We estimate the impact of information disclosure on consumer knowledge in an important context: the calorie content of restaurant food. We conduct a randomized controlled experiment of calorie labels on restaurant menus, and find that information disclosure improves consumer knowledge but does not eliminate the problem of imperfect information. Calorie labels improve consumers’ post-meal estimates of the number of calories they ordered by 4.0 percent and reduce by 28.9 percent the probability that consumers underestimate the calories in their meal by half or more. However, even after information disclosure, the absolute value of percent error averages 34.2 percent.
{"title":"Does Information Disclosure Improve Consumer Knowledge?","authors":"J. Cawley, Alex M. Susskind, Barton Willage","doi":"10.1086/714987","DOIUrl":"https://doi.org/10.1086/714987","url":null,"abstract":"We estimate the impact of information disclosure on consumer knowledge in an important context: the calorie content of restaurant food. We conduct a randomized controlled experiment of calorie labels on restaurant menus, and find that information disclosure improves consumer knowledge but does not eliminate the problem of imperfect information. Calorie labels improve consumers’ post-meal estimates of the number of calories they ordered by 4.0 percent and reduce by 28.9 percent the probability that consumers underestimate the calories in their meal by half or more. However, even after information disclosure, the absolute value of percent error averages 34.2 percent.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"7 1","pages":"427 - 456"},"PeriodicalIF":3.7,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/714987","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43201555","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 exploit the discontinuity in health insurance coverage rates at the Medicare eligibility age of 65 to investigate the impact of Medicare on health-care utilization and spending among the elderly. We find that the discrete change in insurance coverage rates at age 65 leads to a significant increase in office-based physician and outpatient visits, which is mainly driven by those who were not insured before age 65. We also document that Medicare eligibility at age 65 is associated with up to 36.5 percent decrease in out-of-pocket spending for physician and outpatient visits. On the other hand, we find that Medicare eligibility does not have a significant impact on the utilization of inpatient or emergency department services.
{"title":"The Effects of Medicare on Health-Care Utilization and Spending Among the Elderly","authors":"Pinka Chatterji, Tu Nguyen, Barış K. Yörük","doi":"10.1086/716544","DOIUrl":"https://doi.org/10.1086/716544","url":null,"abstract":"We exploit the discontinuity in health insurance coverage rates at the Medicare eligibility age of 65 to investigate the impact of Medicare on health-care utilization and spending among the elderly. We find that the discrete change in insurance coverage rates at age 65 leads to a significant increase in office-based physician and outpatient visits, which is mainly driven by those who were not insured before age 65. We also document that Medicare eligibility at age 65 is associated with up to 36.5 percent decrease in out-of-pocket spending for physician and outpatient visits. On the other hand, we find that Medicare eligibility does not have a significant impact on the utilization of inpatient or emergency department services.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"8 1","pages":"151 - 180"},"PeriodicalIF":3.7,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/716544","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44096377","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 number of disability beneficiaries has doubled in the past two decades. It is difficult to determine how much is explained by changes in health, as we lack a counterfactual. We use undocumented immigrants to form the counterfactual, as they cannot claim benefits. Using data from the National Health Interview Survey, we show that the relationship between health and disability is stronger for the legal population than for the undocumented. Much of the difference in disability rates between the populations is due to different labor supply responses to underlying health impairments and demographic differences, rather than to differences in the impairments or demographic variables themselves.
{"title":"Health, Employment, and Disability","authors":"G. Borjas, David J. G. Slusky","doi":"10.1086/716465","DOIUrl":"https://doi.org/10.1086/716465","url":null,"abstract":"The number of disability beneficiaries has doubled in the past two decades. It is difficult to determine how much is explained by changes in health, as we lack a counterfactual. We use undocumented immigrants to form the counterfactual, as they cannot claim benefits. Using data from the National Health Interview Survey, we show that the relationship between health and disability is stronger for the legal population than for the undocumented. Much of the difference in disability rates between the populations is due to different labor supply responses to underlying health impairments and demographic differences, rather than to differences in the impairments or demographic variables themselves.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"8 1","pages":"1 - 29"},"PeriodicalIF":3.7,"publicationDate":"2021-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44432309","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}
Betsy Q Cliff, Sarah Miller, Jeffrey T. Kullgren, J. Ayanian, R. Hirth
Recent expansions of Medicaid eligibility have come with increased experimentation with enrollee cost-sharing. In this paper, we exploit a discontinuous premium increase at the federal poverty level in Michigan’s Medicaid expansion program to test low-income individuals’ sensitivity to premiums using linked enrollment and claims data. At the cutoff, average premiums increase by $3.15 and the probability of disenrollment increases by 2.3 percentage points. Increased disenrollment occurs among those with fewer documented medical needs at baseline, but not among those with greater medical needs. These results suggest that healthier low-income individuals may be sensitive to even modest health insurance premiums, and that premiums may induce adverse selection in Medicaid plans.
{"title":"Adverse Selection in Medicaid","authors":"Betsy Q Cliff, Sarah Miller, Jeffrey T. Kullgren, J. Ayanian, R. Hirth","doi":"10.1086/716464","DOIUrl":"https://doi.org/10.1086/716464","url":null,"abstract":"Recent expansions of Medicaid eligibility have come with increased experimentation with enrollee cost-sharing. In this paper, we exploit a discontinuous premium increase at the federal poverty level in Michigan’s Medicaid expansion program to test low-income individuals’ sensitivity to premiums using linked enrollment and claims data. At the cutoff, average premiums increase by $3.15 and the probability of disenrollment increases by 2.3 percentage points. Increased disenrollment occurs among those with fewer documented medical needs at baseline, but not among those with greater medical needs. These results suggest that healthier low-income individuals may be sensitive to even modest health insurance premiums, and that premiums may induce adverse selection in Medicaid plans.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"8 1","pages":"127 - 150"},"PeriodicalIF":3.7,"publicationDate":"2021-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45039045","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}
Sumedha Gupta, Thuy Nguyen, Shyam Raman, Byungkyu Lee, Felipe Lozano-Rojas, A. Bento, K. Simon, Coady Wing
This paper examines the determinants of social distancing during the shutdown phase of the COVID-19 epidemic. We classify state and local government actions, and we study multiple proxies for social distancing based on data from smart devices. Mobility fell substantially in all states, even ones that did not adopt major distancing mandates. Most of the fall in mobility occurred prior to the most stringent sanctions against movement, such as stay-at-home laws. However, we find evidence suggesting that state and local policies did have an independent effect on mobility even after the large initial reductions occurred. Event studies show that early and information-focused actions such as first case announcements, emergency declarations, and school closures reduced mobility by 1–5 percent after five days. Between March 1 and April 14, average time spent at home grew from 9.1 hours to 13.9 hours. We find, for example, that without state emergency declarations, hours at home would have been 11.3 hours in April, suggesting that 55 percent of the growth is associated with policy and 45 percent is associated with (non-policy) trends. State and local government actions induced changes in mobility on top of a large and private response across all states to the prevailing knowledge of public health risks.
{"title":"Tracking Public and Private Responses to the COVID-19 Epidemic","authors":"Sumedha Gupta, Thuy Nguyen, Shyam Raman, Byungkyu Lee, Felipe Lozano-Rojas, A. Bento, K. Simon, Coady Wing","doi":"10.1086/716197","DOIUrl":"https://doi.org/10.1086/716197","url":null,"abstract":"This paper examines the determinants of social distancing during the shutdown phase of the COVID-19 epidemic. We classify state and local government actions, and we study multiple proxies for social distancing based on data from smart devices. Mobility fell substantially in all states, even ones that did not adopt major distancing mandates. Most of the fall in mobility occurred prior to the most stringent sanctions against movement, such as stay-at-home laws. However, we find evidence suggesting that state and local policies did have an independent effect on mobility even after the large initial reductions occurred. Event studies show that early and information-focused actions such as first case announcements, emergency declarations, and school closures reduced mobility by 1–5 percent after five days. Between March 1 and April 14, average time spent at home grew from 9.1 hours to 13.9 hours. We find, for example, that without state emergency declarations, hours at home would have been 11.3 hours in April, suggesting that 55 percent of the growth is associated with policy and 45 percent is associated with (non-policy) trends. State and local government actions induced changes in mobility on top of a large and private response across all states to the prevailing knowledge of public health risks.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"7 1","pages":"361 - 404"},"PeriodicalIF":3.7,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41508534","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}
Economic theory suggests that a binding minimum wage increase may reduce the generosity of employer-sponsored insurance (ESI) or other fringe benefits, yet previous empirical studies reach conflicting conclusions about the existence of a trade-off between minimum wages and ESI. We study whether recent state and federal minimum wage increases affect the level or the source of health insurance coverage for low-income families using the 2005–16 Current Population Survey. Our research design uses state and year fixed effects to isolate within-state minimum wage changes while controlling for Medicaid eligibility and other changes in health policy related to implementation of the Affordable Care Act. Because dependent coverage might also be affected by minimum wage hikes, we examine ESI coverage for both low-wage workers and their dependents. We find robust evidence that minimum wage increases lead to reductions in ESI coverage in families below 300 percent of the federal poverty level, with a nominal $1 increase in the minimum wage reducing the probability of ESI coverage by 0.99 percentage points. Reductions in coverage were observed both for workers and for their dependents.
{"title":"The Effect of the Minimum Wage on Employer-Sponsored Insurance for Low-Income Workers and Dependents","authors":"M. Dworsky, C. Eibner, Xiaoyu Nie, J. Wenger","doi":"10.1086/716198","DOIUrl":"https://doi.org/10.1086/716198","url":null,"abstract":"Economic theory suggests that a binding minimum wage increase may reduce the generosity of employer-sponsored insurance (ESI) or other fringe benefits, yet previous empirical studies reach conflicting conclusions about the existence of a trade-off between minimum wages and ESI. We study whether recent state and federal minimum wage increases affect the level or the source of health insurance coverage for low-income families using the 2005–16 Current Population Survey. Our research design uses state and year fixed effects to isolate within-state minimum wage changes while controlling for Medicaid eligibility and other changes in health policy related to implementation of the Affordable Care Act. Because dependent coverage might also be affected by minimum wage hikes, we examine ESI coverage for both low-wage workers and their dependents. We find robust evidence that minimum wage increases lead to reductions in ESI coverage in families below 300 percent of the federal poverty level, with a nominal $1 increase in the minimum wage reducing the probability of ESI coverage by 0.99 percentage points. Reductions in coverage were observed both for workers and for their dependents.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"8 1","pages":"99 - 126"},"PeriodicalIF":3.7,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43609902","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. Avery, J. Cawley, Julia C. P. Eddelbuettel, Matthew D. Eisenberg, Charlie Mann, A. Mathios
This paper estimates the impact on consumer behavior of a firm’s voluntary disclosure of information. Specifically, we study the impact of Starbucks’ disclosure of calorie information on its menu boards in June 2013. Using a large data set of consumers’ visits to specific restaurant chains, we estimate difference-in-difference models that compare the change in the probability that consumers recently visited Starbucks with the change in the probability that they recently visited a similar chain that did not disclose calorie information: Dunkin’ Donuts. Estimates from difference-in-differences models indicate that we cannot reject the null hypothesis that Starbucks’ disclosure of calorie information had no detectable impact on the probability that consumers patronized Starbucks in the past month. However, we find an effect among men; after Starbucks’ information disclosure, the probability that men visit the chain fell by 1.0 percentage points (10.7 percent). There is no evidence of heterogeneity in effect by education or clinical weight classification. These results are useful for understanding how consumers respond to the voluntary disclosure of information, a decision many firms face.
{"title":"Consumer Responses to Firms’ Voluntary Disclosure of Information","authors":"R. Avery, J. Cawley, Julia C. P. Eddelbuettel, Matthew D. Eisenberg, Charlie Mann, A. Mathios","doi":"10.1086/722269","DOIUrl":"https://doi.org/10.1086/722269","url":null,"abstract":"This paper estimates the impact on consumer behavior of a firm’s voluntary disclosure of information. Specifically, we study the impact of Starbucks’ disclosure of calorie information on its menu boards in June 2013. Using a large data set of consumers’ visits to specific restaurant chains, we estimate difference-in-difference models that compare the change in the probability that consumers recently visited Starbucks with the change in the probability that they recently visited a similar chain that did not disclose calorie information: Dunkin’ Donuts. Estimates from difference-in-differences models indicate that we cannot reject the null hypothesis that Starbucks’ disclosure of calorie information had no detectable impact on the probability that consumers patronized Starbucks in the past month. However, we find an effect among men; after Starbucks’ information disclosure, the probability that men visit the chain fell by 1.0 percentage points (10.7 percent). There is no evidence of heterogeneity in effect by education or clinical weight classification. These results are useful for understanding how consumers respond to the voluntary disclosure of information, a decision many firms face.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"22 - 46"},"PeriodicalIF":3.7,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48823164","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}
Even among commercially insured individuals, opioid use disorder is undertreated in the United States: nearly half receive no treatment within six months of a new diagnosis. Using a difference-in-differences specification exploiting the extension of insurance parity requirements for substance use disorder treatment to small-group enrollees in 2014, we find that parity increases utilization of residential treatment but decreases utilization of agonist medications, the standard of care. We find direct interventions to increase access to medication may be more promising: increases in the county-level share of physicians able to prescribe agonists are associated with substitution toward treatment that includes medication.
{"title":"Do Policies to Increase Access to Treatment for Opioid Use Disorder Work?","authors":"E. Barrette, Leemore S. Dafny, Karen Shen","doi":"10.1086/722980","DOIUrl":"https://doi.org/10.1086/722980","url":null,"abstract":"Even among commercially insured individuals, opioid use disorder is undertreated in the United States: nearly half receive no treatment within six months of a new diagnosis. Using a difference-in-differences specification exploiting the extension of insurance parity requirements for substance use disorder treatment to small-group enrollees in 2014, we find that parity increases utilization of residential treatment but decreases utilization of agonist medications, the standard of care. We find direct interventions to increase access to medication may be more promising: increases in the county-level share of physicians able to prescribe agonists are associated with substitution toward treatment that includes medication.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"9 1","pages":"297 - 330"},"PeriodicalIF":3.7,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46211865","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 find that Ohio’s “Vax-a-Million” lottery increased first-dose COVID-19 vaccinations by between 50,000 and 100,000, with most of the additional doses occurring during the two weeks between the announcement and the first lottery drawing. We use county-level data and two empirical approaches to provide causal estimates of the lottery in Ohio. First, a difference-in-differences design compares vaccination rates in border counties in Ohio and Indiana before and after the announcement. Second, we use a pooled synthetic control method to construct a counterfactual for each of Ohio’s counties using control counties in Indiana, Michigan, and Pennsylvania. The synthetic control analysis reveals larger increases in vaccination rates in more populous counties. Our estimates imply that Ohio paid about $75 per additional starting dose during this period.
{"title":"The Ohio Vaccine Lottery and Starting Vaccination Rates","authors":"Margaret E. Brehm, Paul A. Brehm, Martin Saavedra","doi":"10.1086/718512","DOIUrl":"https://doi.org/10.1086/718512","url":null,"abstract":"We find that Ohio’s “Vax-a-Million” lottery increased first-dose COVID-19 vaccinations by between 50,000 and 100,000, with most of the additional doses occurring during the two weeks between the announcement and the first lottery drawing. We use county-level data and two empirical approaches to provide causal estimates of the lottery in Ohio. First, a difference-in-differences design compares vaccination rates in border counties in Ohio and Indiana before and after the announcement. Second, we use a pooled synthetic control method to construct a counterfactual for each of Ohio’s counties using control counties in Indiana, Michigan, and Pennsylvania. The synthetic control analysis reveals larger increases in vaccination rates in more populous counties. Our estimates imply that Ohio paid about $75 per additional starting dose during this period.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"8 1","pages":"387 - 411"},"PeriodicalIF":3.7,"publicationDate":"2021-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47128130","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 use temperature variation within narrowly defined geographic and demographic cells to show that exposure to extreme temperature increases the risk of maternal hospitalization during pregnancy. This effect is driven by emergency hospitalizations for various pregnancy complications, suggesting that it represents a deterioration in underlying maternal health rather than a change in women’s ability to access health care. The effect is larger for black women than for women of other races, suggesting that without significant adaptation, projected increases in extreme temperatures over the next century may further exacerbate racial disparities in maternal health.
{"title":"What to Expect When It Gets Hotter","authors":"Jiyoon Kim, Ajin Lee, Maya Rossin-Slater","doi":"10.1086/714359","DOIUrl":"https://doi.org/10.1086/714359","url":null,"abstract":"We use temperature variation within narrowly defined geographic and demographic cells to show that exposure to extreme temperature increases the risk of maternal hospitalization during pregnancy. This effect is driven by emergency hospitalizations for various pregnancy complications, suggesting that it represents a deterioration in underlying maternal health rather than a change in women’s ability to access health care. The effect is larger for black women than for women of other races, suggesting that without significant adaptation, projected increases in extreme temperatures over the next century may further exacerbate racial disparities in maternal health.","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":"7 1","pages":"281 - 305"},"PeriodicalIF":3.7,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1086/714359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42676629","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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