Appointing or electing professionals to be public officials is a double-edged sword. Experts can use their rich knowledge to implement reforms, but they can also favor their own profession. In this study, we compare physician-trained state health ministers to ministers of other professions in Germany during 1955–2017. German state health ministers have great power to determine hospital capacities and infrastructure. Our results show that physician-trained health ministers increase hospital capacities, capital, and funding by the statutory health insurance (SHI). This prompts hospitals to hire more physicians, but with little impact on hospital outputs. As a result, total factor productivity (TFP) growth in hospital care slows down substantially under physician-ministers. At the same time, job satisfaction of hospital doctors tends to increase. We conclude that, in particular, the medical profession benefits from medical doctors in office.
{"title":"Are Doctors Better Health Ministers?","authors":"Adam Pilny, Felix Roesel","doi":"10.1086/710331","DOIUrl":"https://doi.org/10.1086/710331","url":null,"abstract":"Appointing or electing professionals to be public officials is a double-edged sword. Experts can use their rich knowledge to implement reforms, but they can also favor their own profession. In this study, we compare physician-trained state health ministers to ministers of other professions in Germany during 1955–2017. German state health ministers have great power to determine hospital capacities and infrastructure. Our results show that physician-trained health ministers increase hospital capacities, capital, and funding by the statutory health insurance (SHI). This prompts hospitals to hire more physicians, but with little impact on hospital outputs. As a result, total factor productivity (TFP) growth in hospital care slows down substantially under physician-ministers. At the same time, job satisfaction of hospital doctors tends to increase. We conclude that, in particular, the medical profession benefits from medical doctors in office.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/710331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44473765","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}
In light of persistent shortcomings in nursing home care quality and evidence that lower nurse staffing levels could be harmful to residents, we examine whether staffing levels are affected by changes in Medicare reimbursement rates. We exploit a 2006 change in Medicare’s methodology for adjusting provider payments for geographic differences in costs, a change that generated plausibly exogenous variation in nursing facility reimbursement rates. Our method compares facilities with higher and lower shares of Medicare resident days, which were differentially exposed to the payment changes we examine. Using panel data on US nursing homes from 2003 through 2009, we find that higher Medicare payments increased nurse staffing hours per resident day. Additional results suggest that changes in Medicare payments did not affect other measures of quality.
{"title":"The Effects of Medicare Payment Changes on Nursing Home Staffing","authors":"Daifeng He, Peter McHenry, J. Mellor","doi":"10.1086/710563","DOIUrl":"https://doi.org/10.1086/710563","url":null,"abstract":"In light of persistent shortcomings in nursing home care quality and evidence that lower nurse staffing levels could be harmful to residents, we examine whether staffing levels are affected by changes in Medicare reimbursement rates. We exploit a 2006 change in Medicare’s methodology for adjusting provider payments for geographic differences in costs, a change that generated plausibly exogenous variation in nursing facility reimbursement rates. Our method compares facilities with higher and lower shares of Medicare resident days, which were differentially exposed to the payment changes we examine. Using panel data on US nursing homes from 2003 through 2009, we find that higher Medicare payments increased nurse staffing hours per resident day. Additional results suggest that changes in Medicare payments did not affect other measures of quality.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/710563","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46415408","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}
R. V. van Kleef, F. Eijkenaar, R. van Vliet, M. Nielen
Health insurance markets with regulated premiums typically include risk adjustment (RA) to mitigate selection incentives. Even the most sophisticated RA models, however, tend to undercompensate (overcompensate) insurers for people in poor (good) health. One reason RA models are imperfect is that some predictors cannot serve as risk adjustor because they are not available for the entire population. This paper applies an indirect method to exploit such predictive information: constrained regression. Our focus is on the Netherlands where morbidity data from general practitioners (GPs) are available for only around 10 percent of the population. We combine this incomplete sample with complete data (N=16.7 million) on spending and risk adjustors. In a first step, we find that GP morbidity data are predictive net of the Dutch RA model. In a second step, we use the GP morbidity data to impose constraints on the coefficients of the RA model. This results in more RA funds being sent to undercompensated groups. Using a split-sample approach, we simulate two constrained regression models and compare the outcomes to those of an unconstrained model. Our findings indicate that constrained regression can be a useful tool to exploit predictive information that is available for only a sample of the population.
{"title":"Exploiting Incomplete Information in Risk Adjustment Using Constrained Regression","authors":"R. V. van Kleef, F. Eijkenaar, R. van Vliet, M. Nielen","doi":"10.1086/710526","DOIUrl":"https://doi.org/10.1086/710526","url":null,"abstract":"Health insurance markets with regulated premiums typically include risk adjustment (RA) to mitigate selection incentives. Even the most sophisticated RA models, however, tend to undercompensate (overcompensate) insurers for people in poor (good) health. One reason RA models are imperfect is that some predictors cannot serve as risk adjustor because they are not available for the entire population. This paper applies an indirect method to exploit such predictive information: constrained regression. Our focus is on the Netherlands where morbidity data from general practitioners (GPs) are available for only around 10 percent of the population. We combine this incomplete sample with complete data (N=16.7 million) on spending and risk adjustors. In a first step, we find that GP morbidity data are predictive net of the Dutch RA model. In a second step, we use the GP morbidity data to impose constraints on the coefficients of the RA model. This results in more RA funds being sent to undercompensated groups. Using a split-sample approach, we simulate two constrained regression models and compare the outcomes to those of an unconstrained model. Our findings indicate that constrained regression can be a useful tool to exploit predictive information that is available for only a sample of the population.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/710526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45321859","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}
Alice Chen, Michael R Richards, C. Whaley, Xiaoxi Zhao
Medicare accounts for roughly 20 percent of medical expenditures in the United States and is the dominant payer for many treatments. Consequently, Medicare payment policy may have diffuse consequences. Using a contemporary bundled payment reform (the “CJR” program) and a difference-in-differences research design, we estimate Medicare’s spillover reach. We find that altered treatment decisions for targeted joint replacement procedures are closely, though not perfectly, mirrored between traditional Medicare, Medicare Advantage, and the nonelderly commercially insured populations. Results for untargeted procedures performed by CJR-affected physicians also show suggestive evidence consistent with a secondary spillover effect; however, this behavior change does not extend to less related procedures. Our findings align with the “norms hypothesis” for physician decision making but do not imply rigid and uniform treatment choices. Instead, key decision nodes appear to gain greater salience under Medicare’s new incentive structure, which leads to revised treatment choices for different payer-procedure combinations. Ignoring the breadth of externalities from Medicare policies risks understating their social welfare impact.
{"title":"The Extent of Externalities from Medicare Payment Policy","authors":"Alice Chen, Michael R Richards, C. Whaley, Xiaoxi Zhao","doi":"10.1086/718769","DOIUrl":"https://doi.org/10.1086/718769","url":null,"abstract":"Medicare accounts for roughly 20 percent of medical expenditures in the United States and is the dominant payer for many treatments. Consequently, Medicare payment policy may have diffuse consequences. Using a contemporary bundled payment reform (the “CJR” program) and a difference-in-differences research design, we estimate Medicare’s spillover reach. We find that altered treatment decisions for targeted joint replacement procedures are closely, though not perfectly, mirrored between traditional Medicare, Medicare Advantage, and the nonelderly commercially insured populations. Results for untargeted procedures performed by CJR-affected physicians also show suggestive evidence consistent with a secondary spillover effect; however, this behavior change does not extend to less related procedures. Our findings align with the “norms hypothesis” for physician decision making but do not imply rigid and uniform treatment choices. Instead, key decision nodes appear to gain greater salience under Medicare’s new incentive structure, which leads to revised treatment choices for different payer-procedure combinations. Ignoring the breadth of externalities from Medicare policies risks understating their social welfare impact.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45851463","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}
In this study, we document the effect of food stamp access on adult health-care utilization. While the Food Stamp Program is one of the largest safety net programs in the United States today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this issue, we use variation in documented immigrants’ eligibility for food stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to food stamps reduced physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp Program, as reductions in physician visits due to food stamps may offset some of the program’s impact on the overall government budget because of the existence of government-provided health insurance programs such as Medicaid.
{"title":"An Apple a Day? Adult Food Stamp Eligibility and Health Care Utilization Among Immigrants","authors":"Chloe N. East, Andrew I. Friedson","doi":"10.1086/709368","DOIUrl":"https://doi.org/10.1086/709368","url":null,"abstract":"In this study, we document the effect of food stamp access on adult health-care utilization. While the Food Stamp Program is one of the largest safety net programs in the United States today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this issue, we use variation in documented immigrants’ eligibility for food stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to food stamps reduced physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp Program, as reductions in physician visits due to food stamps may offset some of the program’s impact on the overall government budget because of the existence of government-provided health insurance programs such as Medicaid.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138540228","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}
By favoring early diagnosis, mammography screening decreases breast cancer mortality and treatment costs. However, participation in public screening programs is low in many countries. We ran a randomized field experiment to assess whether costless manipulations of the informational content (restricted or enhanced information) and the framing (gain or loss framing) of the invitation letter to the breast cancer screening program in Messina (Italy) affects participation. We show that giving enhanced loss-framed information about the risks of not having a mammography increases the take-up. This manipulation is most effective among subgroups with lower baseline take-ups, thereby reducing inequalities in screening. Finally, subjects exposed to this manipulation are much less likely to postpone the screening conditional on participation, revealing enhanced awareness about the risks related with delayed participation.
{"title":"The Good Outcome of Bad News","authors":"Marco Bertoni, L. Corazzini, S. Robone","doi":"10.1086/708930","DOIUrl":"https://doi.org/10.1086/708930","url":null,"abstract":"By favoring early diagnosis, mammography screening decreases breast cancer mortality and treatment costs. However, participation in public screening programs is low in many countries. We ran a randomized field experiment to assess whether costless manipulations of the informational content (restricted or enhanced information) and the framing (gain or loss framing) of the invitation letter to the breast cancer screening program in Messina (Italy) affects participation. We show that giving enhanced loss-framed information about the risks of not having a mammography increases the take-up. This manipulation is most effective among subgroups with lower baseline take-ups, thereby reducing inequalities in screening. Finally, subjects exposed to this manipulation are much less likely to postpone the screening conditional on participation, revealing enhanced awareness about the risks related with delayed participation.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/708930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47069628","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}
How do exogenous changes in the macroeconomic environment affect workers’ perceived job security, and consequently, their mental and physical health? To answer this question, we exploit variation in world commodity prices over the period 2001–17 and analyze panel data that include detailed classifications of mining workers. We find that commodity price increases cause increases in perceived job security, which in turn, significantly and substantively improves the mental health of workers. In contrast, we find no effects on physical health. Our results imply that the estimated welfare costs of recessions are much larger when the effects of job insecurity, and not only unemployment, are considered.
{"title":"Macroeconomic Shocks, Job Security, and Health","authors":"D. Johnston, M. Shields, Agne Suziedelyte","doi":"10.1086/708929","DOIUrl":"https://doi.org/10.1086/708929","url":null,"abstract":"How do exogenous changes in the macroeconomic environment affect workers’ perceived job security, and consequently, their mental and physical health? To answer this question, we exploit variation in world commodity prices over the period 2001–17 and analyze panel data that include detailed classifications of mining workers. We find that commodity price increases cause increases in perceived job security, which in turn, significantly and substantively improves the mental health of workers. In contrast, we find no effects on physical health. Our results imply that the estimated welfare costs of recessions are much larger when the effects of job insecurity, and not only unemployment, are considered.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/708929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41283718","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}
James Sears, J. M. Villas-Boas, Vasco Villas-Boas, S. Villas-Boas
The recent spread of COVID-19 across the United States led to concerted efforts by states to “flatten the curve” through the adoption of stay-at-home mandates that encouraged individuals to reduce travel and maintain social distance. Combining data on changes in travel activity and human encounter rates with state policy adoption timing, we first characterize the overall changes in mobility patterns that accompanied the spread of COVID-19. We find evidence of dramatic nationwide declines in mobility and human encounters prior to adoption of any statewide mandates. Then, using difference-in-differences along with weighted and unweighted event study methods, we isolate the portion of those reductions directly attributable to statewide mandates. Once states adopt a mandate, we estimate further mandate-induced declines of between 2.1 and 7.0 percentage points relative to pre-COVID-19 baseline levels. While residents of mandate states soon returned to prior business visitation patterns, the impacts on distances traveled and human encounter rates persisted throughout the observed mandate periods. Our estimates of early mobility reductions and the responses to statewide stay-at-home policies convey important policy implications for the persistence of mobility behavior changes and states’ future reopenings.
{"title":"Are We #Stayinghome to Flatten the Curve?","authors":"James Sears, J. M. Villas-Boas, Vasco Villas-Boas, S. Villas-Boas","doi":"10.1086/721705","DOIUrl":"https://doi.org/10.1086/721705","url":null,"abstract":"The recent spread of COVID-19 across the United States led to concerted efforts by states to “flatten the curve” through the adoption of stay-at-home mandates that encouraged individuals to reduce travel and maintain social distance. Combining data on changes in travel activity and human encounter rates with state policy adoption timing, we first characterize the overall changes in mobility patterns that accompanied the spread of COVID-19. We find evidence of dramatic nationwide declines in mobility and human encounters prior to adoption of any statewide mandates. Then, using difference-in-differences along with weighted and unweighted event study methods, we isolate the portion of those reductions directly attributable to statewide mandates. Once states adopt a mandate, we estimate further mandate-induced declines of between 2.1 and 7.0 percentage points relative to pre-COVID-19 baseline levels. While residents of mandate states soon returned to prior business visitation patterns, the impacts on distances traveled and human encounter rates persisted throughout the observed mandate periods. Our estimates of early mobility reductions and the responses to statewide stay-at-home policies convey important policy implications for the persistence of mobility behavior changes and states’ future reopenings.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46623533","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}
The recent economic literature on child development has underscored the importance of giving babies a healthy start. Despite the widespread use of prenatal care, whether this early investment improves infant health is not well understood. This study provides new causal evidence on this crucial issue using 1.4 million sibling births. The baseline within-family analysis shows a modest effect of prenatal care on the mean birth weight but large effects on adverse outcomes at the lower end of the birth weight distribution, where two channels are preventing low maternal weight gain and promoting prenatal smoking cessation. Similar results hold when we examine different subperiods or subgroups, consider multiple dimensions of care utilization, or use additional birth-varying controls. Overall, this study shows that adequate prenatal care has a significant payoff in terms of newborn health stock. From a policy perspective, it is important to improve prenatal care access for childbearing women.
{"title":"Healthy Babies","authors":"Ji Yan","doi":"10.1086/707831","DOIUrl":"https://doi.org/10.1086/707831","url":null,"abstract":"The recent economic literature on child development has underscored the importance of giving babies a healthy start. Despite the widespread use of prenatal care, whether this early investment improves infant health is not well understood. This study provides new causal evidence on this crucial issue using 1.4 million sibling births. The baseline within-family analysis shows a modest effect of prenatal care on the mean birth weight but large effects on adverse outcomes at the lower end of the birth weight distribution, where two channels are preventing low maternal weight gain and promoting prenatal smoking cessation. Similar results hold when we examine different subperiods or subgroups, consider multiple dimensions of care utilization, or use additional birth-varying controls. Overall, this study shows that adequate prenatal care has a significant payoff in terms of newborn health stock. From a policy perspective, it is important to improve prenatal care access for childbearing women.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/707831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48270749","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}
This paper studies the effects of changes in states’ scope of practice (SOP) laws for advanced practice registered nurses (APRNs) on individual labor supply decisions. Restrictive SOP impose costs and other barriers to practice that may affect these decisions. Using survey data on APRNs, we analyze employment in nursing, work hours, part-time work status, multiple job holding, self-employment, wages, and migration. Results show that the level of SOP restrictions are not strong determinants of many labor market decisions but APRNs working in states without oversight requirements are much more likely to be self-employed and to work more hours. APRNs are also found to commute to less restrictive SOP environments when geographically feasible. Increases in the labor supply of nurses when regulatory environments are relatively free from physician oversight requirements can bring an important change to the delivery of health care in the United States.
{"title":"The Effects of State Scope of Practice Laws on the Labor Supply of Advanced Practice Registered Nurses","authors":"Sara Markowitz, Kathleen Adams","doi":"10.1086/716545","DOIUrl":"https://doi.org/10.1086/716545","url":null,"abstract":"This paper studies the effects of changes in states’ scope of practice (SOP) laws for advanced practice registered nurses (APRNs) on individual labor supply decisions. Restrictive SOP impose costs and other barriers to practice that may affect these decisions. Using survey data on APRNs, we analyze employment in nursing, work hours, part-time work status, multiple job holding, self-employment, wages, and migration. Results show that the level of SOP restrictions are not strong determinants of many labor market decisions but APRNs working in states without oversight requirements are much more likely to be self-employed and to work more hours. APRNs are also found to commute to less restrictive SOP environments when geographically feasible. Increases in the labor supply of nurses when regulatory environments are relatively free from physician oversight requirements can bring an important change to the delivery of health care in the United States.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43672206","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：