International Journal of Health Economics and Management最新文献

This paper analyses the influence of several determinants on life expectancy at birth in 36 OECD countries over the 1999-2018 period. We utilized a cross-country fixed-effects multiple regression analysis with year and country dummies and used dynamic models, backward stepwise selection, and Arellano-Bond estimators to treat potential endogeneity issues. The results show the influence of per capita health-care expenditure, incidence of out-of-pocket expenditure, physician density, hospital bed density, social spending, GDP level, participation ratio to labour, prevalence of chronic respiratory diseases, temperature, and total size of the population on life expectancy at birth. In line with previous studies, this analysis confirms the relevance of both health care expenditure and health care system (physicians and hospital beds in our analysis) in influencing a country's population life expectancy. It also outlines the importance of other factors related to population behaviour and social spending jointly considered on this outcome. Policy makers should carefully consider these mutual influences when allocating public funds, particularly after the COVID-19 pandemic period.

Under Hungary's single payer health care system, hospitals face an annual budget cap on most of their diagnoses-related group based reimbursements. In July 2012, percutaneous coronary intervention (PCI) treatments of acute myocardial infarction were exempted from that hospital level budget cap. We use countrywide individual-level patient data from 2009 to 2015 to map the effect of such a quasi-experimental change in monetary incentives on health provider decisions and health outcomes. We find that direct admissions into PCI-capable hospitals increase, especially in central Hungary, where there are several hospitals which can compete for patients. The proportion of PCI treatments at PCI-capable hospitals, however, does not increase, and neither does the number of patient transfers from non-PCI hospitals to PCI-capable ones. We conclude that only patient pathways, plausibly influenced by hospital management, were affected by the shift in incentives, while physicians' treatment decisions were not. While average length of stay decreased, we do not find any effect on 30-day readmissions or in-hospital mortality.

This study examines the efficacy of Askeskin, a subsidized social health insurance targeted towards poor households and informal sector workers in Indonesia, in mitigating the impact of adverse health shocks on household consumption. To overcome selection bias from non-experimental nature of Askeskin enrolment, I use a robust estimation strategy, where outcome regressions are run on a propensity score-based matching sample. Using longitudinal data from the Indonesia Family Life Survey, this study finds that uninsured households facing extreme health health shocks experience a 1.3% point loss in growth in food and 2% point loss in non-food consumption growth. Importantly, households having Askeskin insurance, are fully insured in terms of food and medical consumption. But non-food spending, a discretionary component, is not insured fully resulting in a 1.2% point fall in consumption growth rate, despite Askeskin. This result is robust to a battery of sensitivity and robustness checks, including alternate definition of health shocks. Further, I investigate whether the Askeskin program simply displaced informal, community-based mechanisms of risk sharing. No crowd out effect is observed and informal risk-sharing coexists with Askeskin.

A large number of the poor elderly in Korea have been exposed to the risk of insufficient proper medical treatments because of financial restrictions. South Korea launched policies to reduce the cost-sharing burden on the elderly, including one compelling the elderly to pay a fixed out-of-pocket amount for outpatient treatments. The impacts of such policies, however, have yet to be elucidated. In this paper, we estimate the short-term effects of the fixed outpatient copayment policy on the health-related behavior of the elderly. We employed a regression discontinuity design by using the exact days before and after the sample's 65th birthdate as the assignment variable, along with the restricted individual-level 2012 and 2013 National Health Insurance claims data. Results show that the policy increased the elderly's health service utilization numbers and reduced out-of-pocket spending for insured services. Moreover, the effects on prescription spending and the insurer's burden differed depending on beneficiaries' characteristics.

Health insurance markets with community-rated premiums typically use risk equalization (RE) to compensate insurers for predictable profits on people in good health and predictable losses on those with a chronic disease. Over the past decades RE models have evolved from simple demographic models to sophisticated health-based models. Despite the improvements, however, non-trivial predictable profits and losses remain. This study examines to what extent the Dutch RE model can be further improved by redesigning one key morbidity adjuster: the Diagnosis-based Cost Groups (DCGs). This redesign includes (1) revision of the underlying hospital diagnoses and treatments ('dxgroups'), (2) application of a new clustering procedure, and (3) allowing multi-qualification. We combine data on spending, risk characteristics and hospital claims for all individuals with basic health insurance in the Netherlands in 2017 (N = 17 m) with morbidity data from general practitioners (GPs) for a subsample (N = 1.3 m). We first simulate a baseline RE model (i.e., the RE model of 2020) and then modify three important features of the DCGs. In a second step, we evaluate the effect of the modifications in terms of predictable profits and losses for subgroups of consumers that are potentially vulnerable to risk selection. While less prominent results are found for subgroups derived from the GP data, our results demonstrate substantial reductions in predictable profits and losses at the level of dxgroups and for individuals with multiple dxgroups. An important takeaway from our paper is that smart design of morbidity adjusters in RE can help mitigate selection incentives.

Public concern about the rising number of older dependent citizens is still based mainly on standard population aging indicators. This includes the old-age dependency ratio (OADR), which divides the state pension age population by the working age population. However, the OADR counts neither the dependent elderly nor those who provide for them. This paper builds on previous research to propose several alternative indicators, including the health care (HC) need-adjusted real elderly dependency ratio and the HC need-adjusted dependent population-to-tax rate. These indicators consider improvements in old-age survival and time to death in order to better define the health care needs of the dependent old-age population and to better approximate their financial burden. We define the old-age population dependent on health care as those above the age at which remaining life expectancy is 15 years or less and are expected to die within 5 years. We use data from the US to illustrate differences between the proposed new and standard measures. Results show that, as a share of the total population, the old-age population dependent on health care has virtually not changed since 1950. Moreover, increases in GDP and state tax revenue have outstripped population aging almost continuously since 1970, irrespective of the indicator used, and they are expected to continue to do so during the coming decade. The demand for health care services is therefore not being fueled by population aging but instead by other factors such as progress in medical knowledge and technology, costs of hospitalization, and the increasing use of long-term care facilities.

Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam's social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006-2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.

We describe a "union advantage" in health insurance coverage and access to care. Using multiple statistical models and data from the Medical Expenditure Panel Survey for 1996-2019, we show that-compared to non-union workers-union workers are more likely to have health insurance coverage (98% vs. 86%), more likely to have a regular care provider (83% vs. 74%), visited office-based providers 31% more often (5.64 vs. 4.27 visits), spend $832 more on healthcare annually, and pay a lower share of their expenditures out-of-pocket (26% vs. 37%). When we control for demographic characteristics across variety of specifications, these differences almost always remain at a statistically significant level. Further, we show that the union advantage is greater for low-income workers. Next, we demonstrate that-although the Affordable Care Act (ACA) appears to have reduced the union advantage in health insurance coverage by increasing coverage rates among non-union workers-a substantial union advantage in access to care remains after the ACA's main provisions become effective. Finally, we explore how the ACA interacted with the trade union  goal of maintaining employer-based health insurance. We show that unionized workers are less likely to contribute to "enrollment shifting," which occurs when individuals shift from existing employer-based insurance to a new government funded program. This suggests that union bargaining over fringe benefits may have positive externalities in the form of cost reductions to the public sector.

This study investigates the effects of minimum wage on health, well-being, and income security in European countries. The empirical strategy consists of exploiting variations in the minimum wage across European countries over time. We show that minimum wage increases improve individuals' self-reported health and income security. Minimum wage increases also improve life satisfaction and happiness. The effects are largest among women, employed individuals, married individuals, and those with less than a secondary education. Our results are robust to several robustness checks and consistent with existing evidence on the relationship between minimum wage and health.