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Author : Naoki Aizawa
Publisher :
ISBN 13 :
Total Pages : 264 pages
Book Rating : 4.:/5 (888 download)
Download or read book Essays on Health Insurance Market Design and Labor Market Interactions written by Naoki Aizawa and published by . This book was released on 2014 with total page 264 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : James Bailey
Publisher :
ISBN 13 :
Total Pages : 84 pages
Book Rating : 4.:/5 (128 download)
Download or read book Three Essays on Health Insurance Regulation and the Labor Market written by James Bailey and published by . This book was released on 2014 with total page 84 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation continues the tradition of identifying the unintended consequences of the US health insurance system. Its main contribution is to estimate the size of the distortions caused by the employer-based system and regulations intended to fix it, while using methods that are more novel and appropriate than those of previous work. Chapter 1 examines the effect of state-level health insurance mandates, which are regulations intended to expand access to health insurance. It finds that these regulations have the unintended consequence of increasing insurance premiums, and that these regulations have been responsible for 9-23% of premium increases since 1996. The main contribution of the chapter is that its results are more general than previous work, since it considers many more years of data, and it studies the employer-based plans that cover most Americans rather than the much less common individual plans. Whereas Chapter 1 estimates the effect of the average mandate on premiums, Chapter 2 focuses on a specific mandate, one that requires insurers to cover prostate cancer screenings. The focus on a single mandate allows a broader and more careful analysis that demonstrates how health policies spill over to affect the labor market. I find that the mandate has a significant negative effect on the labor market outcomes of the very group it was intended to help. The mandate expands the treatments health insurance covers for men over age 50, but by doing so it makes them more expensive to insure and employ. Employers respond to this added expense by lowering wages and hiring fewer men over age 50. According to the theoretical model put forward in the chapter, this suggests the mandate reduces total welfare. Chapter 3 shows that the employer-based health insurance system has deterred entrepreneurship. It takes advantage of the natural experiment provided by the Affordable Care Act's dependent coverage mandate, which de-linked insurance from employment for many 19-25 year olds. Difference-in-difference estimates show that the mandate increased self-employment among the treated group by 13-24%. Instrumental variables estimates show that those who actually received parental health insurance as a result of the mandate were drastically more likely to start their own business. This suggest that concerns over health insurance are a major barrier to entrepreneurship in the United States.
Author : Matthew Mark Knepper
Publisher :
ISBN 13 : 9781321894424
Total Pages : 132 pages
Book Rating : 4.8/5 (944 download)
Download or read book Essays on Health and Labor Markets written by Matthew Mark Knepper and published by . This book was released on 2015 with total page 132 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation looks at the interaction of the legal environment with health and labor market outcomes in a variety of settings. The first chapter examines the effect of state public health insurance expansion decisions on private insurance costs by comparing how private insurance plan costs have evolved over time according to whether a state has pursued a Medicaid coverage expansion as part of the Patient Protection & Affordable Care Act. The second chapter explores how one can test for judicial ingroup biases and applies the test to workplace sex discrimination cases. The third chapter evaluates the potential efficacy of federal incentive payments designed to boost physician access to electronic health records on patient outcomes in an Emergency Department setting.
Author : Ricki Marie Sears Dolan
Publisher :
ISBN 13 :
Total Pages : 368 pages
Book Rating : 4.:/5 (985 download)
Download or read book Essays on the Economics of Health Insurance, Labor Markets, and Migration written by Ricki Marie Sears Dolan and published by . This book was released on 2016 with total page 368 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation contains three chapters, two which focus on health insurance and one focusing on migration. The first chapter examines how a policy expanding public health insurance for young children affected their parents' labor market and health insurance outcomes. I use variation in the initial income thresholds, children's age cutoffs and timing of implementation across states to estimate the effect of a person's youngest child gaining access to public health insurance on self-employment. I find that having a child become Medicaid eligible increases a father's self-employment and increases his business income. I find no significant effect on self-employment for mothers, but I find that the increasing eligibility is associated with a large negative effect on their probability of remaining in a wage job. The second chapter examines how expanding dependent health insurance for young adults affects the health insurance and labor market outcomes of those young adults and their parents. I exploit two sources of variations in the age at which young adults age out of their parents' health insurance: i) state reforms passed between 2000 and 2010 that extended the maximum age of health insurance dependents beyond 18 and ii) the Affordable Care Act that extended coverage for all young adults in the United States until their 26th birthdays. Using regression discontinuity, I find evidence that the policies increased young adult dependent coverage. Dependent coverage for eligible young adults increased by 8 percentage points over ineligible young adults, while health insurance in the young adults' own name decreased by 6.5 percentage points. I also see evidence that parents of eligible young adults responded by changing their own coverage. The final chapter investigates the relationship between children and migration using data from the American Communities Survey. To address the issue that both migration and fertility might be correlated with unobserved variables I use twin births as an instrumental variable for the number of children. I find that that an additional child decreases migration by 0.6 percentage points and decreases the probability that a woman lives in her birth state by 1.4 percentage points. This suggests that more children hinder migration.
Author : Yun Zhou (Ph. D.)
Publisher :
ISBN 13 :
Total Pages : 208 pages
Book Rating : 4.:/5 (1 download)
Download or read book Essays on Public Policy and Labor Economics written by Yun Zhou (Ph. D.) and published by . This book was released on 2017 with total page 208 pages. Available in PDF, EPUB and Kindle. Book excerpt: The majority of insured Americans obtain health insurance coverage through employment as a non-portable fringe benefit. The link between health insurance coverage and employment could have potential important implica- tions on workers’ labor market decisions. My dissertation consists of three chapters that contribute to the understanding of the interaction between health insurance and workers’ job mobility. My first chapter studies the effect of the state dependent coverage man- dates on the job mobility of young adults. Prior to the Affordable Care Act, many states had already implemented insurance mandates that extended the age that young adults could gain access to parental health insurance, an alternative insurance source which is not contingent on employment. If young workers with employer-sponsored insurance (ESI) are locked into less preferred jobs for fear of losing health benefits, expanded dependent coverage is expected to reduce the job lock and increase mobility. Expanded eligibility could also decrease mobility among those who are pushed out of a better matched but uninsured job in search of access to ESI (job push). Using Survey of Income and Program Participation (SIPP) 2000-2010 data, the impact of the state mandates on job mobility is identified by a triple-difference framework that exploits the state level dependent coverage variations in eligibility criteria, mandate implementation states, and mandate implementation time. Results show that expanded dependent coverage led to a 5% decrease in the mobility of workers with no ESI (job push). I find no evidence of reduced job lock. The second chapter of my dissertation extends the analysis of my first chapter to the Affordable Care Act (ACA) Dependent Coverage Mandate. The ACA Dependent Coverage Mandate was passed on March 23rd, 2010, and became effective on September 23, 2010. The mandate requires that health insurance plans that provide dependent coverage must cover dependents until the age of 26. Using SIPP 2008-2013 data, and both difference-in-difference framework and regression discontinuity design, I find consistent evidence of reduced job push and no evidence of reduced job lock. The estimated reduced job push is larger than the state analysis. The third chapter studies the impact of the ACA Medicaid expansion on childless adults’ job mobility. The ACA Medicaid expansion raised the Medi- caid income eligibility threshold to 138% of the Federal Poverty Line (FPL) for everyone including childless adults who were not the traditional beneficiaries of the Medicaid. 32 states adopted the expansion while 19 states opted out. The reform could potentially increase childless adults’ job mobility if they are “locked” in their jobs for fear of losing employer-sponsored health insurance. Using the 2011-2016 basic monthly Current Population Survey (CPS), this paper tests this hypothesis by comparing the job mobility of childless adults in expansion states to those residing in non-expansion states, before and after the expansion. Results show the existence of “job lock” effect: the ACA Medicaid expansion increased the childless adults’ job mobility by 7% - 9%, and the increase comes entirely from job-to-job transitions. I find no evidence of the “employment lock”: the availability of Medicaid did not cause childless adults to be more likely to become unemployed or leave the labor force.
Author : Ana Ines Rocca
Publisher :
ISBN 13 :
Total Pages : 148 pages
Book Rating : 4.:/5 (928 download)
Download or read book Essays in Health and Labor Economics written by Ana Ines Rocca and published by . This book was released on 2015 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, health insurance is often necessary for access to regular, affordable health care. With only eight of every hundred Americans buying private insurance plans on the individual market, the main sources for health insurance traditionally have been employers and the government. As new laws are being debated and introduced to reform an expensive health care industry in which nearly one-sixth of the population is uninsured, research is needed in order to evaluate the costs and benefits of these policy changes and to predict their success. To this end, in addition to understanding how likely individuals are to adopt new health insurance policies, we also should be interested in knowing how the demand for health insurance and changes in its accessibility will affect non-medical decisions. Specifically, labor market choices have been theorized to be directly related to decisions involving insurance coverage. If the availability of health insurance distorts a workers' job-related decisions, then the changing the landscape for how to access insurance may reverberate in employment outcomes. My dissertation focuses on understanding the factors that influence the demand for health insurance and the role that health insurance plays in an individual's decision to work, where to work, and how much to work. Specifically, I focus on the following three related questions: how does the demand for insurance affect labor market decisions such as when to exit unemployment? what drives insurance demand, and in particular, what motivators work best to increase demand for health coverage among the uninsured? and lastly, what are the supply-side employment responses to the provision of free or reduced-cost public health insurance? My first chapter explores how the demand for health insurance can change re-employment decisions among the unemployed, as well as the speed at which individuals return to work. Past research on this issue focuses on job-to-job switches and "job lock" but has yet to focus on individuals looking for work. This chapter uses data on laid-off individuals from the Medical Expenditure Panel Survey to compare the job search behavior and outcomes of individuals who differ in their demand for health insurance. I use three proxies for demand, based on spousal health and past insurance offer take-up decisions. Although each is potentially confounded by unobserved determinants of job search, I use a difference-in-differences and propensity score designs to isolate plausibly causal effects. I find consistent patterns across all three proxies (despite different potential omitted variables biases). Overall unemployment durations do not vary with demand for insurance, but this masks variation in the types of jobs taken. Individuals with higher demand for insurance have higher hazards for exiting unemployment into a job with insurance, but lower hazards for exiting to a job without insurance. This points to effects of insurance demand on both search effort and reservation wages, and to potentially important distorting effects of employer-linked health insurance. Whereas the first chapter takes variation in demand for insurance as a given, my second chapter digs deeper into the basis for this variation and whether it can be affected. In this chapter, I investigate the reasons the uninsured choose to forego insurance coverage and the impact of different messages on their insurance demand. Working with Enroll America, a large non-profit dedicated to decreasing the number of uninsured Americans, I conducted a stratified experiment to determine the best communication strategies to encourage participation in the healthcare exchanges. We test a combination of the following behavioral and information treatments: a risk treatment that emphasizes the average financial risk for someone without health insurance; a norms treatment that alerts our participants that staying uninsured will be against the law; a savings treatment that highlights the average savings available at the exchanges; a wording treatment where we refer to the Affordable Care Act (ACA) as "Obamacare"; and lastly, a cost-calculator treatment that allows individuals to explore the likely cost of insurance based on their own characteristics. Among the uninsured, we find that the cost-calculator treatment, the risk treatment, and the mandate are most effective in increasing intention to purchase insurance. The cost-calculator and the risk treatment increase informedness among this population, but the cost-calculator (when paired with the savings treatment) is the only treatment that increases willingness to pay for insurance. We use the information on willingness to pay to construct sub-group price elasticities of demand to compare to previous work interested in the demand for health insurance. Overall, the results of this chapter highlight the importance of informational campaigns to increase awareness of the costs and benefits of health coverage, particularly after large changes such as those implemented by the ACA. My third chapter continues by looking at the changes that have been introduced as a result of the ACA. Specifically, it explores whether expanding access to government-provided insurance affects individuals' decisions regarding employment and overall hours of work. Recent findings have suggested that increasing access to health insurance outside of employment has a sizable, negative impact on labor force participation. Along these lines, the Congressional Budget Office predicted that the expansion of Medicaid and private health insurance will cause a 1.5 to 2% reduction in hours worked in the first ten years. Comparing states by whether they chose to expand Medicaid under reforms introduced by the ACA, I look at changes in the probability a childless adult receives Medicaid, as well as changes in this group's employment likelihood and hours of work. Using household survey data from the CPS monthly survey and ASEC Supplement, I confirm a marked increase in the percent of childless adults insured by Medicaid but find no statistically significant changes in employment outcomes. I compare these results to other estimates of "employment lock" in recent literature. These results, though imprecise, align with the findings in Chapter 1 which suggest that overall employment is not drastically affected by insurance demand.
Author : Ami Ko
Publisher :
ISBN 13 :
Total Pages : 282 pages
Book Rating : 4.:/5 (124 download)
Download or read book Essays on Health Care Markets written by Ami Ko and published by . This book was released on 2017 with total page 282 pages. Available in PDF, EPUB and Kindle. Book excerpt: The two chapters of my dissertation develop and estimate economic models to analyze the demand for and the provision of health care services. Specifically, I analyze the optimal design of health care markets to promote higher quality and lower cost, which can have profound implications for the well-being of people. The first chapter, "An Equilibrium Analysis of the Long-Term Care Insurance Market," uses a model of family interactions to explain why the long-term care insurance market has not been growing. By developing and estimating a structural model of family interactions, I study how family care affects the workings of the long-term care insurance market. I argue that private information about the availability of family care induces adverse selection where individuals with limited access to family care heavily select into insurance coverage. I demonstrate that pricing on family demographics substantially mitigates adverse selection by reducing the amounts of private information. I propose child demographic-based pricing as an alternative risk adjustment that could decrease the average premium, invigorate the market, and generate welfare gains. The second chapter, "Partial Rating Area Offering in the ACA Marketplaces," joint with Hanming Fang, studies insurance companies' plan offering decisions in the marketplaces established by the Patient Protection and Affordable Care Act of 2010 (ACA). Under the ACA, insurance companies can vary premiums by "rating areas" which usually consist of multiple counties. In a given rating area, the ACA mandates uniform pricing for all counties, but, it does not mandate universal offering. We first demonstrate that it is not uncommon to observe insurance companies selling plans to only a subset of counties within a rating area. Using both theoretical and empirical approaches, we find evidence that partial rating area coverage is explained by insurers' incentive to risk screen consumers. While the ACA allows price discrimination based on rating areas and not on counties, we argue that insurers are effectively price discriminating consumers based on counties by endogenously determining their service area within a rating area.
Author : Juan Gabriel Fernandez
Publisher :
ISBN 13 :
Total Pages : 294 pages
Book Rating : 4.:/5 (826 download)
Download or read book Three Essays on Competition and Health Insurance Markets written by Juan Gabriel Fernandez and published by . This book was released on 2012 with total page 294 pages. Available in PDF, EPUB and Kindle. Book excerpt: Abstract: Health care systems are complex organizations. Multiple agents interact in different settings to provide health care, each one of them with different objectives and information. How markets are organized and which actions are allowed, has a direct impact on the incentives agents face when making health care choices. In this dissertation, I study the determinants and effects of these choices on market outcomes, focusing on private health insurance markets. The first chapter provides insights about health insurance markets in which workers, rather than firms, choose insurance plans in an imperfect competition setting. Using a unique dataset that includes every person enrolled in private plans in Chile in 2009, I estimate underlying preference parameters over health insurance features. I find large heterogeneity in the valuation of these features across age-sex-groups and individual types. Individual characteristics play an important role on health plan choices and therefore, can be used by insurers to design plans targeted to specific groups and for patient selection. The second chapter presents a theoretical model where private insurers compete with a free public alternative to attract clients. Using a two-type model I show that if private insurance companies offer a non-rationing alternative and the public system rationing is done through random selection, an efficiency trap may exist. A marginal increase in the budget allocated to the public system can potentially reduce the expected welfare for all types. This result extends to a model with multiple types, but the negative welfare impact is offset by a crowding-in effect among the rich. Finally, the third chapter provides a general analytical framework that can be used to evaluate risk selection under different health care models. The model is based on the interactions between the four key agents present in every health care system: sponsors, health plans, providers and customers. This framework is used to review risk selection in four countries in the Americas -Canada, Chile, Colombia, and the U.S.-, showing how regulatory policies both create and ameliorate it, and in some cases are as important as risk adjustment, risk sharing and risk selection strategies for reducing risk selection.
Author : Jonathan Gruber
Publisher :
ISBN 13 :
Total Pages : 106 pages
Book Rating : 4.3/5 (91 download)
Download or read book Health Insurance and the Labor Market written by Jonathan Gruber and published by . This book was released on 1998 with total page 106 pages. Available in PDF, EPUB and Kindle. Book excerpt: A distinctive feature of the health insurance market in the U.S. is the restriction of group insurance availability to the workplace. This has a number of important implications for the functioning of the labor market, through mobility from job-to-job or in and out of the labor force, wage determination, and hiring decisions. This paper reviews the large literature that has emerged in recent years to assess the impact of health insurance on the labor market. I begin with an overview of the institutional details relevant to assessing the interaction of health insurance and the labor market. I then present a theoretical overview of the effects of health insurance on mobility and wage/employment determination. I critically review the empirical literature on these topics, focusing in particular on the methodological issues that have been raised, and highlighting the unanswered questions which can be the focus of future work in this area.
Author : Amy Finkelstein
Publisher : Columbia University Press
ISBN 13 : 0231538685
Total Pages : 161 pages
Book Rating : 4.2/5 (315 download)
Download or read book Moral Hazard in Health Insurance written by Amy Finkelstein and published by Columbia University Press. This book was released on 2014-12-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: Addressing the challenge of covering heath care expenses—while minimizing economic risks. Moral hazard—the tendency to change behavior when the cost of that behavior will be borne by others—is a particularly tricky question when considering health care. Kenneth J. Arrow’s seminal 1963 paper on this topic (included in this volume) was one of the first to explore the implication of moral hazard for health care, and Amy Finkelstein—recognized as one of the world’s foremost experts on the topic—here examines this issue in the context of contemporary American health care policy. Drawing on research from both the original RAND Health Insurance Experiment and her own research, including a 2008 Health Insurance Experiment in Oregon, Finkelstein presents compelling evidence that health insurance does indeed affect medical spending and encourages policy solutions that acknowledge and account for this. The volume also features commentaries and insights from other renowned economists, including an introduction by Joseph P. Newhouse that provides context for the discussion, a commentary from Jonathan Gruber that considers provider-side moral hazard, and reflections from Joseph E. Stiglitz and Kenneth J. Arrow. “Reads like a fireside chat among a group of distinguished, articulate health economists.” —Choice
Author : Chelsea Jo Crain
Publisher :
ISBN 13 :
Total Pages : 130 pages
Book Rating : 4.:/5 (113 download)
Download or read book Essays in Health and Labor Economics written by Chelsea Jo Crain and published by . This book was released on 2018 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt: We compare the changes in insurance coverage and labor market outcomes over time of adults in states that expanded Medicaid and in states that did not. Our estimates suggest that the recent expansion significantly increased Medicaid coverage with little decrease in ESI. Overall, the expansion did not impact labor market outcomes, including labor force participation, employment, and hours worked. In the third chapter, I examined the impact of competition among dentists on the labor supply of dentists. I focus on how dentists' working hours will changes when the level of competition increases by examining the effect of the National Health Service Corps (NHSC). The NHSC was created to increase the supply of rural physicians, which might increase the competition in rural areas. I examine the number of dentists (extensive margins of labor supply) and the change in the working hours of dentists (intensive margins of labor supply) in response to the increased level of physician competition. I found that 1 percent increase in NHSC-approved sites increases 5.4% increases in the number of providers and 0.2% of competition in a rural county. In addition, I found that there is a positive relationship between the number of NHSC-approved sites and providers' working hours. If the competition among dentists increases about 1, then working hours of providers increase about 6 hours per week.
Author : Naoki Aizawa
Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (118 download)
Download or read book Interaction Of The Labor Market And The Health Insurance System written by Naoki Aizawa and published by . This book was released on 2020 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The U.S. health insurance system for working-age households is characterized not only by its heavy dependence on the labor market but also by the segregation of risk pools across its three components: employer-sponsored health insurance (ESHI), individual health insurance exchange (HIX), and Medicaid. To assess the potential efficiency loss associated with this risk pool segregation, we develop and estimate an equilibrium model of labor and health insurance markets, with rich heterogeneity across local markets, households, and firms. We estimate the model exploiting variations across states and policy environments before and after the Affordable Care Act. We use the estimated model to implement counterfactual policies that cross-subsidize between ESHI and HIX, which include pure risk pooling between the two markets as a special case. We find that such policies would benefit most households, improve average household welfare, and decrease government expenditure. Furthermore, the welfare gains are larger if the cross subsidization is interacted with Medicaid expansion.
Author : Richard Domurat
Publisher :
ISBN 13 :
Total Pages : 200 pages
Book Rating : 4.:/5 (17 download)
Download or read book Essays on the Economics of Health Insurance Markets written by Richard Domurat and published by . This book was released on 2018 with total page 200 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation includes three chapters on the health insurance markets established by the Affordable Care Act (ACA), known as exchanges. Chapter 1 estimates the demand for each plan in the California exchange using a discrete choice model. The model incorporates heterogeneity in consumer preferences and in product characteristics, including hospital and primary care physician (PCP) networks. Endogeneity of prices is addressed using networking hospital costs as instruments, and prices for any given plan can vary across consumers within a market. Consumers are highly sensitive to prices, with market shares declining by 3%-5% for just a $1 increase in the premium. Demand also responds to hospital and PCP networks, but to a relatively small degree. Along the take-up margin, a $1 increase in premium subsidy increases take-up by 1.4%. Chapter 2 uses a structural model of demand and supply to examine how two insurance market regulations--community rating and risk adjustment--affect prices and enrollment in the ACA exchange in California. Without risk adjustment, community rating in the ACA would lead to a significant reduction in enrollment in desirable plans and in take-up overall. Risk adjustment under the ACA roughly restores relative shares across plans to what they would be without community rating; however, the reduction in take-up is not restored. An alternative risk adjustment method can increase enrollment by 3.0% and would have little impact on government spending. Chapter 3, written jointly with Isaac Menashe and Wesley Yin, examines the impact of information on insurance take-up in the ACA. We exploit experimental variation in the information mailed to 87,000 households in California's exchange to study the role of frictions in insurance take-up. We find that a basic reminder of the enrollment deadline raised enrollment by 1.4 pp (or 16 percent). Compared to the reminder alone, also reporting personalized subsidy benefits increases take-up among low-income individuals, but decreases take-up among higher-income individuals. This is despite reminder-only recipients eventually observing their subsidies before purchase. Finally, the letter interventions induced healthier individuals into the market, lowering aggregate spending risk by 5.9 percent, suggesting these interventions can improve both enrollment and average market risk.
Author : Dajung Jun
Publisher :
ISBN 13 : 9781088344439
Total Pages : 87 pages
Book Rating : 4.3/5 (444 download)
Download or read book Three Essays on Labor and Health Economics written by Dajung Jun and published by . This book was released on 2019 with total page 87 pages. Available in PDF, EPUB and Kindle. Book excerpt: Nonportable fringe benefits, such as health insurance and retirement benefits, can influence an individual's career decisions and financial well-being. To protect employee's utility, state and federal governments enacted policies that regulated these benefits. The first two chapters of my dissertation study two such policies: tax credits for private health insurance coverage and dependent coverage mandates that allowed young adults to be covered through their parents' insurance. I examine the effects of these policies on several health and labor market outcomes. In the last chapter, my coauthor and I explore a slightly different perspective on fringe benefits. We examine to what extent lifetime earnings could explain the variation in wealth at retirement. By researching these topics, I contribute to the understanding of how fringe benefits and lifetime earnings affected outcomes of rational decision-making: health insurance take-up, job mobility and wealth accumulation.In chapter 1, I investigate the effectiveness of tax credits on health insurance premiums. There was a renewed interest in using tax credits to increase health insurance coverage after the push to repeal the Affordable Care Act (ACA). The Health Insurance Tax Credit (HITC) was implemented between 1991--1993 to reduce the burden of health insurance premiums primarily for low-income families. Although it was active for three years, this policy has been studied in only one previous study. In this chapter, I examine the effectiveness of the HITC by using the Survey of Income Program Participation (SIPP), and I provide the first estimates of its effects on healthcare utilization and self‐reported health status. My results align with previous studies and suggest the HITC increased the health insurance take-up by 5.8 percentage points. The implementation of the HITC also significantly improved the self-reported health status of respondents.In the second chapter, I analyze the effects of dependent coverage mandates on working fathers' job mobility and compensation. Due to the low rates of health insurance coverage among young adults, some state governments began mandating health insurance companies to allow adult children to stay on their parents' health insurance plans. First implemented in 1995, these mandates aimed to increase health coverage among young adults. In 2010, the federal government enacted a more comprehensive version of the dependent coverage mandate as part of the Affordable Care Act. These state- and federal-level efforts successfully increased insurance rates for young adults, but they might have also come with unintended consequences for parents. Parents who placed a high value on health insurance for their young adult children might be reluctant to leave jobs with employer-provided health insurance, and employers might offset the mandated-incurred health care costs by reducing other types of employee benefits or earnings. To assess the extent of such consequences, I study the effects of both the state and federal dependent health insurance mandates on fathers. By analyzing the 2004 and 2008 SIPP panels, which are linked with Detailed Earnings Records and Business Registrar data from the United States Census, I examine the mandates' effects on fathers' voluntary job separation rates (job-lock and job-push) and changes in their compensation. After the implementation of the mandates, I observe a significant decrease in the likelihood of voluntary job separation among eligible working fathers aged 45--64 with employer-provided health insurance. Additionally for these fathers, except for those who separated from these jobs within the current wave, my analysis slightly evidences that the mandates reduced the total monetary compensation. In the last chapter, we investigate the impact of lifetime earnings on retirement wealth. Historically, many households accumulated substantial wealth by retirement, while many other households accumulated very little. Venti and Wise (1999, 2001) directly examine this question by utilizing data that was superior to that available to previous researchers and conclude that ``the bulk of the dispersion must be attributed to differences in the amount that households choose to save.'' In this paper, we examine the extent that a remaining problem in their data affected their results: Their measure of lifetime earnings, despite being based on administrative data, was subject to topcoding in each year. Using the 2001 SIPP that was not subject to the same problem, we find that the effect of the topcoding was substantial. At least 35 percent of individuals were misclassified in each of the top four deciles. When replicating a key result of Venti and Wise (2001), our findings suggest that the correlation between lifetime earnings and savings was about 50\\% greater than what was found when using censored deciles. This increased explanatory power came largely at the expense of the other variables in the regression model.
Author : Scott Barkowski
Publisher :
ISBN 13 : 9781321300932
Total Pages : 120 pages
Book Rating : 4.3/5 (9 download)
Download or read book The Influence of Inefficiencies in Health Care and the Labor Market written by Scott Barkowski and published by . This book was released on 2014 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the first essay, ``Does Government Health Insurance Reduce Job Lock and Job Push?'', I estimate the extent that job mobility is affected by the link between health insurance and employment. Workers holding employment-contingent health insurance (ECHI) are often thought to stay in jobs that are otherwise inferior matches out of fear of losing their ECHI, while those without insurance may leave employment states that are otherwise good matches seeking access to ECHI. These two phenomena are known as job lock and job push, respectively. During the late 1980s and early 1990s, Medicaid expansions resulted in many working class households gaining Medicaid eligibility for one or more family members, an alternative source of health insurance that is not contingent on employment. Using this eligibility as a measure of variation in the dependence on ECHI for health insurance coverage, I find large estimates of job lock and job push for men. Medicaid eligibility for one household member results in an increase in the likelihood of a voluntary job exit for men over a four-month period by approximately 34%. Similarly, moves into jobs with ECHI fall by approximately 25% in response to Medicaid eligibility. For women, I do not find evidence consistent with job lock. For the case of job push, some of my estimates suggest large effects, though these estimates have interpretive difficulties. The second essay, titled ``Does Regulation of Physicians Reduce Health Care Spending?'', examines the fear among physicians that legal liability increases health care spending. Theoretically, the effect of legal risk could be positive or negative on spending, and empirical evidence has supported both cases. Previous empirical work, however, has ignored that physicians face risk from centralized regulators -- industry oversight groups like medical boards -- in addition to civil litigation risk. This paper addresses this omission by incorporating previously unused data on punishments by oversight groups against physicians, known as adverse actions, along with malpractice payments data to study state-level health care spending. My analysis suggests that health care spending does not rise in response to higher levels of risk. An increase in adverse actions equal to 16, the mean year-to-year change within a state, is found to be associated with statistically significant average spending decreases of approximately 0.11% to 0.21%. Malpractice payments were generally estimated to have smaller, statistically insignificant effects. The final essay, ``Preliminary Results On The Effect of Specialist Cost Information on Primary Care Physician Referral Patterns'', reports early results on a field experiment designed to test whether primary care physicians (PCPs) would use information on specialist costs in allocating their patient referrals between doctors within the specialty. The experiment was performed in partnership with a private-sector group of medical practices organized as an Independent Practice Association (IPA). Randomly chosen PCP practices within the IPA were provided with a report listing average cost information for Ophthalmology practices within the IPA. The response of the PCPs is compared to a control group of PCP practices within the IPA to see if the information influenced which Ophthalmology practices received PCP referrals. Analysis of experimental data so far available does not find any effects that are statistically significant at conventional levels. These results, however, are based on data from a very short post-period, and are not considered final. The experiment is ongoing at the time of the writing of this essay.
Author : Juan Pablo Atal Chomali
Publisher :
ISBN 13 :
Total Pages : 149 pages
Book Rating : 4.:/5 (957 download)
Download or read book Essays in Health Economics written by Juan Pablo Atal Chomali and published by . This book was released on 2016 with total page 149 pages. Available in PDF, EPUB and Kindle. Book excerpt: These essays study how private incentives affect the functioning of three dimensions of health care markets: health insurance, prescription drugs, and the delivery of health care by physicians. In the first chapter, I study the workings of long term health insurance, a form of contracts with the potential to efficiently insure individuals against reclassification risk, but at the expense of other limitations like provider lock-in. I empirically investigate the workings of long-term guaranteed-renewable contracts, which are subject to this tradeoff. Individuals are shielded against premium increases and coverage denial as long as they stay with their initial contract, but those that become higher risk are subject to premium increases or coverage denials upon switching, potentially leaving them locked-in with their original network of providers. I provide the first empirical evidence on the importance of this phenomenon using administrative panel data from the universe of the private health insurance market in Chile, where competing insurers offer guaranteed-renewable plans. I fit a structural model to yearly plan choices, and am able to jointly estimate evolving preferences for different insurance companies and supply-side underwriting in the form of premium risk-rating and coverage denial. To quantify the welfare effects of lock-in, I compare simulated choices under the current rules to those in a counterfactual scenario with no underwriting. The results show that consumers would be willing to pay around 13 percent more in yearly premiums to avoid lock-in. Finally, I study a counterfactual scenario where guaranteed-renewable contracts are replaced with community-rated spot contracts, and I find only minor general-equilibrium effects on premiums and on the allocation of individuals across insurers. I argue that these small effects are the result of large levels of preference heterogeneity uncorrelated to risk. In the second chapter, David Silver and I study worker interactions among the medical staff in the emergency department. Using rich administrative case-level data from two hospital-based emergency departments, we start by documenting peer effects among physicians. We find that physicians are 1.5 percent faster when working with peers who are 10 percent faster. We devise a test for random patient-physician assignment and we provide a number of tests to discern the mechanisms underlying these spillovers. The evidence points to spillovers that are driven primarily by faster peers responding negatively to working with slower peers. Utilization of shared resources accounts for little of the spillover, and event-study evidence points to spillovers that come into effect as soon as slower peers begin their shifts. In the third chapter, José Ignacio Cuesta, Morten Sæthre and I study regulations to pharmaceutical laboratories in the form of bioequivalence (BE) requirements -- the most prevalent tool used in developed economies to ensure the effectiveness of generic drugs allowed in the market. The main goal is to empirically investigate how the market reacts to BE requirements, and the consequences in prices, market shares, and product availability for branded and generic drugs. In particular, this study is an early exploration of the experience of Chile, where BE requirements were adopted for 172 molecules, leading to the BE approval of 642 generic drugs between March 2009 and March 2015. We show that the introduction of the requirements lead to a significant increase in BE approvals and in the share of BE drugs in the market. However, prices and market shares of other competing drugs were not significantly affected during the period we analyze. Other outcomes, like number of products, and market concentration are also found to be unaffected.
Author : Chenyuan Liu
Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (123 download)
Download or read book Essays on Health Insurance Plan Design written by Chenyuan Liu and published by . This book was released on 2020 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health care markets have great economic importance and represent a large share of GDP in the U.S. Health insurance plans play a key role in the efficiency of these markets. My dissertation studies the design of health insurance contracts and how they affect market efficiency. Chapter 1 of my dissertation the prevalence of financially dominated options in health plan menus. We analyze Kaiser Family Foundation data on health plans that firms offer to their employees. For firms offering both a high-deductible and lower-deductible health plan, 62 percent of the time the high-deductible option has lower maximum spending risk for the employee. We estimate that the high-deductible plan dominates at roughly half of firms. We identify adverse-selection pricing as a likely mechanism for these surprising patterns and discuss implications for our understanding of the value of plan choice in employer-sponsored health insurance. Chapter 2 of my dissertation identifies both theoretically and empirically a new channel of sorting in insurance markets under asymmetric information: sorting by plan design. A model allowing for rich contract designs predicts high-risk individuals will sort into risk-minimizing straight-deductible plans, while lower-risk individuals prefer plans that trade higher maximum expenditure risk for coverage against small losses. Analyzing data from the ACA Exchange, I find that within coverage tiers, plans vary significantly along multi-dimensional cost-sharing attributes. Further, straight-deductible plans attract higher-risk enrollees than other designs as the model predicts. I discuss how these insights can inform discussions around the standardization of insurance plans. Chapter 3 of my dissertation studies the effects of capitated payment models on physicians' treatment decisions in the treatment of lower back pain in the U.S. We use a large employer-sponsored health insurance claim database from 2003 to 2006, and leverage capitation variation within the plan and physician to mitigate selection concerns. We find that the treatment intensity of capitated patients is 5 to 10 percent lower than otherwise similar non-capitated patients, mainly from therapy, diagnostic testing, and drugs. We also find no evidence of increased readmission rates for capitated patients.
