We study how delivery times and prices for hospital medical devices respond to the introduction of centralized procurement. Our identification strategy leverages a legislative change in Italy that mandated centralized purchases for a sub-set of devices. The statutory centralization generated a reduction in prices and an increase in delivery times for centralized purchases relative to non-centralized purchases. We use data on quantities and on suppliers to discuss the mechanisms potentially underlying our findings.
{"title":"Centralized Procurement and Delivery Times: Evidence from a Natural Experiment in Italy","authors":"R. Clark, Decio Coviello, Adriano De Leverano","doi":"10.2139/ssrn.3927250","DOIUrl":"https://doi.org/10.2139/ssrn.3927250","url":null,"abstract":"We study how delivery times and prices for hospital medical devices respond to the introduction of centralized procurement. Our identification strategy leverages a legislative change in Italy that mandated centralized purchases for a sub-set of devices. The statutory centralization generated a reduction in prices and an increase in delivery times for centralized purchases relative to non-centralized purchases. We use data on quantities and on suppliers to discuss the mechanisms potentially underlying our findings.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121796569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When the Patient Protection and Affordable Care Act (ACA) was signed into law in 2010, many groups projected how many people would enroll in health insurance plans satisfying the law’s new rules and requirements (ACA plans). Nearly six years later, enrollment in health insurance exchange plans is far short of initial projections, particularly for people who earn too much to qualify for subsidies to reduce high ACA plan deductibles. The dearth of exchange enrollees with at least a middle-class income indicates that the individual mandate is not motivating as many people, particularly younger, healthier, and wealthier people, to purchase coverage as was originally expected. Large insurer losses on ACA plans show that the overall risk pool is sicker and much more costly than originally projected, and are an indication that the law may require significant revision in order to avoid causing an adverse-selection spiral.
{"title":"Downgrading the Affordable Care Act: Unattractive Health Insurance and Lower Enrollment","authors":"Brian Blase","doi":"10.2139/ssrn.3191481","DOIUrl":"https://doi.org/10.2139/ssrn.3191481","url":null,"abstract":"When the Patient Protection and Affordable Care Act (ACA) was signed into law in 2010, many groups projected how many people would enroll in health insurance plans satisfying the law’s new rules and requirements (ACA plans). Nearly six years later, enrollment in health insurance exchange plans is far short of initial projections, particularly for people who earn too much to qualify for subsidies to reduce high ACA plan deductibles. The dearth of exchange enrollees with at least a middle-class income indicates that the individual mandate is not motivating as many people, particularly younger, healthier, and wealthier people, to purchase coverage as was originally expected. Large insurer losses on ACA plans show that the overall risk pool is sicker and much more costly than originally projected, and are an indication that the law may require significant revision in order to avoid causing an adverse-selection spiral.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122575042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health insurance for a high-paid employee costs an employer the same amount as health insurance for a low-paid employee. At the same time, healthcare costs, and therefore health insurance premiums, are growing much more rapidly than earnings. Therefore, it is reasonable to expect that—while earnings will indeed become more unequal over time—total compensation will not become more unequal, or, when considered over the entire labor force, at least will not become as unequal. Direct empirical evidence supports this hypothesis, based on unique, unpublished survey data about employers’ compensation costs collected by the Bureau of Labor Statistics. The supporting results hold both for the period 1996–2008 and for the period 1992–2010. A regression estimated over the period 1990–2014 also bolsters the understanding that the rising cost of health care is a major cause of increasing earnings inequality. This finding suggests that the best policy to reduce inequality would be to effectively control the rate of growth in the cost of health care.
雇主为高收入雇员购买健康保险的费用与为低收入雇员购买健康保险的费用相同。与此同时，医疗成本以及医疗保险费的增长速度远远快于收入的增长速度。因此，我们有理由预计，尽管收入确实会随着时间的推移变得更加不平等，但总薪酬不会变得更加不平等，或者，当考虑到整个劳动力时，至少不会变得如此不平等。直接的经验证据支持这一假设，这些证据基于美国劳工统计局(Bureau of Labor Statistics)收集的关于雇主薪酬成本的独特、未公布的调查数据。支持结果适用于1996-2008年和1992-2010年期间。对1990年至2014年期间的回归估计也支持了这样一种认识，即医疗保健成本上升是收入不平等加剧的一个主要原因。这一发现表明，减少不平等的最佳政策是有效控制医疗保健费用的增长率。
{"title":"Earnings Inequality: The Implications of the Rapidly Rising Cost of Employer-Provided Health Insurance","authors":"M. Warshawsky","doi":"10.2139/ssrn.3191482","DOIUrl":"https://doi.org/10.2139/ssrn.3191482","url":null,"abstract":"Health insurance for a high-paid employee costs an employer the same amount as health insurance for a low-paid employee. At the same time, healthcare costs, and therefore health insurance premiums, are growing much more rapidly than earnings. Therefore, it is reasonable to expect that—while earnings will indeed become more unequal over time—total compensation will not become more unequal, or, when considered over the entire labor force, at least will not become as unequal. Direct empirical evidence supports this hypothesis, based on unique, unpublished survey data about employers’ compensation costs collected by the Bureau of Labor Statistics. The supporting results hold both for the period 1996–2008 and for the period 1992–2010. A regression estimated over the period 1990–2014 also bolsters the understanding that the rising cost of health care is a major cause of increasing earnings inequality. This finding suggests that the best policy to reduce inequality would be to effectively control the rate of growth in the cost of health care.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"154 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123986667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper sets up a quasi-experiment to estimate the impact of medical innovations on the economic outcomes for the individual and their family based on the rich administrative data for Sweden covering 1 million persons. I find that an increase in medical innovations by one standard deviation raises family income by 15%. Medical innovations strongly influence not only own disposable and labour income and welfare payments but also a spouse’s income. I also find that the economic effects are heterogeneous in relation to the insurance eligibility of the health shock. Results also suggest decreasing yet always positive returns to scale.
{"title":"Heterogeneous Returns to Medical Innovations","authors":"Volha Lazuka","doi":"10.2139/ssrn.3943621","DOIUrl":"https://doi.org/10.2139/ssrn.3943621","url":null,"abstract":"This paper sets up a quasi-experiment to estimate the impact of medical innovations on the economic outcomes for the individual and their family based on the rich administrative data for Sweden covering 1 million persons. I find that an increase in medical innovations by one standard deviation raises family income by 15%. Medical innovations strongly influence not only own disposable and labour income and welfare payments but also a spouse’s income. I also find that the economic effects are heterogeneous in relation to the insurance eligibility of the health shock. Results also suggest decreasing yet always positive returns to scale.","PeriodicalId":309156,"journal":{"name":"PSN: Health Care Delivery (Topic)","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128221155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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