Pub Date : 2016-12-01Epub Date: 2016-05-31DOI: 10.1515/fhep-2015-0027
Maria Serakos, Barbara Wolfe
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. This comprehensive health care reform legislation sought to expand health care coverage to millions of Americans, control health care costs, and improve the overall quality of the health care system. The ACA required that all US citizens and legal residents have qualifying health insurance by 2014. In this paper we give readers a brief overview of the effects of the ACA based on recent research. We then turn our attention to the possibility of using the ACA expansion to answer important underlying questions, such as: To what extent does the holding of insurance lead to improvements in access to care? To what extent does the holding of coverage lead to improvements in health? In mental health? Are there likely general equilibrium effects on labor force participation, hours worked, employment setting, and indeed even the probability of marrying? By necessity, researchers' ability to answer these questions depends on the availability of data, so we discuss current and potential data sources relevant for answering these questions. We also look to what has been studied about the health reform in Massachusetts and early Medicaid expansions to speculate what we can expect to learn about the effects of the ACA on these outcomes in the future.
{"title":"The ACA: Impacts on Health, Access, and Employment.","authors":"Maria Serakos, Barbara Wolfe","doi":"10.1515/fhep-2015-0027","DOIUrl":"10.1515/fhep-2015-0027","url":null,"abstract":"<p><p>On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. This comprehensive health care reform legislation sought to expand health care coverage to millions of Americans, control health care costs, and improve the overall quality of the health care system. The ACA required that all US citizens and legal residents have qualifying health insurance by 2014. In this paper we give readers a brief overview of the effects of the ACA based on recent research. We then turn our attention to the possibility of using the ACA expansion to answer important underlying questions, such as: To what extent does the holding of insurance lead to improvements in access to care? To what extent does the holding of coverage lead to improvements in health? In mental health? Are there likely general equilibrium effects on labor force participation, hours worked, employment setting, and indeed even the probability of marrying? By necessity, researchers' ability to answer these questions depends on the availability of data, so we discuss current and potential data sources relevant for answering these questions. We also look to what has been studied about the health reform in Massachusetts and early Medicaid expansions to speculate what we can expect to learn about the effects of the ACA on these outcomes in the future.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"19 2","pages":"201-259"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097713/pdf/nihms-983987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36408765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We study how the optimal public provision of health care depends on whether or not individuals have an option to seek publicly financed treatment in other regions. We find that, relative to the first-best solution, the government has an incentive to over-provide health care to low-income individuals. When cross-border health care takes place, this incentive is solely explained by that over-provision facilitates redistribution. The reason why more health care facilitates redistribution is that high-ability individuals mimicking low-ability individuals benefit the least from health care when health and labor supply are complements. Without cross-border health care, higher demand for health care among high-income individuals also contributes to the over-provision given that high-income individuals do not work considerably less than low-income individuals and that the government cannot discriminate between the income groups by giving them different access to health care.
{"title":"Public Provision and Cross-Border Health Care","authors":"David Granlund, Magnus Wikström","doi":"10.1515/fhep-2014-0024","DOIUrl":"https://doi.org/10.1515/fhep-2014-0024","url":null,"abstract":"Abstract We study how the optimal public provision of health care depends on whether or not individuals have an option to seek publicly financed treatment in other regions. We find that, relative to the first-best solution, the government has an incentive to over-provide health care to low-income individuals. When cross-border health care takes place, this incentive is solely explained by that over-provision facilitates redistribution. The reason why more health care facilitates redistribution is that high-ability individuals mimicking low-ability individuals benefit the least from health care when health and labor supply are complements. Without cross-border health care, higher demand for health care among high-income individuals also contributes to the over-provision given that high-income individuals do not work considerably less than low-income individuals and that the government cannot discriminate between the income groups by giving them different access to health care.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"13 1","pages":"157 - 177"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88902849","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}
Jean M. Mitchell, J. Reschovsky, L. Franzini, E. A. Reicherter
Abstract Prior research on treatment of low back pain has documented large increases in use of spinal surgery, MRIs and lumbosacral injections linked to physician self-referral arrangements. No recent research has examined whether physician ownership of physical therapy services results in greater use of physical therapy to treat low back pain. The objective of this study is to investigate whether physician ownership of physical therapy services affects frequency of use, visits and types of physical therapy services received by patients with low back pain. Using claims records from insured patients covered by Blue Cross Blue Shield of Texas (2008–2011) we compared several metrics of use of physical therapy services for low back pain episodes controlling for self-referral status. We identified 158,151 low back pain episodes, 27% met the criteria to be classified as “self-referral.” Only 10% of “non-self-referral” episodes received physical therapy compared to 26% of self-referral episodes (p<0.001). The unadjusted and regression adjusted self-referral effect was identical – about 16 percentage point difference (p<0.001). Among patients who received some physical therapy, self-referral episodes were comprised of 2.26 fewer visits and 11 fewer physical therapy service units (p<0.001). Non-self-referring episodes included a significantly higher proportion of “active” (hands on or patient engaged) as opposed to “passive” treatments (p<0.001). The regression-adjusted difference was 30 percentage points when measured as actual counts and 29 percentage points when measured in RVUs (p<0.001). Total spending on back-related care was 35% higher for self-referred episodes compared to their non-self-referred counterparts (p<0.001). Ownership of physical therapy services influence physicians’ referral to initiate a course of physical therapy to treat low back pain, but also affect the types of physical therapy services a patient receives.
先前对腰痛治疗的研究表明，与医生自我转诊安排相关的脊柱手术、核磁共振成像和腰骶注射的使用大幅增加。最近没有研究调查医生拥有物理治疗服务是否会导致更多地使用物理治疗来治疗腰痛。本研究的目的是调查医生对物理治疗服务的所有权是否影响下腰痛患者的使用频率、就诊次数和接受的物理治疗服务类型。使用来自德州蓝十字蓝盾保险公司(Blue Cross Blue Shield of Texas)的保险患者(2008-2011)的索赔记录，我们比较了几种使用物理治疗服务来控制腰痛发作的自我转诊状态的指标。我们确定了158,151次腰痛发作，27%符合“自我转诊”的标准。只有10%的“非自我转诊”患者接受了物理治疗，而26%的自我转诊患者接受了物理治疗(p<0.001)。未经调整和回归调整的自我推荐效应相同，相差约16个百分点(p<0.001)。在接受一些物理治疗的患者中，自我转诊次数减少2.26次，物理治疗服务单位减少11个(p<0.001)。与“被动”治疗相比，非自我指涉发作包括明显更高比例的“主动”治疗(动手或患者参与)(p<0.001)。当以实际计数测量时，经回归校正的差异为30个百分点，当以rvu测量时，差异为29个百分点(p<0.001)。与非自我提及的患者相比，自我提及的患者在背部相关护理方面的总支出高出35% (p<0.001)。物理治疗服务的所有权影响医生的转诊，以启动一个疗程的物理治疗治疗腰痛，但也影响物理治疗服务的类型，病人接受。
{"title":"Physician Self-Referral of Physical Therapy Services for Patients with Low Back Pain: Implications for Use, Types of Treatments Received and Expenditures","authors":"Jean M. Mitchell, J. Reschovsky, L. Franzini, E. A. Reicherter","doi":"10.1515/fhep-2015-0026","DOIUrl":"https://doi.org/10.1515/fhep-2015-0026","url":null,"abstract":"Abstract Prior research on treatment of low back pain has documented large increases in use of spinal surgery, MRIs and lumbosacral injections linked to physician self-referral arrangements. No recent research has examined whether physician ownership of physical therapy services results in greater use of physical therapy to treat low back pain. The objective of this study is to investigate whether physician ownership of physical therapy services affects frequency of use, visits and types of physical therapy services received by patients with low back pain. Using claims records from insured patients covered by Blue Cross Blue Shield of Texas (2008–2011) we compared several metrics of use of physical therapy services for low back pain episodes controlling for self-referral status. We identified 158,151 low back pain episodes, 27% met the criteria to be classified as “self-referral.” Only 10% of “non-self-referral” episodes received physical therapy compared to 26% of self-referral episodes (p<0.001). The unadjusted and regression adjusted self-referral effect was identical – about 16 percentage point difference (p<0.001). Among patients who received some physical therapy, self-referral episodes were comprised of 2.26 fewer visits and 11 fewer physical therapy service units (p<0.001). Non-self-referring episodes included a significantly higher proportion of “active” (hands on or patient engaged) as opposed to “passive” treatments (p<0.001). The regression-adjusted difference was 30 percentage points when measured as actual counts and 29 percentage points when measured in RVUs (p<0.001). Total spending on back-related care was 35% higher for self-referred episodes compared to their non-self-referred counterparts (p<0.001). Ownership of physical therapy services influence physicians’ referral to initiate a course of physical therapy to treat low back pain, but also affect the types of physical therapy services a patient receives.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"30 1","pages":"179 - 199"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88955261","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}
Abstract I construct a disease-based medical expenditure index for Medicare Advantage (private plan) enrollees using data from the Medicare Current Beneficiary Survey from 2001 to 2009. I create the indexes by modeling total health-care expenditure as a function of each respondent’s diagnoses. Total medical inflation for this population is found to be 5.7 percent annually. By comparison, medical inflation in the Medicare fee-for-service (FFS) population is 4.5 percent annually. The difference is partly due to differential reporting of drug and nondrug spending in the MCBS for FFS beneficiaries; once this is corrected for, inflation among FFS beneficiaries is 5.0 percent. The remaining difference results from drug spending increasingly more rapidly among Medicare Advantage enrollees. I show that the introduction of Part D accounts for much of, and possibly all the remaining gap in inflation.
{"title":"Estimating Regression-Based Medical Care Expenditure Indexes for Medicare Advantage Enrollees","authors":"A. Hall","doi":"10.1515/fhep-2015-0031","DOIUrl":"https://doi.org/10.1515/fhep-2015-0031","url":null,"abstract":"Abstract I construct a disease-based medical expenditure index for Medicare Advantage (private plan) enrollees using data from the Medicare Current Beneficiary Survey from 2001 to 2009. I create the indexes by modeling total health-care expenditure as a function of each respondent’s diagnoses. Total medical inflation for this population is found to be 5.7 percent annually. By comparison, medical inflation in the Medicare fee-for-service (FFS) population is 4.5 percent annually. The difference is partly due to differential reporting of drug and nondrug spending in the MCBS for FFS beneficiaries; once this is corrected for, inflation among FFS beneficiaries is 5.0 percent. The remaining difference results from drug spending increasingly more rapidly among Medicare Advantage enrollees. I show that the introduction of Part D accounts for much of, and possibly all the remaining gap in inflation.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"2 1","pages":"261 - 297"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74898458","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}
Abstract Several studies have explored the causes and magnitude of geographic variation in Medicare spending and service use, but most of these studies have not taken into account that pharmaceuticals may substitute for medical service use. We address this issue using Medicare medical and pharmaceutical administrative claims data to explore the correlation between medical and pharmaceutical spending and utilization; we also examine medical and pharmaceutical use for subsets of the Medicare population with certain chronic conditions often treated with drugs. Beneficiary-level regressions with controls for health status and demographics were used to construct standardized medical spending and pharmaceutical spending and utilization measures for each region and patient cohort. Areas with higher medical spending tend to have higher pharmaceutical spending in general. However, areas with higher medical spending also tend to have lower pharmaceutical spending for conditions for which prescription drugs may substitute for additional medical care. Both of these patterns are consistent with less efficient medical practices in higher-spending areas. Likewise, more expensive drugs and more broad-spectrum antibiotics, which are often considered discretionary and overused, are more likely to be prescribed in higher-spending areas. Our results suggest that care may be provided more efficiently in some regions than in others. However, additional research is needed to investigate relationships between spending and health care outcomes, and what types of policies may create incentives for higher-spending regions to reduce spending without a loss in quality.
{"title":"Evidence of Inefficiencies in Practice Patterns: Regional Variation in Medicare Medical and Drug Spending","authors":"Melinda Buntin, T. Hayford","doi":"10.1515/fhep-2015-0034","DOIUrl":"https://doi.org/10.1515/fhep-2015-0034","url":null,"abstract":"Abstract Several studies have explored the causes and magnitude of geographic variation in Medicare spending and service use, but most of these studies have not taken into account that pharmaceuticals may substitute for medical service use. We address this issue using Medicare medical and pharmaceutical administrative claims data to explore the correlation between medical and pharmaceutical spending and utilization; we also examine medical and pharmaceutical use for subsets of the Medicare population with certain chronic conditions often treated with drugs. Beneficiary-level regressions with controls for health status and demographics were used to construct standardized medical spending and pharmaceutical spending and utilization measures for each region and patient cohort. Areas with higher medical spending tend to have higher pharmaceutical spending in general. However, areas with higher medical spending also tend to have lower pharmaceutical spending for conditions for which prescription drugs may substitute for additional medical care. Both of these patterns are consistent with less efficient medical practices in higher-spending areas. Likewise, more expensive drugs and more broad-spectrum antibiotics, which are often considered discretionary and overused, are more likely to be prescribed in higher-spending areas. Our results suggest that care may be provided more efficiently in some regions than in others. However, additional research is needed to investigate relationships between spending and health care outcomes, and what types of policies may create incentives for higher-spending regions to reduce spending without a loss in quality.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"42 1","pages":"299 - 331"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75570006","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}
T. Matsuda, J. Mccombs, I. Tonnu-Mihara, J. McGinnis, D. Fox
Abstract Background: The high cost of new hepatitis C (HCV) treatments has resulted in “watchful waiting” strategies being developed to safely delay treatment, which will in turn delay viral load suppression (VLS). Objective: To document if delayed VLS adversely impacted patient risk for adverse events and death. Methods: 187,860 patients were selected from the Veterans Administration’s (VA) clinical registry (CCR), a longitudinal compilation of electronic medical records (EMR) data for 1999–2010. Inclusion criteria required at least 6 months of CCR/EMR data prior to their HCV diagnosis and sufficient data post-diagnosis to calculate one or more FIB-4 scores. Primary outcome measures were time-to-death and time-to-a composite of liver-related clinical events. Cox proportional hazards models were estimated separately using three critical FIB-4 levels to define early and late viral response. Results: Achieving an undetectable viral load before the patient’s FIB-4 level exceed pre-specified critical values (1.00, 1.45 and 3.25) effectively reduced the risk of an adverse clinical events by 33–35% and death by 21–26%. However, achieving VLS after FIB-4 exceeds 3.25 significantly reduced the benefit of viral response. Conclusions: Delaying VLS until FIB-4 >3.25 reduces the benefits of VLS in reducing patient risk.
{"title":"The Impact of Delayed Hepatitis C Viral Load Suppression on Patient Risk: Historical Evidence from the Veterans Administration","authors":"T. Matsuda, J. Mccombs, I. Tonnu-Mihara, J. McGinnis, D. Fox","doi":"10.1515/fhep-2015-0041","DOIUrl":"https://doi.org/10.1515/fhep-2015-0041","url":null,"abstract":"Abstract Background: The high cost of new hepatitis C (HCV) treatments has resulted in “watchful waiting” strategies being developed to safely delay treatment, which will in turn delay viral load suppression (VLS). Objective: To document if delayed VLS adversely impacted patient risk for adverse events and death. Methods: 187,860 patients were selected from the Veterans Administration’s (VA) clinical registry (CCR), a longitudinal compilation of electronic medical records (EMR) data for 1999–2010. Inclusion criteria required at least 6 months of CCR/EMR data prior to their HCV diagnosis and sufficient data post-diagnosis to calculate one or more FIB-4 scores. Primary outcome measures were time-to-death and time-to-a composite of liver-related clinical events. Cox proportional hazards models were estimated separately using three critical FIB-4 levels to define early and late viral response. Results: Achieving an undetectable viral load before the patient’s FIB-4 level exceed pre-specified critical values (1.00, 1.45 and 3.25) effectively reduced the risk of an adverse clinical events by 33–35% and death by 21–26%. However, achieving VLS after FIB-4 exceeds 3.25 significantly reduced the benefit of viral response. Conclusions: Delaying VLS until FIB-4 >3.25 reduces the benefits of VLS in reducing patient risk.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"12 1","pages":"333 - 351"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85676893","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}
S. Seabury, D. Goldman, Charu N. Gupta, Z. Khan, A. Chandra, T. Philipson, D. Lakdawalla
Abstract Introduction: There have been significant improvements in both treatment and screening efforts for many types of cancer over the past decade. However, the effect of these advancements on the survival of cancer patients is unknown, and many question the value of both new treatments and screening efforts. Methods: This study uses a retrospective analysis of SEER Registry data to quantify reductions in mortality rates for cancer patients diagnosed between 1997 and 2007. Using variation in trends in mortality rates by stage of diagnosis across cancer types, we use logistic regression to decompose separate survival gains into those attributable to advances in treatment versus advances in detection. We estimate the gains in survival due to gains in both treatment and detection overall and separately for 15 of the most common cancer types. Results: We estimate that 3-year cancer-related mortality of cancer patients fell 16.7% from 1997 to 2007. Overall, advances in treatment reduced mortality rates by approximately 12.2% while advances in early detection reduced mortality rates by 4.5%. The relative importance of treatment and detection varied across cancer types. Improvements in detection were most important for thyroid, prostate and kidney cancer. Improvements in treatment were most important for non-Hodgkins lymphoma, lung cancer and myeloma. Conclusion: Both improved treatment options and better early detection have led to significant survival gains for cancer patients diagnosed from 1997 to 2007, generating considerable social value over this time period.
{"title":"Quantifying Gains in the War on Cancer Due to Improved Treatment and Earlier Detection","authors":"S. Seabury, D. Goldman, Charu N. Gupta, Z. Khan, A. Chandra, T. Philipson, D. Lakdawalla","doi":"10.1515/fhep-2015-0028","DOIUrl":"https://doi.org/10.1515/fhep-2015-0028","url":null,"abstract":"Abstract Introduction: There have been significant improvements in both treatment and screening efforts for many types of cancer over the past decade. However, the effect of these advancements on the survival of cancer patients is unknown, and many question the value of both new treatments and screening efforts. Methods: This study uses a retrospective analysis of SEER Registry data to quantify reductions in mortality rates for cancer patients diagnosed between 1997 and 2007. Using variation in trends in mortality rates by stage of diagnosis across cancer types, we use logistic regression to decompose separate survival gains into those attributable to advances in treatment versus advances in detection. We estimate the gains in survival due to gains in both treatment and detection overall and separately for 15 of the most common cancer types. Results: We estimate that 3-year cancer-related mortality of cancer patients fell 16.7% from 1997 to 2007. Overall, advances in treatment reduced mortality rates by approximately 12.2% while advances in early detection reduced mortality rates by 4.5%. The relative importance of treatment and detection varied across cancer types. Improvements in detection were most important for thyroid, prostate and kidney cancer. Improvements in treatment were most important for non-Hodgkins lymphoma, lung cancer and myeloma. Conclusion: Both improved treatment options and better early detection have led to significant survival gains for cancer patients diagnosed from 1997 to 2007, generating considerable social value over this time period.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"17 1","pages":"141 - 156"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72585464","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}
Abstract Motivated by current topics in health economics, we apply the theory of salience to consumer policy. If a government intends to encourage healthier diets without harming consumers by raising taxes, it could initiate information campaigns which focus consumers’ attention either on the healthiness of one item or the unhealthiness of the other item. According to our approach, both campaigns work, but it is more efficient to proclaim the unhealthiness of one product in order to present it as a “ bad.” Our findings imply that comparative advertisement is particularly efficient for entrant firms into established markets.
{"title":"Salience and Health Campaigns","authors":"Markus Dertwinkel-Kalt","doi":"10.1515/fhep-2014-0019","DOIUrl":"https://doi.org/10.1515/fhep-2014-0019","url":null,"abstract":"Abstract Motivated by current topics in health economics, we apply the theory of salience to consumer policy. If a government intends to encourage healthier diets without harming consumers by raising taxes, it could initiate information campaigns which focus consumers’ attention either on the healthiness of one item or the unhealthiness of the other item. According to our approach, both campaigns work, but it is more efficient to proclaim the unhealthiness of one product in order to present it as a “ bad.” Our findings imply that comparative advertisement is particularly efficient for entrant firms into established markets.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"538 1","pages":"1 - 22"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77908348","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}
Abstract Typically, research on the effect of ownership has considered health care providers in isolation of competitive interaction from other firms. This analysis considers how the selection of Medicare reimbursement codes for skilled nursing facilities varies by ownership and is influenced by the competitive spillovers from market dominance of for-profit institutions. We find evidence that not-for-profits are less likely to code patients into the highest reimbursement categories. Further, as the market becomes dominated by for-profits, both for-profit and not-for-profits increase the share of patients in these high reimbursement categories.
{"title":"Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities","authors":"J. Bowblis, Christopher S. Brunt, D. Grabowski","doi":"10.1515/fhep-2014-0006","DOIUrl":"https://doi.org/10.1515/fhep-2014-0006","url":null,"abstract":"Abstract Typically, research on the effect of ownership has considered health care providers in isolation of competitive interaction from other firms. This analysis considers how the selection of Medicare reimbursement codes for skilled nursing facilities varies by ownership and is influenced by the competitive spillovers from market dominance of for-profit institutions. We find evidence that not-for-profits are less likely to code patients into the highest reimbursement categories. Further, as the market becomes dominated by for-profits, both for-profit and not-for-profits increase the share of patients in these high reimbursement categories.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"217 ","pages":"45 - 70"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2014-0006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72505092","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}
Abstract We estimate the marginal benefits of population-based cancer screening by comparing cancer test and detection rates on either side of US guideline-recommended initiation ages (age 40 for breast cancer and age 50 for colorectal cancer during the study period). Using a regression discontinuity design and self-reported test data from national health surveys, we find test rates for breast and colorectal cancer increase at the guideline age thresholds by 109% and 78%, respectively. Data from cancer registries in twelve US states indicate that cancer detection rates increase at the same thresholds by 50% and 49%, respectively. We estimate significant effects of screening on earlier breast cancer detection (1.2 cases/1000 screened) at age 40 and colorectal cancer detection (1.1 cases/1000 individuals screened) at age 50. Forty-eight and 73% of the increases in breast and colorectal case detection occur among middle-stage cancers (localized and regional) with most of the remainder among early-stage (in-situ). Our analysis suggests that the cost of detecting an asymptomatic case of breast cancer at age 40 via population-based screening is $107,000–134,000 and that the cost of detecting an asymptomatic case of colorectal cancer at age 50 is $473,000–485,000.
{"title":"How Effective is Population-Based Cancer Screening? Regression Discontinuity Estimates from the US Guideline Screening Initiation Ages","authors":"S. Kadiyala, E. Strumpf","doi":"10.1515/fhep-2014-0014","DOIUrl":"https://doi.org/10.1515/fhep-2014-0014","url":null,"abstract":"Abstract We estimate the marginal benefits of population-based cancer screening by comparing cancer test and detection rates on either side of US guideline-recommended initiation ages (age 40 for breast cancer and age 50 for colorectal cancer during the study period). Using a regression discontinuity design and self-reported test data from national health surveys, we find test rates for breast and colorectal cancer increase at the guideline age thresholds by 109% and 78%, respectively. Data from cancer registries in twelve US states indicate that cancer detection rates increase at the same thresholds by 50% and 49%, respectively. We estimate significant effects of screening on earlier breast cancer detection (1.2 cases/1000 screened) at age 40 and colorectal cancer detection (1.1 cases/1000 individuals screened) at age 50. Forty-eight and 73% of the increases in breast and colorectal case detection occur among middle-stage cancers (localized and regional) with most of the remainder among early-stage (in-situ). Our analysis suggests that the cost of detecting an asymptomatic case of breast cancer at age 40 via population-based screening is $107,000–134,000 and that the cost of detecting an asymptomatic case of colorectal cancer at age 50 is $473,000–485,000.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"68 1","pages":"139 - 87"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84120848","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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