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Market Power in the Presence of Adverse Selection 逆向选择下的市场力量
Pub Date : 2020-04-06 DOI: 10.2139/ssrn.3570241
Conor Ryan
Market power can reduce the symptoms of adverse selection. To see the relationship, consider the incentive for a firm to offer a product that appeals to low-risk consumers and leads high-risk consumers to purchase insurance elsewhere. This incentive problem can be addressed through regulation but is also absent in a monopoly. This paper develops a model of welfare to explicitly characterize the substitutability between adverse selection regulation and market power. Market concentration has welfare benefits by reducing inefficient sorting of consumers among available plan options, a symptom of adverse selection. However, since market concentration also carries the welfare cost of higher markups, the magnitude and net direction of the effects are an empirical question. The model is estimated for the non-group market using novel choice data from a private online broker and a risk prediction model to relate preferences to marginal cost. The analysis focuses on two policies that target different dimensions of adverse selection: risk adjustment and the individual mandate. A simulation of a proposed merger of two insurance firms shows that, in the absence of a risk adjustment policy, the merger improves consumer welfare in markets that are not already highly concentrated. While the risk adjustment policy does not optimally price the sorting externality, it is successful in reducing the welfare cost of inefficient sorting and also eliminating the potential benefit to consumers from additional market power. The individual mandate is successful in increasing the insurance rate and lowering prices in the least concentrated markets, but leads to higher prices in the most concentrated markets. These results suggest that selection regulation is advantageous in competitive insurance markets, and less necessary and potentially harmful in very concentrated markets.
市场力量可以减少逆向选择的症状。要了解这种关系,请考虑公司提供吸引低风险消费者并导致高风险消费者在其他地方购买保险的产品的动机。这种激励问题可以通过监管来解决,但在垄断中也不存在。本文建立了一个福利模型,以明确表征逆向选择规制与市场力量之间的可替代性。市场集中具有福利效益,因为它减少了消费者在现有计划选择中进行低效分类的现象,而这种现象是逆向选择的一种症状。然而,由于市场集中度也会带来更高加价的福利成本,因此影响的大小和净方向是一个实证问题。该模型使用来自私人在线经纪人的新颖选择数据和将偏好与边际成本联系起来的风险预测模型来估计非集团市场。分析的重点是针对逆向选择不同维度的两种政策:风险调整和个人授权。对两家保险公司拟议合并的模拟表明,在没有风险调整政策的情况下,合并改善了尚未高度集中的市场中的消费者福利。虽然风险调整政策没有对分拣的外部性进行最优定价,但它成功地降低了效率低下的分拣的福利成本,并消除了消费者从额外的市场力量中获得的潜在利益。在最不集中的市场,个人强制医保成功地提高了保险费率,降低了价格,但在最集中的市场,却导致了更高的价格。这些结果表明,在竞争激烈的保险市场中,选择监管是有利的,而在高度集中的市场中,选择监管的必要性和潜在危害则较小。
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引用次数: 0
Promoting Wellness or Waste? Evidence from Antidepressant Advertising 提倡健康还是浪费?来自抗抑郁药广告的证据
Pub Date : 2020-04-01 DOI: 10.2139/ssrn.3130327
Bradley T. Shapiro
It is taken as given by many policy makers that Direct-to-Consumer Advertising of prescription drugs drives inappropriate patients to treatment. Alternatively, advertising may provide useful information that causes appropriate patients to seek treatment. I study this dynamic in the context of antidepressants. Leveraging variation driven by the borders of television markets, I find that a 10% increase in antidepressant advertising leads to a 0.3% ($32 million) increase in new prescriptions followed by reductions in workplace absenteeism worth about $770 million. I find no effect of advertising on prices, generic penetration, drug switches, adverse effects, non-adherence rates or therapist visits.
许多政策制定者认为,处方药的直接面向消费者的广告驱使不合适的患者接受治疗。或者,广告可以提供有用的信息,促使适当的患者寻求治疗。我在抗抑郁药的背景下研究这种动态。利用电视市场边界驱动的变化,我发现,抗抑郁药广告每增加10%,新处方就会增加0.3%(3200万美元),随之而来的是工作场所缺勤减少,价值约为7.7亿美元。我发现广告对价格、仿制药普及率、药物转换、不良反应、不遵守率或治疗师访问量没有影响。
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引用次数: 24
Do Children on Medicaid Benefit from a Weak Labor Market? Evidence from the Great Recession 接受医疗补助的儿童会从疲软的劳动力市场中受益吗?大衰退的证据
Pub Date : 2020-03-13 DOI: 10.2139/ssrn.3484320
Jiajia Chen
In this article, I estimate the association between weak labor market conditions and the quantity of office-based physician services received by children enrolled in Medicaid. I find that children use more services in areas with higher unemployment during the Great Recession, and the result is not influenced by changes in sample composition. The association could reflect either demand factors such as worsening health or supply factors such as changes in the number of physicians willing to accept Medicaid patients. I provide several pieces of evidence supporting a supply-side mechanism: higher unemployment reduces the demand for physician services by privately-insured patients. Physicians respond to the demand shock by serving more Medicaid enrollees.
在这篇文章中,我估计了疲软的劳动力市场状况与参加医疗补助计划的儿童接受的基于办公室的医生服务数量之间的关系。我发现,在大衰退期间,儿童在失业率较高的地区使用更多的服务,结果不受样本组成变化的影响。这种关联既可以反映健康状况恶化等需求因素,也可以反映愿意接受医疗补助病人的医生数量变化等供给因素。我提供了一些支持供给侧机制的证据:高失业率减少了私人保险患者对医生服务的需求。医生通过服务更多的医疗补助计划参保者来应对需求冲击。
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引用次数: 1
Econometric Issues with Laubach and Williams’ Estimates of the Natural Rate of Interest 劳巴赫和威廉姆斯对自然利率估计的计量经济学问题
Pub Date : 2020-02-26 DOI: 10.2139/ssrn.3541959
Daniel Bunčić
Holston, Laubach and Williams' (2017) estimates of the natural rate of interest are driven by the downward trending behaviour of `other factor' $z_{t}$. I show that their implementation of Stock and Watson's (1998) Median Unbiased Estimation (MUE) to determine the size of $lambda_{z}$ is unsound. It cannot recover the ratio of interest $lambda _{z}=a_{r}sigma _{z}/sigma _{tilde{y}}$ from MUE required for the estimation of the full structural model. This failure is due to their Stage 2 model being incorrectly specified. More importantly, the MUE procedure that they implement spuriously amplifies the estimate of $lambda _{z}$. Using a simulation experiment, I show that their MUE procedure generates excessively large estimates of $lambda _{z}$ when applied to data simulated from a model where the true $lambda _{z}$ is equal to zero. Correcting their Stage 2 MUE procedure leads to a substantially smaller estimate of $lambda _{z}$, and a more subdued downward trending influence of `other factor' $z_{t}$ on the natural rate. This correction is quantitatively important. With everything else remaining the same in the model, the natural rate of interest is estimated to be 1.5% at the end of 2019:Q2; that is, three times the 0.5% estimate obtained from Holston et al.'s (2017) original Stage 2 MUE implementation. I also discuss various other issues that arise in their model of the natural rate that make it unsuitable for policy analysis.
Holston, Laubach和Williams(2017)对自然利率的估计是由“其他因素”$z_{t}$的下降趋势行为驱动的。我表明,他们的实现股票和沃森(1998)的中位数无偏估计(MUE),以确定$lambda_{z}$的大小是不健全的。它不能从估计全结构模型所需的MUE中恢复利息比$lambda _{z}=a_{r}sigma _{z}/sigma _{tilde{y}}$。这种失败是由于他们的阶段2模型被错误地指定。更重要的是,它们所执行的最大利用效率程序虚假地放大了$lambda _{z}$的估计值。通过模拟实验,我表明,当应用于从真实的$lambda _{z}$等于零的模型模拟的数据时,他们的MUE过程产生了过大的$lambda _{z}$估计值。修正他们的第2阶段最大利用效率程序导致对$lambda _{z}$的估计值大大减小,并且“其他因素”$z_{t}$对自然率的下降趋势影响更加减弱。这种修正在数量上很重要。在模型中其他因素保持不变的情况下,自然利率估计为1.5% at the end of 2019:Q2; that is, three times the 0.5% estimate obtained from Holston et al.'s (2017) original Stage 2 MUE implementation. I also discuss various other issues that arise in their model of the natural rate that make it unsuitable for policy analysis.
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引用次数: 5
Causal Inference in Matching Markets: Simulable Mechanisms 匹配市场中的因果推理:可模拟机制
Pub Date : 2019-12-29 DOI: 10.2139/ssrn.3510903
Jiafeng Chen
We formalize an econometric model for two-sided matching mechanisms in a school choice context, where exogenous variation is generated by using lotteries as a tie-breaking mechanism. Our model accommodates a wide range of matching algorithms studied in the theoretical market design literature. We propose a Horvitz–Thompson estimator for the average treatment effect that is exactly unbiased, compatible with multiple treatments, and compatible with heterogeneous treatment effects. We present theoretical properties of the estimator and inference procedures. Our work clarifies the econometric model used in Abdulkadiroglu et al. (2017) and provides a robustness check on their results.
在学校选择的背景下,我们形式化了一个双边匹配机制的计量经济学模型,其中外生变异是通过使用彩票作为平局机制产生的。我们的模型包含了理论市场设计文献中广泛研究的匹配算法。我们提出了一个平均治疗效果的Horvitz-Thompson估计量,它完全无偏,与多种治疗兼容,并与异质治疗效果兼容。给出了估计量的理论性质和推理过程。我们的工作澄清了Abdulkadiroglu等人(2017)使用的计量经济学模型,并对其结果进行了稳健性检查。
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引用次数: 1
Large Dimensional Latent Factor Modeling with Missing Observations and Applications to Causal Inference 缺失观测的大维度潜在因子建模及其在因果推理中的应用
Pub Date : 2019-10-18 DOI: 10.2139/ssrn.3465357
Ruoxuan Xiong, Markus Pelger
This paper develops the inferential theory for latent factor models estimated from large dimensional panel data with missing observations. We estimate a latent factor model by applying principal component analysis to an adjusted covariance matrix estimated from partially observed panel data. We derive the asymptotic distribution for the estimated factors, loadings and the imputed values under a general approximate factor model. The key application is to estimate counterfactual outcomes in causal inference from panel data. The unobserved control group is modeled as missing values, which are inferred from the latent factor model. The inferential theory for the imputed values allows us to test for individual treatment effects at any time. We apply our method to portfolio investment strategies and find that around 14% of their average returns are significantly reduced by the academic publication of these strategies.
本文发展了从缺失观测值的大维度面板数据估计潜在因子模型的推论理论。我们通过应用主成分分析对部分观察到的面板数据估计的调整协方差矩阵估计潜在因素模型。在一般近似因子模型下,导出了估计因子、负荷和输入值的渐近分布。关键的应用是从面板数据中估计因果推理中的反事实结果。未观察到的对照组被建模为缺失值,这是从潜在因素模型推断出来的。输入值的推论理论允许我们在任何时候检验个别治疗的效果。我们将我们的方法应用于组合投资策略,发现这些策略的学术发表显著降低了约14%的平均回报。
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引用次数: 9
Can Pre-Commitment Increase Savings Deposits? Evidence from a Tax Time Field Experiment 预承诺能增加储蓄存款吗?税务时间现场实验的证据
Pub Date : 2019-10-04 DOI: 10.2139/ssrn.3464634
S. Roll, M. Grinstein‐Weiss, Emily Gallagher, Cynthia Cryder
This paper presents the results of an experiment testing the roles of a savings pre-commitment and different savings-focused choice architectures on the savings deposit decisions of 845,786 low- and moderate-income (LMI) tax filers. Results suggest that pre-committing to save at the start of the tax filing process can, among certain populations, dramatically increase savings rates. Among early tax filers, pre-commitment is associated with a 20.6 percentage point increase in savings deposits and a $418.86 increase in the amount deposited to savings. We observe more modest effects of pre-commitment on a general sample of tax filers. We also see strong evidence that choice architectures emphasizing savings strongly impact the deposit decisions of tax filers. The experiment also revealed cautionary evidence that the structure of pre-commitment can solidify decisions, making it then harder to later nudge those who opt-out of savings to change their minds. These findings may be broadly applicable to settings beyond the tax time moment – such as to applications that seek to encourage particular behaviors (like work or exercise) on the part of its participants.
本文介绍了一项实验的结果,该实验测试了储蓄预承诺和不同的储蓄选择架构对845,786名低收入和中等收入(LMI)纳税申报人储蓄存款决策的作用。研究结果表明,在报税程序开始时就预先承诺存钱,对某些人群来说,可以显著提高储蓄率。在早期报税者中,预承诺与储蓄存款增加20.6个百分点和储蓄存款增加418.86美元有关。我们观察到预承诺对一般税务申报样本的影响较为温和。我们还看到强有力的证据表明,强调储蓄的选择架构强烈地影响了纳税申报人的存款决策。该实验还揭示了一些值得警惕的证据,即预先承诺的结构可以巩固决定,从而使那些选择不存钱的人以后更难改变主意。这些发现可能广泛地适用于纳税时间以外的设置,例如寻求鼓励参与者的特定行为(如工作或锻炼)的应用程序。
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引用次数: 4
Pharmaceutical Opioid Marketing and Physician Prescribing Behavior 药物阿片类药物营销和医生处方行为
Pub Date : 2019-06-25 DOI: 10.2139/ssrn.3379855
Svetlana Beilfuss
Physicians’ relationships with the pharmaceutical industry have recently come under public scrutiny, particularly in the context of opioid drug prescribing. This study examines the effect of doctor-industry marketing interactions on subsequent prescribing patterns of opioids using linked Medicare Part D and Open Payments data for the years 2014-2017. Results indicate that both the number and the dollar- value of marketing visits increase physicians’ patented opioid claims. Furthermore, direct-to-physician marketing of safer abuse-deterrent formulations of opioids is the primary driver of positive and persistent spillovers on the prescribing of less safe generic opioids - a result that may be driven by insurance coverage policies. These findings suggest that pharmaceutical marketing efforts may have unintended public health implications.
医生与制药行业的关系最近受到公众的审查,特别是在阿片类药物处方的背景下。本研究使用2014-2017年的医疗保险D部分和开放支付数据,研究了医生-行业营销互动对阿片类药物后续处方模式的影响。结果表明,营销访问的数量和美元价值增加了医生的阿片类药物专利索赔。此外,直接向医生推销更安全的防滥用阿片类药物配方,是对不太安全的非专利阿片类药物处方产生积极和持续溢出效应的主要驱动因素——这一结果可能是由保险政策推动的。这些发现表明,药品营销努力可能会产生意想不到的公共卫生影响。
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引用次数: 3
The Health Impacts of Hospital Delivery Practices 医院分娩实践对健康的影响
Pub Date : 2019-06-01 DOI: 10.3386/W25986
David Card, Alessandra Fenizia, D. Silver
Treatment practices vary widely across hospitals, often with little connection to patients’ medical needs. We assess impacts of these differences in delivery practices at childbirth. We find that infants quasi-randomly delivered at hospitals with higher C-section rates are born in better shape and are less likely to be readmitted, with suggestive evidence of improved survival. These benefits are driven by avoidance of prolonged labors that pose risks to infant health. In contrast, these infants are more likely to visit the emergency department for respiratory-related problems, consistent with a large observational literature linking C-section to chronic reductions in respiratory health. (JEL I11, I12, J13, J16)
不同医院的治疗方法差别很大,往往与患者的医疗需求联系不大。我们评估这些差异对分娩实践的影响。我们发现,在剖腹产率较高的医院中,准随机分娩的婴儿出生时身体状况较好,再次入院的可能性较小,生存率有所提高。这些好处是由于避免了对婴儿健康构成风险的长时间分娩。相比之下,这些婴儿更有可能因呼吸相关问题而去急诊室,这与大量观察性文献将剖腹产与呼吸健康的慢性下降联系起来是一致的。(j11, j12, j13, j16)
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引用次数: 27
Predictive Analytics and Predictive Modeling in Healthcare 医疗保健中的预测分析和预测建模
Pub Date : 2019-06-01 DOI: 10.2139/ssrn.3403900
Sourav Mukherjee
Predictive analytics looks forward trying to divine unknown future trials or actions based on data mining, statistics, modeling, deep learning and artificial intelligence, and machine learning. Business Intelligence, its forerunner in analytics, is a look backward. Predictive models are useful to business activities to well understand the customers, with the goal of forecasting buying patterns, potential risks, and its possible prospects. Healthcare industry organizes predictive analytics in different ways to improve operations and minimize risk. This article will explain the understanding of predictive analytics and predictive modeling, how the healthcare industry adopted predictive analytics and modeling and the importance of data mining in healthcare.
预测分析是基于数据挖掘、统计学、建模、深度学习和人工智能以及机器学习,试图预测未知的未来试验或行动。作为分析学的先驱,商业智能是一种回顾。预测模型对业务活动非常有用,可以很好地了解客户,其目标是预测购买模式、潜在风险及其可能的前景。医疗保健行业以不同的方式组织预测分析,以改进操作并最大限度地降低风险。本文将解释对预测分析和预测建模的理解,医疗保健行业如何采用预测分析和建模,以及数据挖掘在医疗保健中的重要性。
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引用次数: 11
期刊
Demand & Supply in Health Economics eJournal
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