The US population over 65 has seen significant and sustained improvement in its absolute and relative well-being over the past half century. This paper offers a survey of trends in old-age poverty, income, inequality, labor market activity, educational attainment, insurance coverage, and health status. It concludes with a brief discussion of whether the favorable trends of the past half century can continue in the next few decades. Even though the absolute and relative positions of the nation’s aged have steadily improved over time, much of the improvement is traceable to public programs like Social Security and Medicare. These programs face gloomy financial prospects. If future voters and lawmakers scale back benefits to keep payroll taxes close to their current level, the nation’s elderly will need to rely on private resources to pay for a bigger fraction of their retirement needs. The statistics on saving and wealth accumulation suggest that relatively few working-age Americans plan to accomplish this by increasing the share of their current incomes they devote to saving. The future economic well-being of the elderly may therefore depend on their willingness to work longer and delay the age at which they rely on public programs and private savings to pay for their consumption.
{"title":"Trends in the Well-Being of the Aged and Their Prospects through 2030","authors":"Gary T. Burtless","doi":"10.1515/FHEP-2015-0039","DOIUrl":"https://doi.org/10.1515/FHEP-2015-0039","url":null,"abstract":"The US population over 65 has seen significant and sustained improvement in its absolute and relative well-being over the past half century. This paper offers a survey of trends in old-age poverty, income, inequality, labor market activity, educational attainment, insurance coverage, and health status. It concludes with a brief discussion of whether the favorable trends of the past half century can continue in the next few decades. Even though the absolute and relative positions of the nation’s aged have steadily improved over time, much of the improvement is traceable to public programs like Social Security and Medicare. These programs face gloomy financial prospects. If future voters and lawmakers scale back benefits to keep payroll taxes close to their current level, the nation’s elderly will need to rely on private resources to pay for a bigger fraction of their retirement needs. The statistics on saving and wealth accumulation suggest that relatively few working-age Americans plan to accomplish this by increasing the share of their current incomes they devote to saving. The future economic well-being of the elderly may therefore depend on their willingness to work longer and delay the age at which they rely on public programs and private savings to pay for their consumption.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"68 1","pages":"118 - 97"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86470715","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 About 30 percent of Medicare beneficiaries enroll in private Medicare Advantage (MA) plans but do so at a relatively high-cost. This paper explores the advantages and challenges of introducing competitive bidding among MA plans (Plan One) or among MA plans and Fee-for-Service (Plan Two or Premium Support). We conclude that competitive bidding could reduce the cost of Medicare, especially in densely populated urban areas. However, there would be serious challenges in rural areas and risk adjustment methodology would have to be substantially improved. In Plan Two, sicker beneficiaries might move to Fee-for-Service and beneficiaries might have to pay more to stay with a preferred provider or broader network. If these problems are addressed, we believe that premium support can be a meaningful improvement to the MA program.
{"title":"Could Improving Choice and Competition in Medicare Advantage be the Future of Medicare?","authors":"A. Rivlin, Willemsen Daniel","doi":"10.1515/fhep-2015-0046","DOIUrl":"https://doi.org/10.1515/fhep-2015-0046","url":null,"abstract":"Abstract About 30 percent of Medicare beneficiaries enroll in private Medicare Advantage (MA) plans but do so at a relatively high-cost. This paper explores the advantages and challenges of introducing competitive bidding among MA plans (Plan One) or among MA plans and Fee-for-Service (Plan Two or Premium Support). We conclude that competitive bidding could reduce the cost of Medicare, especially in densely populated urban areas. However, there would be serious challenges in rural areas and risk adjustment methodology would have to be substantially improved. In Plan Two, sicker beneficiaries might move to Fee-for-Service and beneficiaries might have to pay more to stay with a preferred provider or broader network. If these problems are addressed, we believe that premium support can be a meaningful improvement to the MA program.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"181 1","pages":"151 - 168"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74383235","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 Legal prohibitions on sex-selective abortions are proliferating in the United States. Eight state legislatures have banned abortions sought on the basis of the sex of the fetus, 21 states have considered such laws since 2009, and a similar bill is pending in U.S. Congress. These laws have been introduced and enacted without any empirical data about their impact or effectiveness. Prior studies of U.S. Census data found sex ratios among foreign-born Chinese, Korean and Indian immigrants were skewed in favor of boys, but only in families where there were already one or two girls. Using the variation in the timing of bans in Illinois and Pennsylvania as natural experiments, we compare the pre-ban and post-ban sex ratios of certain Asian newborn children in these states over 12-year periods. We then compare these ratios with the sex ratios of Asian newborn children in neighboring states during the same period. We find that the bans in Illinois and Pennsylvania are not associated with any changes in sex ratios at birth among Asians. In Illinois and its neighboring states, the sex ratio at birth of Asian children was not male-biased during our study period. On the other hand, the sex ratio at birth among Asians in Pennsylvania and its neighboring states was skewed slightly in favor of boys, but the enactment of the ban did not normalize the sex ratio. This strongly suggests that sex-selective abortion bans have had no impact on the practice of sex selection, to the extent that it occurs, in these states. This finding is highly relevant to legislative and policy debates in the U.S. Congress and state legislatures where sex-selective abortion laws are being considered.
{"title":"Sex-selective Abortion Bans are Not Associated with Changes in Sex Ratios at Birth among Asian Populations in Illinois and Pennsylvania","authors":"Arindam Nandi, Sital Kalantry, B. Citro","doi":"10.1515/fhep-2014-0018","DOIUrl":"https://doi.org/10.1515/fhep-2014-0018","url":null,"abstract":"Abstract Legal prohibitions on sex-selective abortions are proliferating in the United States. Eight state legislatures have banned abortions sought on the basis of the sex of the fetus, 21 states have considered such laws since 2009, and a similar bill is pending in U.S. Congress. These laws have been introduced and enacted without any empirical data about their impact or effectiveness. Prior studies of U.S. Census data found sex ratios among foreign-born Chinese, Korean and Indian immigrants were skewed in favor of boys, but only in families where there were already one or two girls. Using the variation in the timing of bans in Illinois and Pennsylvania as natural experiments, we compare the pre-ban and post-ban sex ratios of certain Asian newborn children in these states over 12-year periods. We then compare these ratios with the sex ratios of Asian newborn children in neighboring states during the same period. We find that the bans in Illinois and Pennsylvania are not associated with any changes in sex ratios at birth among Asians. In Illinois and its neighboring states, the sex ratio at birth of Asian children was not male-biased during our study period. On the other hand, the sex ratio at birth among Asians in Pennsylvania and its neighboring states was skewed slightly in favor of boys, but the enactment of the ban did not normalize the sex ratio. This strongly suggests that sex-selective abortion bans have had no impact on the practice of sex selection, to the extent that it occurs, in these states. This finding is highly relevant to legislative and policy debates in the U.S. Congress and state legislatures where sex-selective abortion laws are being considered.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"53 1","pages":"41 - 64"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79408534","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 Tobacco taxes in Canada varied markedly across time and across regions in the early 1990s. We exploit this variation to estimate the long reach of prices faced in adolescence on smoking behavior roughly a decade later in early to mid-adulthood. Results from a variety of econometric approaches suggest that there is a small but detectable long-run effect of price faced during adolescence. A 10% increase in prices faced during adolescence, holding contemporaneous prices constant, leads to roughly a 1% reduction in adult smoking propensity and intensity. The results are somewhat sensitive to specification and to how price during adolescence is measured.
{"title":"Long-Term Effects of Tobacco Prices Faced by Adolescents","authors":"M. Auld, M. Zarrabi","doi":"10.1515/fhep-2014-0005","DOIUrl":"https://doi.org/10.1515/fhep-2014-0005","url":null,"abstract":"Abstract Tobacco taxes in Canada varied markedly across time and across regions in the early 1990s. We exploit this variation to estimate the long reach of prices faced in adolescence on smoking behavior roughly a decade later in early to mid-adulthood. Results from a variety of econometric approaches suggest that there is a small but detectable long-run effect of price faced during adolescence. A 10% increase in prices faced during adolescence, holding contemporaneous prices constant, leads to roughly a 1% reduction in adult smoking propensity and intensity. The results are somewhat sensitive to specification and to how price during adolescence is measured.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"20 1","pages":"1 - 24"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83325692","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 The BRICS countries (Brazil, Russia, India, China, and South Africa) have experienced tremendous economic and health gains in recent decades. Two of the major health challenges faced by the BRICS and other low and middle income countries are decreasing inequity in health outcomes and increasing affordability of health insurance. One fiscally sustainable option for the BRICS governments is a public subsidy system for private health insurance plans. This essay lays out the potential applicability and impacts of public subsidies for private health insurance plans, as well as opportunities and challenges for implementation, in the BRICS countries. Overall, providing public subsidies rather than health insurance would enable the BRICS governments to avoid the open-ended financial liabilities that have plagued advanced economies, while still expanding access to health insurance and encouraging the develoment of a robust private health insurance market. We conclude by suggesting an array of pilot programs that could serve as the seeds for publicly subsidized health insurance schemes within the BRICS markets.
{"title":"Public-Private Partnership as a Path to Affordable Healthcare in Emerging Markets","authors":"J. W. Chou, D. Lakdawalla, J. Vanderpuye-Orgle","doi":"10.1515/fhep-2014-0023","DOIUrl":"https://doi.org/10.1515/fhep-2014-0023","url":null,"abstract":"Abstract The BRICS countries (Brazil, Russia, India, China, and South Africa) have experienced tremendous economic and health gains in recent decades. Two of the major health challenges faced by the BRICS and other low and middle income countries are decreasing inequity in health outcomes and increasing affordability of health insurance. One fiscally sustainable option for the BRICS governments is a public subsidy system for private health insurance plans. This essay lays out the potential applicability and impacts of public subsidies for private health insurance plans, as well as opportunities and challenges for implementation, in the BRICS countries. Overall, providing public subsidies rather than health insurance would enable the BRICS governments to avoid the open-ended financial liabilities that have plagued advanced economies, while still expanding access to health insurance and encouraging the develoment of a robust private health insurance market. We conclude by suggesting an array of pilot programs that could serve as the seeds for publicly subsidized health insurance schemes within the BRICS markets.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"44 1","pages":"65 - 74"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83011524","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}
Pub Date : 2014-11-01Epub Date: 2014-11-04DOI: 10.1515/fhep-2014-0013
Julie Zissimopoulos, Eileen Crimmins, Patricia St Clair
Alzheimer's disease (AD) extracts a heavy societal toll. The value of medical advances that delay onset of AD could be significant. Using data from nationally representative samples from the Health and Retirement Study (1998-2008) and Aging Demographics and Memory Study (2001-2009), we estimate the prevalence and incidence of AD and the formal and informal health care costs associated with it. We use microsimulation to project future prevalence and costs of AD under different treatment scenarios. We find from 2010 to 2050, the number of individuals ages 70+ with AD increases 153%, from 3.6 to 9.1 million, and annual costs increase from $307 billion ($181B formal, $126B informal costs) to $1.5 trillion. 2010 annual per person costs were $71,303 and double by 2050. Medicare and Medicaid are paying 75% of formal costs. Medical advances that delay onset of AD for 5 years result in 41% lower prevalence and 40% lower cost of AD in 2050. For one cohort of older individuals, who would go on to acquire AD, a 5-year delay leads to 2.7 additional life years (about 5 AD-free), slightly higher formal care costs due to longer life but lower informal care costs for a total value of $511,208 per person. We find Medical advances delaying onset of AD generate significant economic and longevity benefits. The findings inform clinicians, policymakers, businesses and the public about the value of prevention, diagnosis, and treatment of AD.
{"title":"The Value of Delaying Alzheimer's Disease Onset.","authors":"Julie Zissimopoulos, Eileen Crimmins, Patricia St Clair","doi":"10.1515/fhep-2014-0013","DOIUrl":"https://doi.org/10.1515/fhep-2014-0013","url":null,"abstract":"<p><p>Alzheimer's disease (AD) extracts a heavy societal toll. The value of medical advances that delay onset of AD could be significant. Using data from nationally representative samples from the Health and Retirement Study (1998-2008) and Aging Demographics and Memory Study (2001-2009), we estimate the prevalence and incidence of AD and the formal and informal health care costs associated with it. We use microsimulation to project future prevalence and costs of AD under different treatment scenarios. We find from 2010 to 2050, the number of individuals ages 70+ with AD increases 153%, from 3.6 to 9.1 million, and annual costs increase from $307 billion ($181B formal, $126B informal costs) to $1.5 trillion. 2010 annual per person costs were $71,303 and double by 2050. Medicare and Medicaid are paying 75% of formal costs. Medical advances that delay onset of AD for 5 years result in 41% lower prevalence and 40% lower cost of AD in 2050. For one cohort of older individuals, who would go on to acquire AD, a 5-year delay leads to 2.7 additional life years (about 5 AD-free), slightly higher formal care costs due to longer life but lower informal care costs for a total value of $511,208 per person. We find Medical advances delaying onset of AD generate significant economic and longevity benefits. The findings inform clinicians, policymakers, businesses and the public about the value of prevention, diagnosis, and treatment of AD.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"18 1","pages":"25-39"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2014-0013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34361480","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 Bans on retail tobacco displays, of the type proposed by New York’s Mayor Bloomberg in March 2013, have been operative in several economies since 2001. Despite an enormous number of studies in public health journals using attitudinal data, we can find no econometric event studies of the type normally used in Economics. This paper attempts to fill that gap by using data from 13 cross sections of the annual Canadian Tobacco Use Monitoring Surveys. These data afford an ideal opportunity to study events of this type given that each of Canada’s 10 provinces implemented display bans at various points between 2003 and 2009. Accordingly, we use difference-in-difference methods to study three behaviors following the introduction of bans: participation in smoking, the intensity of smoking and quit intentions. A critical element of the study concerns the treatment of contraband tobacco. Our estimates provide very little support for the hypothesis that behaviors changed following the bans.
{"title":"Retail Tobacco Display Bans","authors":"I. Irvine, V. Nguyen","doi":"10.1515/fhep-2013-0019","DOIUrl":"https://doi.org/10.1515/fhep-2013-0019","url":null,"abstract":"Abstract Bans on retail tobacco displays, of the type proposed by New York’s Mayor Bloomberg in March 2013, have been operative in several economies since 2001. Despite an enormous number of studies in public health journals using attitudinal data, we can find no econometric event studies of the type normally used in Economics. This paper attempts to fill that gap by using data from 13 cross sections of the annual Canadian Tobacco Use Monitoring Surveys. These data afford an ideal opportunity to study events of this type given that each of Canada’s 10 provinces implemented display bans at various points between 2003 and 2009. Accordingly, we use difference-in-difference methods to study three behaviors following the introduction of bans: participation in smoking, the intensity of smoking and quit intentions. A critical element of the study concerns the treatment of contraband tobacco. Our estimates provide very little support for the hypothesis that behaviors changed following the bans.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"34 1","pages":"169 - 195"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82740935","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}
D. Lakdawalla, J. Snider, D. Perlroth, C. LaVallee, M. Linthicum, T. Philipson, J. Partridge, P. Wischmeyer
Abstract We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000–2010). ONS use was associated with reductions in probability of 30-day readmission by 12.0% in AMI and 10.1% in CHF. LOS decreases of 10.9% in AMI, 14.2% in CHF, and 8.5% in PNA were associated with ONS, as were decreases in episode costs in AMI, CHF and PNA of 5.1%, 7.8% and 10.6%, respectively. The effect on LOS and episode cost was greatest for the Any Diagnosis population, with decreases of 16.0% and 15.8%, respectively. ONS use in hospitalized Medicare patients ≥65 is associated with improved outcomes and decreased healthcare costs, and is therefore relevant to providers seeking an inexpensive, evidence-based approach for meeting Affordable Care Act quality targets.
我们分析了口服营养补充剂(ONS)使用对住院医保患者(≥65岁)30天再入院率、住院时间(LOS)和发作费用的影响，以及诊断为急性心肌梗死(AMI)、充血性心力衰竭(CHF)或肺炎(PNA)患者亚群的影响。倾向得分匹配和工具变量用于分析来自Premier Research Database(2000-2010)的国家统计局和非国家统计局事件。使用ONS与AMI患者30天再入院概率降低12.0%和CHF患者降低10.1%相关。AMI患者的LOS降低10.9%，CHF患者的LOS降低14.2%，PNA患者的LOS降低8.5%与ONS相关，AMI、CHF和PNA患者的发作成本分别降低5.1%、7.8%和10.6%。对任意诊断人群的LOS和发作费用的影响最大，分别下降了16.0%和15.8%。在65岁以上的住院医疗保险患者中使用ONS与改善预后和降低医疗成本相关，因此与寻求廉价、循证方法以满足《平价医疗法案》质量目标的提供者相关。
{"title":"Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital?","authors":"D. Lakdawalla, J. Snider, D. Perlroth, C. LaVallee, M. Linthicum, T. Philipson, J. Partridge, P. Wischmeyer","doi":"10.1515/fhep-2014-0011","DOIUrl":"https://doi.org/10.1515/fhep-2014-0011","url":null,"abstract":"Abstract We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000–2010). ONS use was associated with reductions in probability of 30-day readmission by 12.0% in AMI and 10.1% in CHF. LOS decreases of 10.9% in AMI, 14.2% in CHF, and 8.5% in PNA were associated with ONS, as were decreases in episode costs in AMI, CHF and PNA of 5.1%, 7.8% and 10.6%, respectively. The effect on LOS and episode cost was greatest for the Any Diagnosis population, with decreases of 16.0% and 15.8%, respectively. ONS use in hospitalized Medicare patients ≥65 is associated with improved outcomes and decreased healthcare costs, and is therefore relevant to providers seeking an inexpensive, evidence-based approach for meeting Affordable Care Act quality targets.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"41 1","pages":"131 - 151"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79479196","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 Both tobacco use and obesity are among the most important and costly health challenges faced in developed countries. Unfortunately, they may be inversely linked. While policy interventions that have placed limits on tobacco use have increased substantially over time, one unintended consequence may be to increase obesity rates. Issues of selection and unobserved heterogeneity make it difficult to empirically assess the relationship between the two health outcomes. Additionally, there may be heterogeneous policy effects by cessation cause – smoking bans or medical treatments or tobacco prices. This paper focuses on the effects of a rapidly expanding policy by using within-individual differences in exposure to workplace smoking bans to estimate the impact of smoking cessation on weight gain using a large study of over 5000 White and Black respondents followed since 1986. Findings suggest that individuals affected by the smoking bans gained more weight in the short-term than suggested by OLS estimates.
{"title":"The Effects of Smoking Cessation on Weight Gain: New Evidence Using Workplace Smoking Bans","authors":"Jason M. Fletcher","doi":"10.1515/fhep-2013-0004","DOIUrl":"https://doi.org/10.1515/fhep-2013-0004","url":null,"abstract":"Abstract Both tobacco use and obesity are among the most important and costly health challenges faced in developed countries. Unfortunately, they may be inversely linked. While policy interventions that have placed limits on tobacco use have increased substantially over time, one unintended consequence may be to increase obesity rates. Issues of selection and unobserved heterogeneity make it difficult to empirically assess the relationship between the two health outcomes. Additionally, there may be heterogeneous policy effects by cessation cause – smoking bans or medical treatments or tobacco prices. This paper focuses on the effects of a rapidly expanding policy by using within-individual differences in exposure to workplace smoking bans to estimate the impact of smoking cessation on weight gain using a large study of over 5000 White and Black respondents followed since 1986. Findings suggest that individuals affected by the smoking bans gained more weight in the short-term than suggested by OLS estimates.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"28 1","pages":"105 - 129"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80018539","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. Lakdawalla, D. Walter, J. Hayes, T. Gustafson, A. Shrestha, D. Goldman
Abstract Many state Medicaid programs have implemented policies designed to reduce spending on prescription drugs by restricting access to branded products. For patients with major depressive disorder, formulary restrictions could severely limit access to antidepressant therapies and disrupt care. We linked data on patient outcomes and spending from 24 state Medicaid programs to information on formulary restrictions from 2001 to 2008. Outcomes included frequency of MDD-related hospitalizations and ER visits per patient and total healthcare spending. We estimated the effect of the policies on patient outcomes and spending using a difference-and-difference approach. We found that restricting access to antidepressants increased the probability of an MDD-related hospitalization by 1.7 percentage points (16.6%). Furthermore, we found no evidence that these restrictions resulted in any net savings for Medicaid.
{"title":"Patient Outcomes and Cost Effects of Medicaid Formulary Restrictions on Antidepressants","authors":"S. Seabury, D. Lakdawalla, D. Walter, J. Hayes, T. Gustafson, A. Shrestha, D. Goldman","doi":"10.1515/fhep-2014-0016","DOIUrl":"https://doi.org/10.1515/fhep-2014-0016","url":null,"abstract":"Abstract Many state Medicaid programs have implemented policies designed to reduce spending on prescription drugs by restricting access to branded products. For patients with major depressive disorder, formulary restrictions could severely limit access to antidepressant therapies and disrupt care. We linked data on patient outcomes and spending from 24 state Medicaid programs to information on formulary restrictions from 2001 to 2008. Outcomes included frequency of MDD-related hospitalizations and ER visits per patient and total healthcare spending. We estimated the effect of the policies on patient outcomes and spending using a difference-and-difference approach. We found that restricting access to antidepressants increased the probability of an MDD-related hospitalization by 1.7 percentage points (16.6%). Furthermore, we found no evidence that these restrictions resulted in any net savings for Medicaid.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"17 1","pages":"153 - 168"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89589914","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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