Health Economics Commons^™

Learning From Delivery System Behavior, Dynamics & Interactions To Advance A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

A new "Systems for Action" national research program flows directly from the Robert Wood Johnson Foundation's Culture of Health action framework. This program will build evidence on how best to align the delivery and financing systems for medical care, public health, and community services & supports so as to promote wellbeing and resiliency, realize efficiencies in resource use, and reduce inequities in health.

Changes In Public Health System Capital And Long-Run Health And Economic Outcomes: 1998 To 2014, Glen P. Mays, Cezar B. Mamaril

Health Management and Policy Presentations

Research Objective: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health “system capital”; and (2) the effects of these changes on preventable mortality and resource use. …

Cost Estimation In Public Health Services & Systems Research, Glen P. Mays

Health Management and Policy Presentations

Considerable uncertainty persists about the resources required to implement public health programs and policies, and about the factors that drive variation in resource needs and utilization across community and institutional settings. This paper reviews several alternative approaches to cost estimation that we have used in the field of public health services & systems research (PHSSR). This review was prepared for an expert panel meeting convened as part of a study commissioned by the U.S. Assistant Secretary for Planning and Evaluation (ASPE) to estimate the costs associated with public health emergency preparedness capabilities.

Still “Saving Babies”? The Impact Of Child Medicaid Expansions On High School Completion Rates, Lincoln H. Groves

Center for Policy Research

Precipitated by the legislative decision to decouple child Medicaid benefits from welfare receipt, the number of young children qualifying for public health insurance grew markedly throughout the 1980s and early 1990s. From a baseline of roughly 15% in the average state at the beginning of the decade, the rate increased to more than 40% of all young children in the United States by the time all federal mandates were fully enacted in 1992. This paper extends the academic literature examining early childhood investments and longer-term human capital measures by exploring whether public health insurance expansions to low-income children led to …

The Impact Of Borehole Wells And A Hygiene And Sanitation Program On Diarrhea: Evidence From Rural Southwest Uganda, Morgan Adams

Master's Theses

Diarrheal disease is the second leading cause of death for children under age five, killing approximately 2,089 children a day (WHO, 2013). Clean water access, sanitation facilities, and good hygiene behavior are solutions to decreasing child mortality and morbidity caused by fecal contamination. I estimate the impact of borehole wells and a hygiene and sanitation program on diarrhea by creating a retrospective panel. I ask mothers to rank children from the most to least diarrhea when under the age of two and use this ranking to compare siblings, where at least one had been exposed to the program. The methodology …

Chutes And Ladders: Climate Variability And The Decision To Enter Sex Work In India, Kate Pennington

Master's Theses

There is widespread consensus that climate change will drive large-scale changes in poverty distributions, migration, and participation in risky informal labor markets, especially for poor households in developing countries which are both more likely to depend on the environment for their livelihood and less able to insulate against climate shocks. Within poor households, gender inequality means that women and children will bear a disproportional amount of welfare losses. I examine the impact of climate variability on migration and participation in risky informal labor markets for a particularly vulnerable population: female sex workers in India. Using a unique survey of 5,498 …

A Cost Analysis Of The 1-2-3 Pap Intervention, Kristina M. Rabarison, Rui Li, Connie L. Bish, Robin C. Vanderpool, Richard A. Crosby, Mehran S. Massoudi

Frontiers in Public Health Services and Systems Research

Background: Cervical cancer places a substantial economic burden on our healthcare system. The three-dose human papillomavirus (HPV) vaccine series is a cost-effective intervention to prevent HPV infection and resultant cervical cancer. Despite its efficacy, completion rates are low in young women aged 18 through 26 years. 1-2-3 Pap is a video intervention tested and proven to increase HPV vaccination completion rates.

Purpose: To provide the full scope of available evidence for 1-2-3 Pap, this study adds economic evidence to the intervention’s efficacy. This study tested the economies of scale hypothesis that the cost of 1-2-3 Pap intervention per number of …

The Potential Effects Of Federal Health Insurance Reforms On Employment Arrangements And Compensation, Marcus Dillender, Carolyn J. Heinrich, Susan N. Houseman

Upjohn Institute Working Papers

The Affordable Care Act (ACA) presents an opportunity to significantly improve compensation for American workers. A potential concern, though, is that employers will circumvent the employer mandate by increasing their use of workers in staffing arrangements that are not covered by the mandate: workers averaging less than 30 hours per week, working on a temporary basis, or working in organizations with fewer than 50 full-time employees. In this paper, we shed light on the likely effects that the ACA will have on employment arrangements. We first examine how part-time employment in Massachusetts changed after its health insurance reform, which is …

Critical Analysis Of The Confounding Of Clinical Trials, Eleanor L. Jordan

Senior Honors Projects, 2010-2019

To provide a comprehensive overview of issues confounding clinical trials, Chapter 2 will discuss the parties involved in the research and development of medications and detail the individual responsibilities of each. However, the ambition of these individual entities often produces a conflict of interest especially when profits are involved [9]. Organizations and individuals such as insurance corporations, pharmaceutical companies (sponsors), pharmacy benefit managers, investigators (doctors/medical professionals) and most importantly patients, are all involved in carrying out clinical research and have definitive responsibilities they are required to follow for unbiased results. However, many rules are overlooked and biases go unrecorded causing …

The Effects Of Social Status On The Quality And Affordability Of Healthcare, Robert O. Burns

Honors College Theses

Access to healthcare is very important in today's society, as is the quality of said healthcare. The socioeconomic status (SES) of an individual is the most important factor when it comes to determining both the accessibility and quality of said care, and as such has been studied extensively. Across different countries, lower SES has been linked to the decreased affordability and success rates of medical treatments such as coronary heart disease medication or health risk prevention regimes. In many cases, low SES patients were found to be less likely to seek treatment than higher SES patients as the debt they …

Geographic Variation In The Delivery Of Public Health Services: Understanding Causes And Consequences, Glen P. Mays

Health Management and Policy Presentations

The implementation and reach of evidence-based prevention and public health programs varies widely across the U.S., as does the availability of cross-cutting infrastructure and foundational capabilities required to support these interventions. This talk profiles ongoing research to uncover the causes and consequences of variation in public health delivery. This research points to policy and administrative strategies that can reduce inequities and inefficiencies in public health protections.

Reference-Dependence Effects In Benefit Assessment: Beyond The Wta-Wtp Dichotomy And Wta-Wtp Ratios, W. Kip Viscusi

Vanderbilt Law School Faculty Publications

Willingness-to-pay (WTP) values and willingness-to-accept (WTA) values have received considerable attention, but the role of reference-dependence effects is more diverse. Policies involving cost and risk may have reference point effects with respect to both cost and risk, leading to four potential valuation measures. Experimental evidence for water quality policies suggests that the cost reference effects are particularly influential in that context. There is, however, no evidence of significant reference effects for labor market estimates of the value of a statistical life. Sound application of benefit values other than WTP measures requires pertinent empirical evidence and an assessment of the underlying …

Medicaid And The Labor Supply Of Single Mothers: Implications For Health Care Reform, Vincent Pohl

Upjohn Institute Working Papers

The Patient Protection and Affordable Care Act expands Medicaid and introduces health insurance subsidies, thereby changing work incentives for single mothers. To undertake an ex ante policy evaluation of the employment effects of the PPACA, I structurally estimate a model of labor supply and health insurance choice exploiting existing variation in Medicaid policies. Simulations show that single mothers increase their labor supply at the extensive and the intensive margin by six and five percent, respectively. The PPACA leads to crowding-out of employer-sponsored health insurance of about 40 percent and increases single mothers' welfare by about $190 per month.

Price Subsidies, Diagnostic Tests, And Targeting Of Malaria Treatment: Evidence From A Randomized Controlled Trial, Jessica Cohen, Pascaline Dupas, Simone Schaner

Dartmouth Scholarship

Both under- and over-treatment of communicable diseases are public bads. But efforts to decrease one run the risk of increasing the other. Using rich experimental data on household treatment- seeking behavior in Kenya, we study the implications of this trade-off for subsidizing life-saving antimalarials sold over-the-counter at retail drug outlets. We show that a very high subsidy (such as the one under consideration by the international community) dramatically increases access, but nearly one-half of subsidized pills go to patients without malaria. We study two ways to better target subsidized drugs: reducing the subsidy level, and introducing rapid malaria tests over-the-counter. …

Mandate-Based Health Reform And The Labor Market: Evidence From The Massachusetts Reform, Jonathan T. Kolstad, Amanda E. Kowalski

Upjohn Institute Working Papers

We model the labor market impact of the key provisions of the national and Massachusetts "mandate-based" health reforms: individual mandates, employer mandates, and subsidies. We characterize the compensating differential for employer-sponsored health insurance (ESHI) and the welfare impact of reform in terms of "sufficient statistics." We compare welfare under mandate-based reform to welfare in a counterfactual world where individuals do not value ESHI. Relying on the Massachusetts reform, we find that jobs with ESHI pay $2,812 less annually, somewhat less than the cost of ESHI to employers. Accordingly, the deadweight loss of mandate-based health reform was approximately 8 percent of …

Aca Implementation In The South: The Political Economy Of Full Participation In Kentucky, Glen P. Mays

Health Management and Policy Presentations

This analysis, conducted as part of the ACA Implementation Research Network, examines economic and political forces shaping Kentucky's early experience with implementation of the Patient Protection and Affordable Care Act.

The Effect Of Medicare Eligibility On Spousal Insurance Coverage, Marcus Dillender, Karen Mulligan

Upjohn Institute Working Papers

A majority of married couples in the United States take advantage of the fact that employers often provide health insurance coverage to spouses. When the older spouses become eligible for Medicare, however, many of them can no longer provide their younger spouses with coverage. In this paper, we study how spousal eligibility for Medicare affects the health insurance and health care access of the younger spouse. We find spousal eligibility for Medicare results in the younger spouse having worse insurance coverage and reduced access to health care services.

Health Care Use, Out-Of-Pocket Expenditure, And Macroeconomic Conditions During The Great Recession, Juan Du, Takeshi Yagihashi

Economics Faculty Publications

We study how macroeconomic conditions during the Great Recession affected health care utilization and out-of-pocket expenditures of American households. We use two data sources: the Consumer Expenditure (CE) Survey and the Survey of Income and Program Participation (SIPP); each has its own advantages. The CE contains quarterly frequency variables, and the SIPP provides panel data at the individual level. Consistent evidence across the two datasets shows that utilization of routine medical care was counter-cyclical, whereas hospital care was pro-cyclical during the Great Recession. When we examine the pre-recession period, the relationship between macroeconomic conditions and health care use was either …

Health Care Inflation And It's Implications For Monetary Policy, Takeshi Yagihashi, Juan Du

Economics Faculty Publications

Motivated by recent findings on the cyclical movement of both health and health spending, we construct a general equilibrium model that distinguishes health care demand from the demand for other goods. Using this model, we are able to generate inflation dynamics and cyclicality of health that match the US data. When the model is subjected to an expansionary monetary policy shock, it yields different output and inflation responses compared with a two-sector model with homogeneous demand. We show that the trade-off between leisure and health spending plays an important role in model dynamics. The model further predicts different degrees of …

Procedural Triage, Matthew B. Lawrence

Faculty Articles

Prior scholarship has assumed that the inherent value of a “day in court” is the same for all claimants, so that when procedural resources (like a jury trial or a hearing) are scarce, they should be rationed the same way for all claimants. That is incorrect. This Article shows that the inherent value of a “day in court” can be far greater for some claimants, such as first-time filers, than for others, such as corporate entities and that it can be both desirable and feasible to take this variation into account in doling out scarce procedural protections. In other words, …