Tamás Hajdu, G. Kertesi, G. Kézdi, Á. Szabó‐Morvai
{"title":"The Effects of Neonatal Intensive Care on Infant Mortality and Long-Term Health Impairments","authors":"Tamás Hajdu, G. Kertesi, G. Kézdi, Á. Szabó‐Morvai","doi":"10.1086/724219","DOIUrl":"https://doi.org/10.1086/724219","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48470369","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}
Cheng Chen, Shin-Yi Chou, Hsien-Ming Lien, Jin-Tan Liu
{"title":"The Long-Term Health Effects of Early-Life Malaria Exposure: Evidence from Taiwan's Malaria Eradication in the 1950s","authors":"Cheng Chen, Shin-Yi Chou, Hsien-Ming Lien, Jin-Tan Liu","doi":"10.1086/724216","DOIUrl":"https://doi.org/10.1086/724216","url":null,"abstract":"","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45666446","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 : 2023-01-01Epub Date: 2023-03-29DOI: 10.1086/722982
Silvia Helena Barcellos, Mireille Jacobson, Helen G Levy
We use a regression discontinuity design to understand the impact of a sharp change in eligibility for Medicaid versus subsidized marketplace insurance at 138 percent of the federal poverty line on coverage, medical spending, health status, and other public program participation. We find a 5.5 percentage point shift from Medicaid to private insurance, with no net change in coverage. The shift increases individual health spending by $341 or 2 percent of income, with larger increases at higher points in the spending distribution. Two-thirds of the increase is from premiums and one-thirdfrom out-of-pocket medical spending. Self-rated health and other public program participation appear unchanged. We find no evidence of bunching below the eligibility threshold, which suggests either that individuals are willing to pay more for private insurance or that optimization frictions are high.
{"title":"THE IMPACT OF ELIGIBILITY FOR MEDICAID VERSUS SUBSIDIZED PRIVATE HEALTH INSURANCE ON MEDICAL SPENDING, SELF-REPORTED HEALTH, AND PUBLIC PROGRAM PARTICIPATION.","authors":"Silvia Helena Barcellos, Mireille Jacobson, Helen G Levy","doi":"10.1086/722982","DOIUrl":"10.1086/722982","url":null,"abstract":"<p><p>We use a regression discontinuity design to understand the impact of a sharp change in eligibility for Medicaid versus subsidized marketplace insurance at 138 percent of the federal poverty line on coverage, medical spending, health status, and other public program participation. We find a 5.5 percentage point shift from Medicaid to private insurance, with no net change in coverage. The shift increases individual health spending by $341 or 2 percent of income, with larger increases at higher points in the spending distribution. Two-thirds of the increase is from premiums and one-thirdfrom out-of-pocket medical spending. Self-rated health and other public program participation appear unchanged. We find no evidence of bunching below the eligibility threshold, which suggests either that individuals are willing to pay more for private insurance or that optimization frictions are high.</p>","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43324378","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}
This study examines the long-term link between in utero cigarette taxes and adult prenatal smoking. We use US birth certificate records to demonstrate that exposure to higher in utero cigarette taxes (over 1965–2001) reduces later-life adult pre-pregnancy and prenatal smoking. We also show that higher in utero cigarette taxes have long-lasting effects on adult health and intergenerational consequences for infant health. Finally, we demonstrate that larger in utero tax responsiveness correlates with smaller contemporary cigarette tax responsiveness, suggesting that higher in utero taxes may alter the composition of remaining smokers and contribute to reductions in contemporary cigarette tax responsiveness.
{"title":"The Long-term Impact of In-Utero Cigarette Taxes on Adult Prenatal Smoking","authors":"Lauren Hoehn‐Velasco, M. Pesko, S. Phillips","doi":"10.1086/723825","DOIUrl":"https://doi.org/10.1086/723825","url":null,"abstract":"This study examines the long-term link between in utero cigarette taxes and adult prenatal smoking. We use US birth certificate records to demonstrate that exposure to higher in utero cigarette taxes (over 1965–2001) reduces later-life adult pre-pregnancy and prenatal smoking. We also show that higher in utero cigarette taxes have long-lasting effects on adult health and intergenerational consequences for infant health. Finally, we demonstrate that larger in utero tax responsiveness correlates with smaller contemporary cigarette tax responsiveness, suggesting that higher in utero taxes may alter the composition of remaining smokers and contribute to reductions in contemporary cigarette tax responsiveness.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46977178","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}
Childhood obesity is one of the major public health challenges of the 21st century. Randomized interventions have shown promising evidence of long-term effects from nutrition services on children’s health. However, it is yet unclear whether scaled-up programs, such as school meals, prevent children’s obesity risk. I implement a fuzzy regression discontinuity approach on national administrative data to estimate the short- and medium-run effects of the Chilean school meal program (SMP) on children’s body mass index (BMI) z-scores. Girls’ eligibility in first grade reduces local average obesity prevalence by 4 percentage points. Continued eligibility reduces boys’ local average obesity prevalence in fifth grade by .10 percentage points. Effects concentrate among children with high BMI z-scores and are partly driven by improvements in the nutritional quality of meals. Children attending schools providing psychosocial support exhibit larger benefits from SMP eligibility, consistent with spillover effects from the integration of stimulation and nutrition interventions.
{"title":"Scaled-up nutrition services for child development: evidence from the Chilean School Meals Program","authors":"J. C. Caro","doi":"10.1086/723824","DOIUrl":"https://doi.org/10.1086/723824","url":null,"abstract":"Childhood obesity is one of the major public health challenges of the 21st century. Randomized interventions have shown promising evidence of long-term effects from nutrition services on children’s health. However, it is yet unclear whether scaled-up programs, such as school meals, prevent children’s obesity risk. I implement a fuzzy regression discontinuity approach on national administrative data to estimate the short- and medium-run effects of the Chilean school meal program (SMP) on children’s body mass index (BMI) z-scores. Girls’ eligibility in first grade reduces local average obesity prevalence by 4 percentage points. Continued eligibility reduces boys’ local average obesity prevalence in fifth grade by .10 percentage points. Effects concentrate among children with high BMI z-scores and are partly driven by improvements in the nutritional quality of meals. Children attending schools providing psychosocial support exhibit larger benefits from SMP eligibility, consistent with spillover effects from the integration of stimulation and nutrition interventions.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42022947","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}
Public pay-for-performance (P4P) programs tie hospital payments to predetermined sets of quality measures and are intended to encourage or discourage certain outcomes. To the extent that financial penalties from these programs induce some response by hospitals, such penalties may translate into higher negotiated payments from commercial insurance payers. In this paper, we employ data on commercial insurance payments from a large, multi-payer database to study the extent to which penalties levied under the Hospital Readmission Reduction Program (HRRP) and the Hospital Value-Based Purchasing (HVBP) program, two major P4P components of the Affordable Care Act, caused changes in private hospital payments. We find that the bulk of any penalties resulting from HRRP and HVBP are borne by private insurance patients in the form of higher private insurance payments. Specifically, we show that HRRP and HVBP financial penalties led to increases in private payments of 1.9 percent, with effects concentrated among circulatory system procedures. These penalties were also associated with a 3.1 percent reduction in Medicare discharges. Our estimates are larger for hospitals with higher shares of privately insured patients, which suggests the importance of hospital bargaining power in facilitating higher commercial insurance payments.
{"title":"Who Pays in Pay-for-Performance?","authors":"Michael E Darden, Ian Paul McCarthy, E. Barrette","doi":"10.1086/723280","DOIUrl":"https://doi.org/10.1086/723280","url":null,"abstract":"Public pay-for-performance (P4P) programs tie hospital payments to predetermined sets of quality measures and are intended to encourage or discourage certain outcomes. To the extent that financial penalties from these programs induce some response by hospitals, such penalties may translate into higher negotiated payments from commercial insurance payers. In this paper, we employ data on commercial insurance payments from a large, multi-payer database to study the extent to which penalties levied under the Hospital Readmission Reduction Program (HRRP) and the Hospital Value-Based Purchasing (HVBP) program, two major P4P components of the Affordable Care Act, caused changes in private hospital payments. We find that the bulk of any penalties resulting from HRRP and HVBP are borne by private insurance patients in the form of higher private insurance payments. Specifically, we show that HRRP and HVBP financial penalties led to increases in private payments of 1.9 percent, with effects concentrated among circulatory system procedures. These penalties were also associated with a 3.1 percent reduction in Medicare discharges. Our estimates are larger for hospitals with higher shares of privately insured patients, which suggests the importance of hospital bargaining power in facilitating higher commercial insurance payments.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45496869","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 opioid epidemic led to the creation of state Prescription Drug Monitoring Programs (PDMPs) that eventually mandated access. We examine how these “must-access” PDMPs influenced prescribing after an emergency department (ED) visit and in the long term for the working-age population. By using data from a large multistate commercial insurance database from 2010 to 2014 and estimating difference-in-differences models, we show that only the broadest must-access PDMPs reduced opioid prescribing after an ED visit and in the long term. We then compared changes in prescribing rates for opioid naïve relative to non–opioid naïve individuals to disentangle the influence of information from administration costs on prescriber behavior. Findings suggest that hassle cost explains the majority of the decline in initial prescribing, and that the information value drives most of the reduction in long-term outcomes.
{"title":"How Do “Must-Access” Prescription Drug Monitoring Programs Address Opioid Misuse?","authors":"Benjamin Ukert, D. Polsky","doi":"10.1086/722979","DOIUrl":"https://doi.org/10.1086/722979","url":null,"abstract":"The opioid epidemic led to the creation of state Prescription Drug Monitoring Programs (PDMPs) that eventually mandated access. We examine how these “must-access” PDMPs influenced prescribing after an emergency department (ED) visit and in the long term for the working-age population. By using data from a large multistate commercial insurance database from 2010 to 2014 and estimating difference-in-differences models, we show that only the broadest must-access PDMPs reduced opioid prescribing after an ED visit and in the long term. We then compared changes in prescribing rates for opioid naïve relative to non–opioid naïve individuals to disentangle the influence of information from administration costs on prescriber behavior. Findings suggest that hassle cost explains the majority of the decline in initial prescribing, and that the information value drives most of the reduction in long-term outcomes.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47721732","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}
Jeffrey S. DeSimone, D. Grossman, Nicolas R. Ziebarth
Increases in youth vaping rates and concerns of a new generation of nicotine addicts recently prompted an increase in the federal minimum legal purchase age (MLPA) for tobacco products, including e-cigarettes, to 21 years. This study presents the first regression discontinuity evidence on the effectiveness of e-cigarette MLPA laws. Using data on 12th graders from Monitoring the Future, we obtain robust evidence that federal and state age 18 MLPAs decreased underage e-cigarette use by 15–20 percent and frequent use by 20–40 percent. These findings suggest that the age 21 federal MLPA could meaningfully reduce e-cigarette use among 18- to 20-year-olds.
{"title":"Regression Discontinuity Evidence on the Effectiveness of the Minimum Legal E-cigarette Purchasing Age","authors":"Jeffrey S. DeSimone, D. Grossman, Nicolas R. Ziebarth","doi":"10.1086/723401","DOIUrl":"https://doi.org/10.1086/723401","url":null,"abstract":"Increases in youth vaping rates and concerns of a new generation of nicotine addicts recently prompted an increase in the federal minimum legal purchase age (MLPA) for tobacco products, including e-cigarettes, to 21 years. This study presents the first regression discontinuity evidence on the effectiveness of e-cigarette MLPA laws. Using data on 12th graders from Monitoring the Future, we obtain robust evidence that federal and state age 18 MLPAs decreased underage e-cigarette use by 15–20 percent and frequent use by 20–40 percent. These findings suggest that the age 21 federal MLPA could meaningfully reduce e-cigarette use among 18- to 20-year-olds.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48940109","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}
We study whether teams’ productivity improves as they gain experience working together. We leverage unique clinical data to observe team experience and individual physician and staff experience in coronary catheterization laboratories. Teams are composed of cardiologists, nurses, and technicians who work together synchronistically. We observe teams and individuals at hospitals across the United States from 2001 to 2009, including the rate at which they gain experience using drug-eluting stents (DES) from their introduction in the US in 2003 onward. We estimate models of productivity and clinical outcomes that account for team experience, physician experience, and staff experience conditional on each other and on time-invariant physician and staff characteristics, hospital-specific monthly effects, and an extensive set of patient-level clinical factors. Greater experience performing DES cases together improves teams’ productivity, lowering total case time, procedure time, and non-physician labor costs while leaving clinical outcomes unchanged. In contrast, physicians’ and staffs’ individual experience with DES does not improve productivity conditional on other factors. The effects of team experience with DES appears generalized, with gains from experience with competitor brands of DES about as large as those from the specific brand of DES being used for a given case.
{"title":"Learning to Work Together","authors":"Chad Stecher, Jonathan D. Ketcham","doi":"10.1086/722605","DOIUrl":"https://doi.org/10.1086/722605","url":null,"abstract":"We study whether teams’ productivity improves as they gain experience working together. We leverage unique clinical data to observe team experience and individual physician and staff experience in coronary catheterization laboratories. Teams are composed of cardiologists, nurses, and technicians who work together synchronistically. We observe teams and individuals at hospitals across the United States from 2001 to 2009, including the rate at which they gain experience using drug-eluting stents (DES) from their introduction in the US in 2003 onward. We estimate models of productivity and clinical outcomes that account for team experience, physician experience, and staff experience conditional on each other and on time-invariant physician and staff characteristics, hospital-specific monthly effects, and an extensive set of patient-level clinical factors. Greater experience performing DES cases together improves teams’ productivity, lowering total case time, procedure time, and non-physician labor costs while leaving clinical outcomes unchanged. In contrast, physicians’ and staffs’ individual experience with DES does not improve productivity conditional on other factors. The effects of team experience with DES appears generalized, with gains from experience with competitor brands of DES about as large as those from the specific brand of DES being used for a given case.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41862209","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}
We seek to understand how the labor market decisions of the family adjust in response to plausibly exogenous health shocks. Family members might work less to provide caregiving, or work more in response to medical expenditures and loss of income by the ill individual. We use records of emergency department (ED) visits and hospitalizations to empirically determine the size of these effects. Using ED events, we find evidence of intra-family insurance. By exploring how insurance varies by the severity of the health shock, we find that family labor supply responses decrease as the caregiving need increases.
{"title":"Caring to Work or Working to Care","authors":"Gonzalo Arrieta, Jun Yu Li","doi":"10.1086/722588","DOIUrl":"https://doi.org/10.1086/722588","url":null,"abstract":"We seek to understand how the labor market decisions of the family adjust in response to plausibly exogenous health shocks. Family members might work less to provide caregiving, or work more in response to medical expenditures and loss of income by the ill individual. We use records of emergency department (ED) visits and hospitalizations to empirically determine the size of these effects. Using ED events, we find evidence of intra-family insurance. By exploring how insurance varies by the severity of the health shock, we find that family labor supply responses decrease as the caregiving need increases.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46809967","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号