Pub Date : 2025-01-01Epub Date: 2024-12-17DOI: 10.1086/726748
Alice J Chen, J Michael McWilliams
In voluntary alternative payment models, participation is essential for model viability and the progression of provider payment reform. We study participation decisions of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). We leverage a natural experiment in which a 2017 rule change introduced differential shocks to an ACO's baseline spending and performance-year spending. The net effect was an effective change in benchmarks that varied across ACOs. Dropout was 7 percentage points more likely among ACOs with effective benchmark decreases. While small reductions in the effective benchmark did not affect program participation, larger reductions increased dropout by 11 percentage points. ACOs with spending already above their benchmarks were particularly sensitive to effective benchmark reductions, consistent with the program's weak long-term incentives to reduce spending. Our results highlight the causal role benchmarks play in determining ACO participation and the need to consider the consequences of participation effects in the design of new payment models.
{"title":"How Benchmark Changes Affect Participation in Accountable Care Organizations: Prospects for Voluntary Payment Models.","authors":"Alice J Chen, J Michael McWilliams","doi":"10.1086/726748","DOIUrl":"10.1086/726748","url":null,"abstract":"<p><p>In voluntary alternative payment models, participation is essential for model viability and the progression of provider payment reform. We study participation decisions of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). We leverage a natural experiment in which a 2017 rule change introduced differential shocks to an ACO's baseline spending and performance-year spending. The net effect was an effective change in benchmarks that varied across ACOs. Dropout was 7 percentage points more likely among ACOs with effective benchmark decreases. While small reductions in the effective benchmark did not affect program participation, larger reductions increased dropout by 11 percentage points. ACOs with spending already above their benchmarks were particularly sensitive to effective benchmark reductions, consistent with the program's weak long-term incentives to reduce spending. Our results highlight the causal role benchmarks play in determining ACO participation and the need to consider the consequences of participation effects in the design of new payment models.</p>","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":" ","pages":"38-62"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41519318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel M. Werner, Norma B. Coe, Seiyoun Kim, R. Konetzka
{"title":"The Effects of Post-Acute Care Payment Reform on Caregiving","authors":"Rachel M. Werner, Norma B. Coe, Seiyoun Kim, R. Konetzka","doi":"10.1086/729337","DOIUrl":"https://doi.org/10.1086/729337","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"55 45","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139384582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-04-09DOI: 10.1086/728931
Luca Fumarco, Benjamin J Harrell, Patrick Button, David J Schwegman, E Dils
Racial, ethnic, and gender minorities face mental health disparities. While mental health care can help, minorities could face discriminatory barriers in accessing it. Discrimination may be particularly pronounced in mental health care because providers have more discretion over accepting patients. Research documents discrimination, including in access to health care, but there is limited empirical research on discrimination in access to mental health care. We provide the first experimental evidence, from an audit ("simulated patients") study, of the extent to which transgender and non-binary people, African Americans, and Hispanics face discrimination in access to mental health care appointments. We find significant discrimination against transgender or non-binary African Americans and Hispanics. We do not find evidence of discrimination against White transgender and non-binary prospective patients. We are mostly inconclusive as to if cisgender African Americans or Hispanics face discrimination, except we find evidence of discrimination against cisgender African American women. Our study occurred before and during the initial onset of the COVID-19 pandemic and we study if COVID-19 affected access to (or discrimination in access to) appointments. We find some suggestive evidence that increased COVID-19 intensity may have reduced access, and discrimination in access, to appointments.
{"title":"Gender Identity-, Race-, and Ethnicity-Based Discrimination in Access to Mental Health Care.","authors":"Luca Fumarco, Benjamin J Harrell, Patrick Button, David J Schwegman, E Dils","doi":"10.1086/728931","DOIUrl":"10.1086/728931","url":null,"abstract":"<p><p>Racial, ethnic, and gender minorities face mental health disparities. While mental health care can help, minorities could face discriminatory barriers in accessing it. Discrimination may be particularly pronounced in mental health care because providers have more discretion over accepting patients. Research documents discrimination, including in access to health care, but there is limited empirical research on discrimination in access to mental health care. We provide the first experimental evidence, from an audit (\"simulated patients\") study, of the extent to which transgender and non-binary people, African Americans, and Hispanics face discrimination in access to mental health care appointments. We find significant discrimination against transgender or non-binary African Americans and Hispanics. We do not find evidence of discrimination against White transgender and non-binary prospective patients. We are mostly inconclusive as to if cisgender African Americans or Hispanics face discrimination, except we find evidence of discrimination against cisgender African American women. Our study occurred before and during the initial onset of the COVID-19 pandemic and we study if COVID-19 affected access to (or discrimination in access to) appointments. We find some suggestive evidence that increased COVID-19 intensity may have reduced access, and discrimination in access, to appointments.</p>","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"10 2","pages":"182-214"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12547971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2024-10-01DOI: 10.1086/726584
Julia M Dennett
This paper investigates the effects of cigarette tax changes at different ages on long-term smoking behaviors. Using survey data on six decades of birth cohorts and a generalized difference-in-differences study design, I show that an increase in the cigarette tax at any age diminishes the long-term probabilities of smoking initiation and participation and reduces smoking intensity amongst people who currently smoke. These findings suggest that cigarette taxes prevent adults from beginning to smoke and cause people who smoke to promptly smoke less and quit over time. My estimates suggest that an average state tax hike applied to the national population would have caused over 400,000 people to quit smoking and prevented 4,000 deaths from smoking-related causes.
{"title":"The Long-Term Impacts of Cigarette Taxes on Smoking.","authors":"Julia M Dennett","doi":"10.1086/726584","DOIUrl":"10.1086/726584","url":null,"abstract":"<p><p>This paper investigates the effects of cigarette tax changes at different ages on long-term smoking behaviors. Using survey data on six decades of birth cohorts and a generalized difference-in-differences study design, I show that an increase in the cigarette tax at any age diminishes the long-term probabilities of smoking initiation and participation and reduces smoking intensity amongst people who currently smoke. These findings suggest that cigarette taxes prevent adults from beginning to smoke and cause people who smoke to promptly smoke less and quit over time. My estimates suggest that an average state tax hike applied to the national population would have caused over 400,000 people to quit smoking and prevented 4,000 deaths from smoking-related causes.</p>","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"10 4","pages":"568-602"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"From Lawn Care to Home Care: Undocumented Immigration and Aging in Place","authors":"Youngjoo Jung, Domininkas Mockus","doi":"10.1086/728717","DOIUrl":"https://doi.org/10.1086/728717","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"88 2","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139253337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Heterogeneous Effects of the Affordable Care Act on Emergency Department Visits and Payer Composition among Older Adults by Race and Ethnicity","authors":"Y. A. Antwi, Giacomo Meille, Asako Moriya","doi":"10.1086/728787","DOIUrl":"https://doi.org/10.1086/728787","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"12 4","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139254073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Financial Risk and the Decision of Small Employers to Self-Fund Health Insurance: Evidence from Stop Loss Regulation in California","authors":"Mark Meiselbach, Matthew Eisenberg","doi":"10.1086/728588","DOIUrl":"https://doi.org/10.1086/728588","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"74 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dahai Yue, Ninez A. Ponce, Jack Needleman, Susan L. Ettner, Adriana Lleras-Muney
{"title":"Increased Schooling Reduces Hospitalization Later in Life: New Evidence with Optimal Instruments from the United States","authors":"Dahai Yue, Ninez A. Ponce, Jack Needleman, Susan L. Ettner, Adriana Lleras-Muney","doi":"10.1086/728403","DOIUrl":"https://doi.org/10.1086/728403","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Previous articleNext article No AccessThe Roles of Cost and Recommendations in Driving Vaccine Take-Up: Evidence from the Herpes Zoster Vaccine for Shingles PreventionBrandyn Churchill and Laura HenkhausBrandyn Churchill Search for more articles by this author and Laura Henkhaus Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmailPrint SectionsMoreDetailsFiguresReferencesCited by American Journal of Health Economics Just Accepted Published for the American Society of Health Economists (ASHEcon) Article DOIhttps://doi.org/10.1086/723541 Views: 12Total views on this site HistoryAccepted September 20, 2022 PDF download Crossref reports no articles citing this article.
{"title":"The Roles of Cost and Recommendations in Driving Vaccine Take-Up: Evidence from the Herpes Zoster Vaccine for Shingles Prevention","authors":"Brandyn Churchill, Laura Henkhaus","doi":"10.1086/723541","DOIUrl":"https://doi.org/10.1086/723541","url":null,"abstract":"Previous articleNext article No AccessThe Roles of Cost and Recommendations in Driving Vaccine Take-Up: Evidence from the Herpes Zoster Vaccine for Shingles PreventionBrandyn Churchill and Laura HenkhausBrandyn Churchill Search for more articles by this author and Laura Henkhaus Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmailPrint SectionsMoreDetailsFiguresReferencesCited by American Journal of Health Economics Just Accepted Published for the American Society of Health Economists (ASHEcon) Article DOIhttps://doi.org/10.1086/723541 Views: 12Total views on this site HistoryAccepted September 20, 2022 PDF download Crossref reports no articles citing this article.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135043737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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