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Shopping Frequency, Fresh Produce Consumption, and Food Retail Environment 购物频率,生鲜消费,食品零售环境
Pub Date : 2015-11-02 DOI: 10.2139/ssrn.2726859
Scott J. Colby
As households shop less frequently, food decay makes perishable food consumption more costly. Therefore, I hypothesize that shopping frequency is an important factor of household food choice. I test this hypothesis using an instrumental variables approach on a system of equations using household panel data and conclude that fresh produce consumption and shopping frequency are jointly chosen. Positive causal impacts are found in both directions. However, the causal impact of shopping frequency on fresh produce consumption is of modest magnitude. Therefore, policy initiatives that improve access to food retailers with the intention of increasing healthful food consumption — by inducing households to shop more frequently at store formats that carry fruits and vegetables — may be ineffective even if the policy is successful at increasing household shopping frequency to those stores.
随着家庭购物频率的降低,食品腐烂使易腐食品的消费成本更高。因此,我假设购物频率是家庭食品选择的重要因素。我使用工具变量方法对使用家庭面板数据的方程系统进行了测试,并得出结论,新鲜农产品消费和购物频率是共同选择的。在两个方向上都发现了正因果影响。然而,购物频率对新鲜农产品消费的因果影响是适度的。因此,旨在通过引导家庭更频繁地在出售水果和蔬菜的商店购物来增加健康食品消费的食品零售商的机会的政策举措可能是无效的,即使该政策成功地增加了家庭到这些商店购物的频率。
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引用次数: 0
Does Retirement Impact Health Care Utilization? 退休会影响医疗保健的利用吗?
Pub Date : 2015-11-01 DOI: 10.2139/ssrn.2714144
Norma B. Coe, Gema Zamarro
The objective of this paper is to estimate the causal effect of retirement on health care utilization. To do so, we use data from the 1992-2008 waves of the Health and Retirement Study (HRS) and the 2004-2006 waves of the Survey of Health, Aging, and Retirement in Europe (SHARE). In particular, we estimate the causal impact of retirement on health care utilization as measured by: doctor visits, visits to a general practitioner, nights in the hospital, and preventative care use. This paper uses panel data and instrumental variable methods, exploiting variation in statutory retirement ages across countries, to estimate the causal effects. Cross-country comparisons allow us to examine the role of a health care system’s use of the general practitioner as a gate keeper to specialists in this relationship. We find that while retirement is associated with increased health care use, our causal estimates show that retirement leads to fewer doctor visits in both the US and continental Europe. Nights in the hospital are unaffected by retirement status. Further we find that health care systems with primary care physicians who act as gatekeepers are particularly effective at decreasing doctor visits at retirement. Therefore, we conclude that increasing the statutory retirement age to help the solvency of the retirement systems will also increase doctor visits as individuals continue to work longer. In the US, the burden of this increased utilization will likely be borne by private insurance companies and public insurance to the extent it covers working individuals in their 60’s. European evidence suggests that this increase in doctor visits due to delayed retirement will be particularly evident in health systems without strong gatekeeper roles for general practitioners.
摘要本研究的目的是估计退休对医疗保健利用的因果效应。为此,我们使用了1992-2008年健康与退休研究(HRS)和2004-2006年欧洲健康、老龄化和退休调查(SHARE)的数据。特别是,我们估计了退休对医疗保健利用的因果影响,通过以下指标来衡量:医生就诊次数、全科医生就诊次数、住院天数和预防性护理使用。本文使用面板数据和工具变量方法,利用各国法定退休年龄的差异来估计因果关系。跨国比较使我们能够检查卫生保健系统在这种关系中使用全科医生作为专家看门人的作用。我们发现,虽然退休与医疗保健使用的增加有关,但我们的因果估计表明,退休导致美国和欧洲大陆的医生就诊次数减少。医院的夜间工作不受退休状况的影响。此外,我们发现初级保健医生作为看门人的卫生保健系统在减少退休人员就诊方面特别有效。因此,我们得出结论,提高法定退休年龄以帮助退休制度的偿付能力,也会增加个人继续工作更长时间的医生访问。在美国,私人保险公司和公共保险公司可能会承担这种增加的负担,因为它涵盖了60多岁的在职个人。欧洲的证据表明,由于延迟退休而导致的就诊人数增加,在没有全科医生强有力的看门人作用的卫生系统中尤为明显。
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引用次数: 18
Variable Selection for a Categorical Varying-Coefficient Model with Identifications for Determinants of Body Mass Index 具有身体质量指数决定因素识别的分类变系数模型的变量选择
Pub Date : 2015-10-09 DOI: 10.2139/ssrn.2672074
Jiti Gao, B. Peng, Zhao Ren, Xiaohui Zhang
In this paper, we propose a variable selection procedure based on the shrinkage estimation technique for a categorical varying-coefficient model. We apply the method to identify the relevant determinants for body mass index (BMI) from a large amount of potential factors proposed in the multidisciplinary literature, using data from the 2013 National Health Interview Survey in the United States. We quantify the varying impacts of the relevant determinants of BMI across demographic groups.
在本文中,我们提出了一种基于收缩估计技术的变量选择程序,用于分类变系数模型。我们运用该方法从多学科文献中提出的大量潜在因素中确定体重指数(BMI)的相关决定因素,使用的数据来自2013年美国全国健康访谈调查。我们量化了不同人口群体中BMI相关决定因素的不同影响。
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引用次数: 5
Strategic Dynamics of Antibiotic Use and the Evolution of Antibiotic-Resistant Infections 抗生素使用的策略动态和抗生素耐药感染的演变
Pub Date : 2015-10-01 DOI: 10.2139/ssrn.2738783
J. Albert
This paper studies a dynamic model of a fee-for-service healthcare system in which healthcare providers compete for patients by prescribing antibiotics. Using antibiotics limits antibiotic-treatable infections, but fosters the growth of antibiotic-resistant infections. The paper demonstrates a 'Goldilocks' effect from provider competition. A perfectly competitive market for providers over-prescribes antibiotics because providers do not bear the cost of antibiotic-resistant infections. A patient monopolist under-prescribes antibiotics in order to increase the level of treatable infection. This is because while infection is a 'bad' for society, infection is a 'good' for a provider of antibiotics under a fee-for-service regime. Due to more moderate antibiotic use, oligopolistic competition can be the optimal decentralized market structure. The paper then demonstrates how the model can be used for policy analysis by computing the optimal licensing regime, prescription quota, and tax on antibiotics.
本文研究了收费服务医疗保健系统的动态模型,其中医疗保健提供者通过处方抗生素争夺患者。使用抗生素限制了抗生素可治疗的感染,但却促进了抗生素耐药感染的增长。本文论证了供应商竞争的“金发姑娘”效应。对于供应商来说,一个完全竞争的市场会过度开抗生素处方,因为供应商不承担抗生素耐药感染的成本。病人垄断者少开抗生素以增加可治疗感染的水平。这是因为,虽然感染对社会来说是一件“坏事”,但在按服务收费的制度下,感染对抗生素提供者来说是一件“好事”。由于抗生素的使用较为适度,寡头垄断竞争可能是最优的分散市场结构。然后,本文演示了如何通过计算最佳许可制度、处方配额和抗生素税来将该模型用于政策分析。
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引用次数: 2
Incentives to Eat Healthy: Evidence from a Grocery Store Field Experiment 健康饮食的动机:来自杂货店现场实验的证据
Pub Date : 2015-09-01 DOI: 10.2139/ssrn.2664818
J. List, A. Samek, Terri Zhu
We use a field experiment to investigate the effect of incentives on food purchase decisions at a grocery store. We recruit over 200 participants and track their purchases for a period of 6 months, permitting us a glimpse of more than 3,500 individual shopping trips. We randomize participants to one of several treatments, in which we incentivize fresh fruit and vegetable purchases, provide tips for fruit and vegetable preparation, or both. We report several key insights. First, our informational content treatment has little effect. Second, we find an important price effect: modest pecuniary incentives more than double the proportion of dollars spent on produce in the grocery store. Third, we find an interesting pattern of consumption after the experiment ends: even when incentives are removed, the treatment group has higher fruit and vegetable purchases compared to the control group. These long-term results are in stark contrast to either a standard price model or a behavioral model of 'crowd out.' Rather, our results are consonant with a habit formation model. This opens up the distinct possibility that short term incentives can be used as a key instrument to combat obesity.
我们使用实地实验来调查激励对杂货店食品购买决策的影响。我们招募了200多名参与者,在6个月的时间里跟踪他们的购买情况,让我们得以一窥超过3500次的个人购物之旅。我们将参与者随机分配到几种治疗方法中,其中我们鼓励购买新鲜水果和蔬菜,提供水果和蔬菜准备技巧,或两者兼而有之。我们报告了几个关键的见解。首先,我们的信息内容处理效果甚微。其次,我们发现了一个重要的价格效应:适度的金钱激励使人们在杂货店购买农产品的支出比例增加了一倍以上。第三,在实验结束后,我们发现了一个有趣的消费模式:即使取消了奖励,实验组的水果和蔬菜购买量也高于对照组。这些长期结果与标准价格模型或“挤出”行为模型形成了鲜明对比。相反,我们的结果与习惯形成模型是一致的。这开辟了一种明显的可能性,即短期激励可以作为对抗肥胖的关键工具。
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引用次数: 8
Patient Complaint Reduction: A Case Study in Maternity Ward of Kemang Medical Care (KMC) 减少患者投诉:以科芒医院产科病房为例
Pub Date : 2015-07-12 DOI: 10.2139/ssrn.2632792
A. H. Iswanto
Introduction -- Complaint is "a statement of dissatisfaction formally to an aspect of the experience of the service". Formally, complaint is only one of the four types of complaining behavior. The majority appears in form of voicer, which is the complaint that something is wrong in the organization. Another type is activism, which is revenge. Two smaller types are irates and passivism. Irates shows the complaint by involving in the spread of negative news about hospital services, whereas the pacifists do not state the complaint but use the word "wait a second" to "finish" and finally never comeback.Methodology -- This study consists of qualitative and quantitative components. Qualitative component consists of interviews and document studies in the planning stage. While the interview, document study, and observation methods were performed in the implementation stage. The analysis was performed by comparing the theoretical principles adapted from the existing context.Result -- Patient complaints were reduced with sigma level from 2.98 to 3.78. Patients were satisfied with the services; 82%. Number of complaints was from 26 to 14. Sigma level for inpatient preparation was from 3.77 to be 4.03. 88%, the room was ready in Conclusion -- This study proved that the implementation of Lean Six Sigma in KMC has succeeded to reduce the patient complaints upon all output variables. Results found the highest sigma contained in the inpatient preparation.
导言——投诉是“对服务体验的某一方面正式表达不满”。正式地说,抱怨只是四种抱怨行为中的一种。大多数人以声音的形式出现,即抱怨组织中出现了问题。另一种是行动主义,也就是报复。两种较小的类型是愤怒和被动。Irates通过散布有关医院服务的负面消息来表达不满,而和平主义者则不陈述不满,而是使用“等一秒钟”来“完成”,最后再也不回来。方法论——本研究由定性和定量两部分组成。定性部分包括规划阶段的访谈和文件研究。而访谈法、文献研究法、观察法则在实施阶段进行。分析是通过比较从现有背景改编的理论原则来进行的。结果:患者投诉减少,sigma水平从2.98降至3.78。患者对服务满意;82%。投诉数量从26件到14件。住院准备的Sigma水平从3.77到4.03。结论——本研究证明精益六西格玛在KMC的实施成功地减少了所有输出变量上的患者投诉。结果发现住院患者制剂中sigma含量最高。
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引用次数: 1
Do Hospitals Respond to Increasing Prices by Supplying Fewer Services? 医院会通过减少服务来应对价格上涨吗?
Pub Date : 2015-07-05 DOI: 10.2139/ssrn.2640116
M. Salm, A. Wübker
Medical providers often have a significant influence on treatment decisions which they can use in their own financial interest. Classical models of supplier-induced demand predict that medical providers will supply fewer services if they face increasing prices. We test this prediction based on a reform of hospital financing in Germany. Uniquely, this reform changed the overall level of reimbursement – with increasing prices for some hospitals and decreasing prices for others – without affecting the relative prices for different types of patients. Based on administrative data, we find that hospitals do indeed react to increasing prices by reducing service supply.
医疗服务提供者通常对治疗决定有重大影响,他们可以利用自己的经济利益。供应商诱导需求的经典模型预测,如果医疗服务提供者面临价格上涨,他们将提供更少的服务。我们在德国医院融资改革的基础上检验了这一预测。独特的是,这一改革改变了报销的总体水平——一些医院的价格上涨,另一些医院的价格下降——而不影响不同类型患者的相对价格。根据行政数据,我们发现医院确实通过减少服务供应来应对价格上涨。
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引用次数: 5
Modeling the Impact of Health Care Reform on Consumers 医疗改革对消费者的影响建模
Pub Date : 2015-05-31 DOI: 10.2139/ssrn.2612607
Su Xie, S. Zenios
This paper studies the impact of the Health Insurance Marketplace (the Marketplace) on consumers. The aim is to study the motivation behind the consumer choice and the roles that insurers and government play. It also provide insights in improving the efficiency in the Marketplace.This paper introduces a cost point of view in modeling consumer decision. Consumers make rational choice by optimizing the objective function. The objective function includes the actual costs and the cost equivalent of health utilization. It is driven by the evidence that consumers value their costs most importantly. Moreover, this paper presents a conceptual framework of dividing health utilization into regions. This captures the practical features such as over utilization in healthcare. Bounded rationality is also discussed and three potential directions are provided. This paper also builds a model to predict medical expenditure which consists of a regression, a transition, and an evolution of the parameters. This model is the first to use the number of service visits as predictors. This is consistent with the collecting process of data which is at an service event base. Moreover, it incorporates the behavior considerations of the different insurance status of consumers. Aside from this model, two alternatives models are considered for comparison. They reflect two existing approaches: regression on personal characteristics and log transformation for nonzero expenditures. The predictors are selected and their coefficients are evaluated using the longitudinal data from Medical Expenditure Panel Survey (MEPS). The two alternatives are compared with the model and it turns out that the model outperforms them in both prediction accuracy and variability explanation. Finally this paper presents simulation of consumer choice. The results suggest that the cost saver better matches the statistics from the federal government than the utility maximizer. The results provides implications to the share between insurers and consumers. The actuarial values (the share of expenditure paid by insurers) is calculated based on simulated participation. They demonstrates inconsistency with the standard ones. Therefore inefficiency exits in the actuarial value calculation. This paper also evaluates the government involvements in the Marketplace. The results suggest that its involvements, especially the government subsidies, effectively encourage the broader participation of insurance plans.
本文研究健康保险市场(市场)对消费者的影响。目的是研究消费者选择背后的动机,以及保险公司和政府所扮演的角色。它还提供了提高市场效率的见解。在消费者决策建模中引入了成本的观点。消费者通过优化目标函数进行理性选择。目标函数包括卫生利用的实际成本和成本当量。有证据表明,消费者最看重的是他们的成本。此外,本文还提出了卫生利用区域划分的概念框架。这捕获了医疗保健中的过度使用等实际特性。讨论了有限理性,并提出了三个可能的发展方向。本文还建立了一个由回归、过渡和参数演化组成的医疗费用预测模型。该模型是第一个使用服务访问次数作为预测因子的模型。这与服务事件基础上的数据收集过程是一致的。此外,它还纳入了消费者不同保险状况的行为考虑。除了这个模型之外,还考虑了两个备选模型进行比较。它们反映了两种现有的方法:对个人特征的回归和对非零支出的对数变换。选取预测因子,利用医疗支出调查(MEPS)的纵向数据对预测因子的系数进行评估。将两种备选方案与模型进行比较,结果表明,该模型在预测精度和变异解释方面都优于两种备选方案。最后给出了消费者选择的仿真。结果表明,成本节约者比效用最大化者更符合联邦政府的统计数据。该结果对保险公司和消费者之间的份额提供了启示。精算值(保险公司支付的支出份额)是基于模拟参与计算的。它们显示出与标准的不一致。因此,精算价值计算存在着低效率。本文还对政府在市场中的参与进行了评估。结果表明,其参与,特别是政府补贴,有效地鼓励了保险计划的更广泛参与。
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引用次数: 0
Hospital Readmissions Reduction Program: An Economic and Operational Analysis 医院再入院减少计划:经济和操作分析
Pub Date : 2015-05-30 DOI: 10.2139/ssrn.2366493
Dennis J. Zhang, I. Gurvich, J. V. Mieghem, Eric Park, R. Young, Mark V. Williams
The Hospital Readmissions Reduction Program (HRRP), a part of the U.S. Patient Protection and Affordable Care Act, requires the Centers for Medicare and Medicaid Services to penalize hospitals with excess readmissions. We take an economic and operational (patient flow) perspective to analyze the effectiveness of this policy in encouraging hospitals to reduce readmissions. We develop a game-theoretic model that captures the competition among hospitals inherent in HRRP’s benchmarking mechanism. We show that this competition can be counterproductive: it increases the number of nonincentivized hospitals, which prefer paying penalties over reducing readmissions in any equilibrium. We calibrate our model with a data set of more than 3,000 hospitals in the United States and show that under the current policy, and for a large set of parameters, 4%–13% of the hospitals remain nonincentivized to reduce readmissions. We also validate our model against the actual performance of hospitals in the three years since the introduction of the policy. We draw several policy recommendations to improve this policy’s outcome. For example, localizing the benchmarking process—comparing hospitals against similar peers—improves the performance of the policy. This paper was accepted by Serguei Netessine, operations management .
医院再入院减少计划(HRRP)是美国患者保护和平价医疗法案的一部分,要求医疗保险和医疗补助服务中心对再入院过多的医院进行处罚。我们采取经济和操作(病人流)的角度来分析这一政策在鼓励医院减少再入院方面的有效性。我们开发了一个博弈论模型,捕捉医院之间的竞争内在的HRRP的基准机制。我们表明,这种竞争可能适得其反:它增加了不受激励的医院的数量,在任何平衡情况下,这些医院宁愿支付罚款,也不愿减少再入院人数。我们用美国3000多家医院的数据集校准了我们的模型,结果表明,在目前的政策下,对于大量的参数,4%-13%的医院仍然没有减少再入院的激励。我们还根据该政策实施以来三年来医院的实际表现验证了我们的模型。我们提出了几项政策建议,以改善这一政策的结果。例如,将基准测试过程(将医院与类似的同行进行比较)本地化可以提高策略的性能。这篇论文被Serguei Netessine,运营管理接受。
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引用次数: 75
The Effect on Mental Health of Retiring During the Economic Crisis 经济危机中退休对心理健康的影响
Pub Date : 2015-05-20 DOI: 10.2139/ssrn.2707058
Michele Belloni, E. Meschi, G. Pasini
This paper investigates the causal impact of retirement on late-life mental health, a growing concern for public health, because major depressive disorders are the second leading cause of disability. We shed light on the role of economic conditions in shaping the effect of retirement on mental health by exploiting time and regional variation in the severity of the economic crisis across 10 European countries during 2004-2013. We use data from four waves of the Survey of Health, Ageing and Retirement in Europe and address the potential endogeneity of the retirement decision to mental health by applying a fixed-effects instrumental variables approach. The results indicate that retirement improves the mental health of men but not that of women. This effect is stronger for blue-collar men working in regions that have been severely hit by the economic crisis. These findings may be explained by the worsening of working conditions and the rise in job insecurity stemming from the economic downturn: under these circumstances, exit from the labour force is perceived as a relief. Copyright © 2016 John Wiley & Sons, Ltd.
这篇论文调查了退休对晚年心理健康的因果影响,这是一个日益受到公众关注的健康问题,因为重度抑郁症是导致残疾的第二大原因。我们利用2004-2013年期间10个欧洲国家经济危机严重程度的时间和区域差异,揭示了经济条件在形成退休对心理健康影响方面的作用。我们使用来自欧洲健康、老龄化和退休调查的四波数据,并通过应用固定效应工具变量方法来解决退休决定对心理健康的潜在内生性。结果表明,退休改善了男性的心理健康,但对女性没有改善。在受经济危机影响严重的地区工作的蓝领男性受到的影响更大。这些发现可以用工作条件的恶化和经济衰退造成的工作不安全感的增加来解释:在这些情况下,退出劳动力被认为是一种解脱。版权所有©2016 John Wiley & Sons, Ltd。
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引用次数: 47
期刊
Demand & Supply in Health Economics eJournal
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