Health economics最新文献

For over 3 decades, the Centers for Medicare & Medicaid Services (CMS) has provided a bonus payment for outpatient physician services provided to beneficiaries under Medicare Part B in areas designated as Primary Care Health Professional Shortage Areas (HPSAs) during the previous calendar year. Despite the longstanding existence of the program, no studies have explicitly evaluated how previously established physicians practicing in areas subject to an HPSA designation respond to the bonus payments. Using 2012-2019 physician-level data with stacked event study models that control for several characteristics, including the underlying criteria used to construct HPSA scores, I find little to no statistically significant changes in access to care (as measured through total annual beneficiaries treated or services delivered to Medicare beneficiaries) in the years leading up to HPSA designation. However, once physicians become eligible for a 10% bonus payment, their annual number of beneficiaries treated and volume of services decline, consistent with recent empirical work and CMS's actuarial assumptions about how physicians respond to changes in reimbursement.

This paper examines, using exogenous variation generated by a Finnish pension reform implemented in 2005, the interplay between health and financial incentives to postpone retirement. Based on detailed administrative data on individual health and retirement behavior, we focus on whether individual reactions to incentives vary according to health status and analyze whether individuals with ill health are also able to take advantage of the potential monetary benefits of delayed retirement created by the reform. We find that on average, individuals react to the financial incentives created by the reform as expected. This result holds for most of the health-related subgroups we analyze. However, those with a long period of sickness absence are less likely to respond to changes in the financial incentives to postpone retirement.

Waiting time is a rationing mechanism that is used in publicly funded healthcare systems as a mean to ensure equal access for equal need. However, several studies suggest that individuals with higher socioeconomic status wait less. These studies typically measure patients' socioeconomic status as an aggregate measure from patients' residential area and the results are hence vulnerable for aggregation biases. We shed light on the magnitude of the aggregation bias by analyzing socioeconomic gradients in waiting times when education and income are measured on three different levels: the individual level, the population cell level, and the municipal level. Our individual level socioeconomic gradient is modest compared with the literature. When socioeconomic status is measured on an aggregate level, we observe stronger associations with socioeconomic variables and less accurate estimates. A researcher who only has access to the aggregate data runs the risk of overstating the magnitude of the socioeconomic gradients.

After years of reductions in the rate of murder in the United States, the national murder rate has increased since 2015. The causes of this trend are generally unknown, though there is some evidence related to narcotic drugs. Arrests related to heroin and cocaine had been stable between 2010 and 2014 before a sudden increase in 2015. Likewise, the number of murders related to narcotic drugs has increased since 2013, with a jump in 2015. Increased rates of these crimes parallel recent dramatic growth in overdoses involving heroin. However, the causal relationship between the recent opioid crisis and the rise in murder rates is missing from the literature. I used OxyContin reformulation as an exogenous shock to illicit markets. OxyContin reformulation led some people who misused OxyContin to switch to illicit opioids. Previous work has shown that areas with higher rates of OxyContin misuse experienced faster growth in heroin overdoses post-reformulation. I tested whether this growth in illicit drug use caused an increase in crime. After reformulation, I find significantly greater relative increases in murder rates in states with high pre-reformulation rates of OxyContin misuse. The results support a causal link between the opioid epidemic and crime.

As population aging will likely lead to an increasing number of people in need of care, the demand for informal care is expected to rise. In this context, it is often discussed whether financial incentives can motivate more individuals to assume caregiving responsibilities. We analyze the potential effect of financial incentives on the provision of informal care by estimating a structural model with endogenous labor supply and caregiving decisions. This allows us to investigate how both individual wages and financial compensations for caregiving affect the caregiving decision, while accounting for heterogeneous preferences. We find that wage increases are associated with a decreased willingness to care. Financially compensating potential carers for the opportunity costs from caregiving significantly increases the probability of providing care. However, across different subgroups, a large share of about 50% of potential carers remains unwilling to provide care despite the financial incentive. For these individuals, factors such as preferences and social norms outweigh financial considerations in their caregiving decision.

Despite being one of the most common surgical procedures in industrialized countries, there is limited causal evidence on the long-term consequences of Cesarean section (CS). We study the impacts of CS on health during ages 1–12 years and human capital outcomes at age 16 years, using exogenous variation in the probability of receiving a CS for breech births at term—a group with high CS risk. We use administrative data from Denmark, Norway, and Sweden to show that preventing complicated vaginal births benefits health at birth and reduces the number of all-cause hospital nights during childhood. Our findings for childhood diagnoses for asthma, allergies, diabetes mellitus type 1, and school outcomes are imprecise and do thus not lend strong support for prominent hypotheses on CS causing long-term immune dysfunction disorders and, thereby, worse human capital outcomes.

This study examines the impact of the Affordable Care Act (ACA) on health insurance coverage among rent-burdened households—those spending more than 30% of their income on rent—and non-rent-burdened households. Using data from American Community Survey, we find that Medicaid take-up rate increased 8.88 percentage points (pp) among rent-burdened households and 7.54 pp among non-rent-burdened households in expansion states. Conditional on household income and demographic characteristics, rent-burdened households exhibit a 1.5 pp higher likelihood of Medicaid enrollment, with an additional decline of 0.7 pp in employer-sponsored insurance and 1.0 pp in directly purchased insurance enrollment. These effects were more pronounced among individuals aged over 26 and those in states without state-run exchanges. The findings show the importance of tailored Medicaid policies to assist households facing housing burdens, especially for those ineligible for housing vouchers.