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Firm Responses to Targeted Consumer Incentives: Evidence from Reference Pricing for Surgical Services 对目标消费者激励的坚定回应:来自外科服务参考定价的证据
Pub Date : 2015-11-04 DOI: 10.2139/ssrn.2686938
C. Whaley, T. Brown
This paper examines how health care providers respond to a reference pricing insurance program that increases consumer cost sharing when consumers choose high-priced surgical providers. We use geographic variation in the population covered by the program to estimate supply-side responses. We find limited evidence of market segmentation and price reductions for providers with baseline prices above the reference price. Finally, approximately 75% of the reduction in provider prices is in the form of a positive externality that benefits a population not subject to the program.
本文探讨了医疗保健提供者如何回应一个参考定价保险计划,增加消费者的成本分担,当消费者选择高价手术提供者。我们利用该计划所涵盖人口的地理差异来估计供方的反应。我们发现有限的证据表明,市场细分和降价的基准价格高于参考价格的供应商。最后,大约75%的供应商价格下降是以正外部性的形式出现的,这使不受该计划影响的人群受益。
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引用次数: 22
Would You Choose to Be Happy? Tradeoffs between Happiness and the Other Dimensions of Life in a Large Population Survey 你会选择快乐吗?在一项大型人口调查中,幸福与生活其他方面的权衡
Pub Date : 2015-08-05 DOI: 10.2139/ssrn.2640117
M. Adler, P. Dolan, G. Kavetsos
A large literature documents the determinants of happiness. But is happiness all that people want from life; and if so, what type of happiness matters to them? Or are they willing to sacrifice happiness (however it is defined) for other attributes in their lives? We show direct evidence that individuals trade-off levels of happiness with levels of income, physical health, family, career success and education in a large sample of UK and US individuals. On average, all types of happiness are preferred to other attributes except health. People prefer affective happiness (feeling good) over evaluative (life satisfaction) and eudaimonic (worthwhileness) components. This result is robust to methodological innovations, such as the use of vignettes and judgements of the lives described.
大量文献记录了幸福的决定因素。但是,幸福是人们想从生活中得到的全部吗?如果是这样的话,什么样的幸福对他们来说很重要呢?或者他们愿意牺牲幸福(不管它是如何定义的)来换取生活中的其他属性吗?我们在英国和美国的大量样本中展示了直接证据,表明个人的幸福水平与收入、身体健康、家庭、事业成功和教育水平之间存在权衡关系。平均而言,除了健康之外,所有类型的幸福都比其他属性更受欢迎。人们更喜欢情感幸福(感觉良好),而不是评估幸福(生活满意度)和幸福幸福(价值感)。这一结果对于方法上的创新是强有力的,比如使用小插曲和对所描述的生活的判断。
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引用次数: 64
Estimating Sign-Dependent Societal Preferences for Quality of Life 估计符号依赖的社会生活质量偏好
Pub Date : 2015-08-01 DOI: 10.2139/ssrn.2490462
A. Attema, W. Brouwer, Olivier L’Haridon, J. Pinto-Prades
This paper is the first to apply prospect theory to societal health-related decision making. In particular, we allow for utility curvature, equity weighting, sign-dependence, and loss aversion in choices concerning quality of life of other people. We find substantial inequity aversion, both for gains and losses, which can be attributed to both diminishing marginal utility and differential weighting of better-off and worse-off. There are also clear framing effects, which violate expected utility. Moreover, we observe loss aversion, indicating that subjects give more weight to one group's loss than another group's gain of the same absolute magnitude. We also elicited some information on the effect of the age of the studied group. The amount of inequity aversion is to some extent influenced by the age of the considered patients. In particular, more inequity aversion is observed for gains of older people than gains of younger people.
本文首次将前景理论应用于社会健康相关决策。特别是,我们考虑了效用曲率、权益加权、符号依赖和损失厌恶等因素对他人生活质量的影响。我们发现,无论是对收益还是损失,都存在大量的不平等厌恶,这可以归因于边际效用递减和富裕与贫困的差异权重。也有明显的框架效应,这违反了预期效用。此外,我们观察到损失厌恶,这表明在相同绝对值的情况下,受试者更重视一组的损失,而不是另一组的收益。我们还得到了一些关于研究对象年龄影响的信息。不公平厌恶程度在一定程度上受考虑患者年龄的影响。特别是,老年人的收益比年轻人的收益更令人厌恶不平等。
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引用次数: 14
Cost-Effectiveness of Referring Patients to Centers of Excellence for Mitral Valve Surgery 转介患者到二尖瓣手术卓越中心的成本效益
Pub Date : 2015-05-27 DOI: 10.2139/ssrn.2611186
Guihua Wang, Jun Yu Li, W. Hopp, F. Fazzalari, S. Bolling
BACKGROUNDThe 2014 American Heart Association/American College of Cardiology Valvular Heart Disease Guidelines state that mitral valve diseases should be repaired at a Center of Excellence (CoE). We evaluate the cost-effectiveness of such referrals. METHODSWe estimate patients’ life expectancy based on projected survival of patients after mitral valve surgery and develop a cost model to calculate short- and long-term benefits and costs to both patients and payers. Benefits include increased life expectancy and avoidance of medical complications for patients. Short-term costs include all upfront payments by patients and payers at the time of discharge. Long-term costs include all payments associated with the condition that prompted the surgical procedure incurred during the remainder of a patient’s life. We assess cost-effectiveness of treating patients with various ages and major comorbidities at CoEs vs non-CoEs. RESULTSFull implementation of the guidelines would result in an increase in the percentage of patients obtaining mitral valve repair instead of valve replacement from 58% to 72%. Depending on the patient’s age and comorbidities, it would also result in a 6.64% to 12.47% reduction in mortality, 7.85% to 9.97% reduction in reoperation, 9.97% to 17.16% reduction in stroke, and an average gain of 3.77 to 9.88 months of life expectancy. Finally, greater reliance on CoEs results in financial savings to payers, due to avoidance of the costs of future complications.CONCLUSIONPatients benefit from mitral valve surgery at a CoE regardless of their age or comorbidities. Payers may incur additional short-term costs when patients are referred to a CoE, but these are fully offset by long-term savings at the current repair rate gap of 24% between CoEs and non-CoEs in New York State. Redesigning co-pay structures and/or refining the set of patients who are referred to CoEs could further align the incentives of patients and payers on a case-by-case basis and achieve an even more desirable social outcome.
2014年美国心脏协会/美国心脏病学会瓣膜性心脏病指南指出,二尖瓣疾病应在卓越中心(CoE)进行修复。我们评估这种转诊的成本效益。方法:我们根据二尖瓣手术后患者的预计生存期来估计患者的预期寿命,并建立一个成本模型来计算患者和支付方的短期和长期收益和成本。其好处包括延长了患者的预期寿命和避免了医疗并发症。短期费用包括病人和付款人在出院时支付的所有预付款。长期费用包括在病人余下的生命中与促使手术的条件有关的所有费用。我们评估了CoEs与非CoEs治疗不同年龄和主要合并症患者的成本效益。结果指南的全面实施将导致二尖瓣修复而不是瓣膜置换术的患者比例从58%增加到72%。根据患者的年龄和合并症,它还将导致死亡率降低6.64%至12.47%,再手术减少7.85%至9.97%,中风减少9.97%至17.16%,平均预期寿命增加3.77至9.88个月。最后,由于避免了未来并发症的成本,更多地依赖CoEs可为付款人节省财务费用。结论:无论患者的年龄或合并症如何,均可从CoE的二尖瓣手术中获益。当患者转介到CoE时,支付方可能会产生额外的短期费用,但这些费用完全被纽约州CoE和非CoE之间24%的修复率差距所抵消。重新设计共同支付结构和/或完善转介到CoEs的患者群体,可以进一步在个案基础上协调患者和付款人的激励,并实现更理想的社会结果。
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引用次数: 1
The Relationship of the Collective Effectiveness with the Leadership in a Group Work: A Project in the Field of Health 群体工作中集体效能与领导力的关系:卫生领域的一个项目
Pub Date : 2015-05-20 DOI: 10.13187/ER.2015.95.429
Nejmeddine Ben Abdellatif, Ayda Arjoun, S. Belhadj, N. Belhabib
Based on the work of Bandura, the four effectiveness training sources were examined with respect to the frequency and the perception of a hospital staff. In a context of a group work, where there is no assigned leader, the collective effectiveness of groups is not considered only in case there is a relationship with the individual features of leadership. In addition to the relationship between the existence of an identified group leader and the collective effectiveness of the group, the relationship between collective effectiveness and the group performance result was also examined. The results of the investigation and the interview showed that the control experience was the most frequent and powerful source of effectiveness among the four sources. Moreover, groups with identified leader showed a greater collective effectiveness rather than groups without leaders. The level of groups’ collective effectiveness also showed a positive correlation with the groups' performance result.
在Bandura工作的基础上,对医院工作人员的频率和感知方面的四种有效性培训来源进行了审查。在团队工作的背景下,没有指定的领导者,只有在与领导的个人特征有关系的情况下,才会考虑团队的集体有效性。除了被认同的群体领导者的存在与群体的集体有效性之间的关系外,集体有效性与群体绩效结果之间的关系也进行了研究。调查和访谈的结果表明,控制经验是四个来源中最常见和最强大的有效性来源。此外,有明确领导者的团队比没有领导者的团队表现出更大的集体效率。群体的集体效能水平也与群体的绩效结果呈正相关。
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引用次数: 0
Estimating Preferences in Hedonic Wage Models: Lessons from the Deadliest Catch 在享乐工资模型中估计偏好:来自致命捕捞的教训
Pub Date : 2015-02-14 DOI: 10.2139/ssrn.1697243
Kurt Lavetti
This paper uses unique longitudinal survey data to provide new insights on the empirical estimation of hedonic wage models. First, I estimate the bias components caused by latent worker, establishment, and match heterogeneity that have not been previously identified. Second, I remove the confounding effects of endogenous mobility and sorting to identify workers' preferences for occupational fatality risk. The estimates imply that aversion to marginal increases in fatal risk falls as the level of risk rises. I then extend the model to correct for expectational errors about risk, which I find to cause bias that substantially attenuates compensating wage differentials. Finally, I demonstrate the importance of accounting for on-the-job human capital accumulation in hedonic wage models. In the particular industry studied, the bias from ignoring human capital formation is larger than all sources of static omitted variable bias combined. Although industry-specific, the results identify parameters and biases that it has only been possible to speculate about in more general empirical settings, and aim to narrow the conceptual gap between hedonic wage theory and its empirical applications.
本文利用独特的纵向调查数据,为享乐工资模型的实证估计提供了新的见解。首先,我估计了由潜在工人、建立和匹配异质性引起的偏见成分,这些因素以前没有被识别出来。其次,我消除了内生流动性和分类的混淆效应,以确定工人对职业死亡风险的偏好。这些估计表明,随着风险水平的上升,对致命风险边际增长的厌恶程度会下降。然后,我扩展了这个模型,以纠正对风险的预期错误,我发现这会导致偏差,从而大大削弱补偿性工资差异。最后,我论证了在享乐工资模型中考虑在职人力资本积累的重要性。在研究的特定行业中,忽略人力资本形成的偏差大于所有静态省略变量偏差的总和。尽管是针对特定行业的,但研究结果确定了只有在更一般的实证环境中才能推测的参数和偏差,旨在缩小享乐工资理论与其实证应用之间的概念差距。
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引用次数: 9
Short Term Effects of Public Smoking Bans on Health 公共场所禁烟对健康的短期影响
Pub Date : 2015-02-12 DOI: 10.2139/ssrn.2564186
Fabrizio Mazzonna, P. Salari
This paper evaluates the causal negative effect of environmental tobacco exposure on health by exploiting the time and geographical variation in public-place smoking bans implemented in Switzerland between 2007 and 2011. Using monthly data from the universe of Swiss hospitals between 2004 and 2012, we show that the incidence of acute myocardial infarction hospitalizations decreases by about 10-12% immediately after the law implementation. We also find evidence of heterogeneity by age and sex and across income and education groups. In particular, the policy affected mainly men aged 50+ and the regions characterized by a lower level of income and education.
本文通过利用瑞士在2007年至2011年间实施的公共场所禁烟令的时间和地理变化,评估了环境烟草暴露对健康的因果负面影响。利用2004年至2012年间瑞士各医院的月度数据,我们发现,在法律实施后,急性心肌梗死住院的发生率立即下降了约10-12%。我们还发现了年龄、性别、收入和教育程度不同的异质性证据。特别是,该政策主要影响50岁以上的男性以及收入和教育水平较低的地区。
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引用次数: 2
Cannabis Decriminalization and the Age of Onset of Cannabis Use 大麻非刑事化和开始使用大麻的年龄
Pub Date : 2015-01-27 DOI: 10.2139/ssrn.2556731
Jakub Červený, P. Chomynová, V. Mravčík, J. van Ours
BACKGROUNDIn the Czech Republic in 2010 a law was introduced decriminalizing personal possession of small quantities of several illicit drugs, including cannabis.METHODSWe use 2012 survey data to examine the effect of a change in cannabis policy on the age of onset of cannabis use. We estimate the effect of the policy change using a mixed proportional hazards framework that models the transition to first cannabis use.RESULTSThe change in cannabis policy did not affect the transition to first cannabis use.CONCLUSIONWe find no evidence of cannabis decriminalization affecting the age of onset of cannabis use.
捷克共和国于2010年出台了一项法律,将个人持有少量非法毒品(包括大麻)合法化。方法我们使用2012年的调查数据来检验大麻政策变化对大麻开始使用年龄的影响。我们使用混合比例风险框架来估计政策变化的影响,该框架模拟了向首次使用大麻的过渡。结果大麻政策的改变对首次使用大麻的过渡没有影响。结论我们没有发现大麻非刑事化影响大麻使用年龄的证据。
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引用次数: 27
Will a Fat Tax Work? 肥胖税会奏效吗?
Pub Date : 2015-01-27 DOI: 10.2139/ssrn.2556643
Romana Khan, Kanishka Misra, Vishal Singh
Of the many proposals to reverse the obesity epidemic, the most contentious is the use of price-based interventions such as the fat tax. Previous investigations of the efficacy of such initiatives in altering consumption behavior yielded contradictory findings. In this article, we use six years of point-of-sale scanner data for milk from a sample of over 1,700 supermarkets across the United States to investigate the potential of small price incentives for inducing substitution of healthier alternatives. We exploit a pricing pattern particular to milk in the United States, whereby prices in some geographical regions are flat across whole, 2%, 1%, and skim milk; whereas in other regions they are decreasing with the fat content level. The prevailing price structure is determined at a chain and regional level, and is independent of local demand conditions. This exogenous variation in price structure provides a quasi-experimental set-up to analyze the impact of small price differences on substitution across fat content. We use detailed demographics to evaluate price sensitivity and substitution patterns for different socioeconomic groups. Results show that small price differences are highly effective in inducing substitution to lower calorie options. The impact is highest for low-income households who are also most at risk for obesity. Our results suggest that a selective taxation mechanism that lowers the relative prices of healthier options, such that those price changes are reflected in shelf prices at the point-of-purchase, can serve as an effective health policy tool in the efforts to control obesity.Data, as supplemental material, are available at http://dx.doi.org/10.1287/mksc.2015.0917 . Press Release
在许多扭转肥胖流行的建议中,最具争议的是使用基于价格的干预措施,如脂肪税。先前对此类举措在改变消费行为方面的有效性的调查得出了相互矛盾的结果。在这篇文章中,我们使用了六年的销售点扫描数据,这些数据来自美国1700多家超市的样本,以调查小额价格激励的潜力,以诱导更健康的替代品的替代。我们利用了美国牛奶特有的定价模式,即在某些地理区域,全脂牛奶、2%牛奶、1%牛奶和脱脂牛奶的价格持平;而在其他地区,它们随着脂肪含量水平而下降。现行的价格结构是在连锁和区域一级决定的,不受当地需求条件的影响。这种价格结构的外生变化提供了一种准实验设置,可以分析小的价格差异对脂肪含量替代的影响。我们使用详细的人口统计数据来评估不同社会经济群体的价格敏感性和替代模式。结果表明,小的价格差异非常有效地诱导替代低卡路里的选择。低收入家庭受到的影响最大,他们也最有可能肥胖。我们的研究结果表明,有选择性的税收机制可以降低更健康选择的相对价格,从而使这些价格变化反映在购买点的货架价格上,可以作为控制肥胖的有效卫生政策工具。作为补充资料的数据可在http://dx.doi.org/10.1287/mksc.2015.0917上获得。新闻稿
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引用次数: 38
A Drug Cost Estimation Model and its Determinant Factors for Breast Cancer Patient Hospitalized in Indonesia 印度尼西亚乳腺癌住院患者药物成本估算模型及其决定因素
Pub Date : 2015-01-04 DOI: 10.2139/ssrn.2545043
D. A. Puspandari, A. Mukti, H. Kusnanto
The study offers the drug cost of breast cancer in Indonesia. their associated factors and the magnitude of the factors. The design of research was a cross sectional descriptive analysis using health facilities costing study that was conducted in Indonesia in 2011. The drug cost model was formulated as a cost of illness employing the prevalence based approach from a provider’s perspective.Based on the fitted model, the variables include patient characteristics (age, length of stay, ICU facility usage), hospital characteristics (drug supply problem), hospital location (Java and non-Java). The formula is as follows : Ln drug cost = 13,41 (0,31 X % patient age 40-
这项研究提供了印度尼西亚治疗乳腺癌的药物成本。它们的相关因素和这些因素的大小。研究设计采用横断面描述性分析,采用2011年在印度尼西亚进行的卫生设施成本计算研究。从提供者的角度出发,采用基于流行率的方法,将药物成本模型制定为疾病成本。根据拟合模型,变量包括患者特征(年龄、住院时间、ICU设施使用情况)、医院特征(药物供应问题)、医院位置(Java和非Java)。公式为:Ln药费= 13,41 (0,31)X %患者年龄40-
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引用次数: 1
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Health Economics Evaluation Methods eJournal
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