation is not adjusted by individual risk. This study aimed to calculate the capitation by age, using cross sectional design. The result of this study was capitation by age groups at the primary health care level. It was indicated that there was different capitation between age groups, with higher capitation observed in the age group of 0-4 and ≥50 years old and declining in productive age.

Analisis Pembiayaan Program Promotif Dan Preventif Pemberantasan Demam Berdarah Dengue (Dbd) Bersumber Pemerintah Di Kota Semarang Tahun 2013-2015, Nisa Kamila, Mardiati Nadjib

Jurnal Ekonomi Kesehatan Indonesia

In 2010–2014, Semarang was involved as the big three city with high incidence rate of dengue in Central Java province. This study aimed to analyze the financing by the local government for Dengue preventive program in 2013-2015, as well as the resources gap. The health account approach was used to analyze spending by source, function, and provider. Total local government spending for dengue in 2013 were IDR 4.018.927.020,- increased by 101% in 2014 and increased by 218% in 2015. The largest expenditure for Dengue Preventive program is epidemiological surveillance and infectious disease control. There was no gap between available resources …

Analisis Faktor-Faktor Yang Berhubungan Dengan Tingginya Rujukan Kasus Non Spesialistik Pasien Jaminan Kesehatan Nasional Pada Puskesmas Di Kabupaten Sukabumi Tahun 2015, Masykur Alawi, Purnawan Junadi, Siti Nur Latifah

Jurnal Ekonomi Kesehatan Indonesia

Public Health Center is the frontline in the basic health services that include non-specialist cases to be solved in this primary health care level. However, a report from BPJS Kesehatan in 2015 showed that there were 11.487 referral of non-specialist cases in Primary Health Cares (PHCs) in Sukabumi. This study was to determine factors associated with high referral rate of National Health Insurance’s members with non-specialist cases by PHCs in Sukabumi in 2015. The study employed cross-sectional design in 58 PHCs along with a general practitioner in each centers using a whole sampling. The result showed that there were correlation …

Pemanfaatan Dana Kapitasi Oleh Puskesmas Di Kota Lubuklinggau Tahun 2014-2016, Muhammad Muhammad Yulianto Muhammad Yulianto, Mardiati Nadjib

Jurnal Ekonomi Kesehatan Indonesia

Since the implementationof National Health Insurance (JKN), Health Centers received the payment from Social Security Agency for Health (BPJS) using capitation. In Lubuklinggau City, there has been problem inutilizing capitation and financing surplus (SiLPA) for approximately 23% per year. This research aimed to analyze the utilization of capitationin Lubuklinggau City 2014-2016. This qualitative study was implemented in SimpangPeriuk Health Center, Taba, Citra Medika and Swasti Saba which werethe lowest and highest SiLPA absorption, and data were collected retrospectively. The study revealedthat the capitation funds have achieved the target (69,5%) while spending for operational was still under utilized (12,4%). The planning …

Analisis Karakteristik Dan Persepsi Pengguna Pelayanan Terhadap Pemanfaatan Puskesmas Sebagai Gatekeeper Di Dua Puskesmas Kota Bekasi Tahun 2016, Fitria Kusumawati Wulandari, Anhari Achadi

Jurnal Ekonomi Kesehatan Indonesia

The concept of primary health care in the era of National Health Insurance (JKN) is developed by strengthening primary health care as a gatekeeper with the concept of managed care. In this concept of managed care, one og the success story of the gatekeeper system is assessed by the visit and referral rates to the Higher Level of Health Facilities (ALHF/Fasilitas Kesehatan Tingkat Lanjut). This study aimed to determine the characteristics and perception of service users towards utilization of public health centers (PHC/Puskesmas) as gatekeeper in two PHC in City of Bekasi. This study used cross-sectional design and data collection …

Social Health Insurance And Maternal And Child Health Outcomes In Developing Countries: The Case Of Ghana, Ama Agyeiwaa Abrokwah

Dissertations

About 25% of all maternal deaths occur during pregnancy; 99% of these maternal deaths occur in developing countries and half of these occur in Sub-Saharan Africa (WHO 2015). Two of the eight Millennium Development Goals are to reduce infant mortality and improve maternal and child health outcomes. To improve health outcomes and reduce the financial burden on households, a number of developing countries, including Ghana, Botswana, and Croatia, have introduced social health insurance programs which are heavily subsidized. This dissertation is a collection of three essays evaluating how maternal and child health care-seeking behavior, utilization and outcomes changed as a …

Does Increased Access To Health Insurance Impact Claims For Workers' Compensation? Evidence From Massachusetts Health Care Reform, Erin Todd Bronchetti, Melissa Mcinerney

Upjohn Institute Working Papers

We study over 20 million emergency room (ER) discharges in Massachusetts and three comparison states to estimate the impact of Massachusetts health care reform on claims for Workers’ Compensation (WC). Prior evidence on the relationship between health insurance and WC claiming behavior is mixed. We find that the reform caused a significant decrease in the number of per-capita ER discharges billed to WC. This result is driven by larger decreases in WC discharges for conditions for which there is greater scope to change the payer or the location of care. Conversely, we estimate smaller impacts for weekend versus weekday admissions …

Do Marketing Strategies Impact Condom Sales In Uganda?, Meyhar Mohammed

Master's Theses

What attracts people to buy condoms? HIV/AIDS remain one of the biggest health dangers of the world, especially in Sub-Saharan Africa. A lot of efforts have been pursued in the past two decades to drastically reduce prevalence of HIV and increase awareness about preventive mechanisms. In order to prevent relapse of success achieved so far, it is important to recognize transformation of consumer behavior due to growth in social networks, education and awareness over time. There are a lot of behavioral triggers captured by social marketing interventions in the field of public health. In an attempt to investigate the role …

Community Benefits Spending By Private Tax-Exempt Hospitals In The U.S., Wael Elrayes

Theses & Dissertations

The Internal Revenue Service issued the long awaited regulatory guidelines for the Community Benefits (CB) spending for private tax-exempt hospitals in December 2008, which required these hospitals to report their policies, practices, and spending on CB activities. The Affordable Care Act amended these rules in 2010 by adding a section on Community Health Needs Assessment.

This study evaluates and tracks spending on the total and different CB activities by all private tax-exempt hospitals in seven states after the implementation of the latest IRS and ACA reporting regulations from 2010 - 2013. Moreover, this study investigates which community health indicators are …

The Design Of An Instrument To Assess Clinical Laboratories Efficacy Post Implementation Of The Patient Protection Affordable Care Act, Harry Mcdonald Jr.

Dissertations

The healthcare system in the United States has undergone substantial changes in support of the Patient Protection and Affordable Care Act (PPACA). On March 23, 2010, the implementation of the new healthcare law brought universal healthcare access to all Americans, while attempting to increase quality and decrease medical costs. The new law promotes more of a quality-focused, outcome-based model rather than a pay-for-fee service model; thus, moving the paradigm from infrequent to preemptive healthcare. The PPACA postulates as the only way to achieve cost savings while increasing quality and access. Never before has there been such an extensive change to …

Why Do Women Delay In Seeking Prenatal Care? A Discrete-Time Survival Analysis, Ama Agyeiwaa Abrokwah

Research and Creative Activities Poster Day

Prenatal care during early stages of pregnancy can result in early detection of some pregnancy related complications which can help reduce both maternal and infant mortality (Conway et al., 2006). The cost of service has been identified as an important determinant of the utilization of prenatal care in most developing countries. This paper evaluates how Ghana’s social health insurance program affects the timing of prenatal care utilization using survival analysis techniques. This paper hypothesizes that having insurance will result in early utilization of prenatal care.

Maternal Autonomy And Child Health Care Utilization: Evidence From Bangladesh, Ashiqul Alam

Undergraduate Research Symposium 2017

My research looked into the relationship between maternal autonomy and how child health care is utilized in third world countries. I worked with my professor, Dr. Bibhudutta Panda, to specifically look at Bangladesh as our country of interest. The country itself is smaller than Florida but is ranked number 8 for the most populated country. In Bangladesh the infant mortality rate is 6 times more than the US, at 30.7 per 1000 live births and government expenditure is also low. The main reason behind to pick Bangladesh is also that it is a third world country and also a patriarchal …

Determinants Of Health Expenditures In Oecd Countries, Giang Phi

Honors Projects in Economics

Around the world, governments are coping with spiraling health care spending. This spurs the need for further insight in the determinants of such expenditures. This study investigates the determinants of health care expenditures for a sample of thirty five countries in the Organization for Economic Cooperation and Development (OECD) from 2000 to 2013 in order to understand the impact of different factors on health care spending growth. Besides Gross Domestic Product (GDP), the study accounts for many different driving forces such as demographics, medical progress, health system characteristics, public financing, and other non-medical determinants of health spending such as alcohol …