American Journal of Health Economics最新文献

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Hospital Avoidance and Unintended Deaths during the COVID-19 Pandemic COVID-19大流行期间的住院回避和意外死亡

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2021-05-04 DOI: 10.1086/715158

Jonathan Zhang

The COVID-19 pandemic significantly altered individual behaviors, including the consumption of health care. I study utilization and mortality in the largest integrated health-care system in the United States, the Veterans Health Administration, and find that between the middle of March and the beginning of May 2020, emergency department and inpatient hospital visits declined by 37 percent and 46 percent, and remained 10 percent and 17 percent below expected levels by the end of October. Declines were more pronounced for nonurgent and non-life-threatening conditions, although urgent and life-threatening conditions also dropped by a quarter during the early months. Conditional on arrival at the emergency department, conditions were more severe at presentation. In the first two months of the pandemic, veteran mortality increased by 19.5 percent, yet non-COVID-19 mortality in VA inpatient settings declined. I find suggestive evidence that hospital avoidance may have resulted in higher non-COVID-19 mortality. By focusing on counties with no official COVID-19 deaths by May 19, 2020, I estimate that an upper bound of 7.9 percent of excess veteran deaths in the first two months of the pandemic were due to hospital avoidance.

新冠肺炎大流行显著改变了个人行为，包括医疗保健的消费。我研究了美国最大的综合医疗保健系统退伍军人健康管理局的利用率和死亡率，发现从2020年3月中旬到5月初，急诊科和住院医院的就诊人数分别下降了37%和46%，到10月底仍比预期水平低10%和17%。非紧急和无生命危险的情况下降更为明显，尽管紧急和危及生命的情况在最初几个月也下降了四分之一。在到达急诊室时，情况更为严重。在大流行的前两个月，退伍军人死亡率增加了19.5%，但弗吉尼亚州住院患者的非COVID-19死亡率有所下降。我发现有提示性证据表明，避免住院可能导致了更高的非COVID-19死亡率。通过将重点放在2020年5月19日之前没有官方新冠肺炎死亡病例的县，我估计在大流行的前两个月，退伍军人死亡人数的上限为7.9%是由于避免住院。

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引用次数: 17

Tiered Cost-Sharing for Primary Care Gatekeeper Clinics 初级保健看门人诊所的分层费用分担

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2021-03-17 DOI: 10.1086/714360

B. Dowd, Tsan-Yao Huang, T. McDonald

Efforts to improve the efficiency of the US health-care system involve both provider payment reform and efforts to give consumers the information they need to choose efficient providers and a financial incentive to do so. An example of the latter type of initiative is tiered cost-sharing. We analyze data from a long-standing tiered cost-sharing system for primary care gatekeeper clinics. These clinics control access to specialists and hospitals and are held accountable for their patients’ total annual risk-adjusted spending on covered health-care services. Consumers choosing higher cost clinics face higher levels of deductibles, copayments, and out-of-pocket maximums. We find that when choosing a primary care clinic, consumers are responsive to the clinic’s tier. Consumers exhibit a high level of inertia, but nonetheless, many clinics voluntarily reduce their fees to move to, or retain placement in, lower cost tiers.

提高美国医疗保健系统效率的努力既包括提供者支付改革，也包括向消费者提供选择高效提供者所需的信息，以及为此提供经济激励。后一类举措的一个例子是分级成本分担。我们分析了长期以来初级保健看门人诊所的分层成本分担系统的数据。这些诊所控制着获得专家和医院的机会，并对患者在覆盖的医疗服务上的年度风险调整支出总额负责。选择高成本诊所的消费者面临更高水平的免赔额、自付额和自付最高限额。我们发现，在选择初级保健诊所时，消费者对诊所的级别有反应。消费者表现出高度的惰性，但尽管如此，许多诊所还是自愿降低费用，以转移到或保留在成本较低的级别。

引用次数: 6

Health Insurance Coverage in Tax and Survey Data 税收和调查数据中的健康保险覆盖范围

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2021-03-01 DOI: 10.1086/712213

I. Lurie, James E. Pearce

The Current Population Survey provides official estimates of the number of people covered by health insurance and the number of uninsured in the United States. This type of survey data are also used to study the effects of policy changes on health insurance coverage. However, there is evidence that individuals sometimes misreport health insurance coverage, which might bias findings that use survey data. We use new administrative health insurance information from tax data to evaluate health insurance coverage in survey data across several dimensions, including age, income, and state. Our main findings suggest that although overall coverage counts are similar between survey and administrative data across all demographic characteristics, coverage rates and uninsured counts differ because of differences in population size. These similarities mask coverage differences by insurance type. Medicaid coverage is very well reported in tax data, whereas surveys tend to underreport it, especially for low-income individuals and people under the age of 40. Employer-sponsored coverage counts are higher in survey data than in administrative data. Finally, this study provides researchers that use survey data a benchmark for how to adjust Medicaid coverage to align with administratively reported levels.

当前人口调查提供了美国健康保险覆盖人数和未保险人数的官方估计。这类调查数据也用于研究政策变化对健康保险覆盖面的影响。然而，有证据表明，个人有时会误报健康保险覆盖范围，这可能会使使用调查数据的结果产生偏差。我们使用来自税务数据的新的行政健康保险信息，跨几个维度评估调查数据中的健康保险覆盖范围，包括年龄、收入和州。我们的主要发现表明，尽管在所有人口特征中，调查数据和行政数据的总体覆盖率是相似的，但由于人口规模的差异，覆盖率和未参保人数有所不同。这些相似之处掩盖了不同保险类型承保范围的差异。医疗补助覆盖范围在税收数据中得到了很好的报告，而调查往往会少报，尤其是对低收入个人和40岁以下的人。雇主赞助的覆盖率在调查数据中比在行政数据中更高。最后，本研究为使用调查数据的研究人员提供了如何调整医疗补助覆盖范围以与行政报告水平保持一致的基准。

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引用次数: 10

Pandemics, Protests, and Firearms 流行病、抗议和枪支

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2021-03-01 DOI: 10.1086/713035

Bree J. Lang, Matthew Lang

A record number of firearm background checks were completed at the onset of the COVID-19 pandemic and during the protests following the murder of George Floyd. Using monthly state-level data, we show that the increase in firearm background check rates in March 2020 and June 2020 differ from previous gun-buying events in at least two important ways. First, the increases in the background check rates surrounding COVID-19 and the George Floyd protests are significantly larger than previous gun-buying events. Second, the gun-buying events of 2020 are nonpartisan; the effect in Republican-leaning states is statistically indistinguishable from the effect in Democrat-leaning states. Our estimates suggest that there were 62 percent more background checks completed between March and August 2020 than expected, which amounts to over 7 million additional background checks. We provide evidence that the recent spikes in background checks are not motivated by gun policy uncertainty and discuss policy recommendations that may alleviate any negative outcomes associated with expanded gun ownership during an unprecedented pandemic.

在新冠肺炎大流行开始时以及在乔治·弗洛伊德被谋杀后的抗议活动中，完成了创纪录数量的枪支背景调查。使用月度州级数据，我们发现，2020年3月和2020年6月枪支背景调查率的上升至少在两个重要方面与之前的枪支购买事件不同。首先，围绕新冠肺炎和乔治·弗洛伊德抗议活动的背景调查率的上升幅度明显大于之前的持枪事件。其次，2020年的枪支购买事件是无党派的；从统计数据来看，倾向共和党的州的影响与倾向民主党的州的效果难以区分。我们的估计表明，2020年3月至8月期间完成的背景调查比预期多62%，相当于增加了700多万次背景调查。我们提供的证据表明，最近背景调查的激增并非出于枪支政策的不确定性，并讨论了可能缓解在前所未有的疫情期间扩大枪支所有权带来的任何负面后果的政策建议。

引用次数: 13

COVID-19 and Crime 新冠肺炎与犯罪

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2021-02-02 DOI: 10.1086/713787

L. Bullinger, J. Carr, Analisa Packham

COVID-19 has led to an abrupt change in time spent at home, with many cities and states implementing official stay-at-home (SAH), or “lockdown,” policies. Using cell phone block-level activity data and administrative 911 and crime data from the City of Chicago, we estimate the effects of the Illinois governor’s SAH order on calls for police service, crimes recorded by police, and arrests made relating to domestic violence. We find that the SAH order announcement increased time spent at home, leading to a decrease in total calls for police service, but a subsequent increase in domestic violence–related calls for police service. However, we find that official reports by police officers and arrests for domestic violence crimes fell by 6.8 percent and 26.4 percent, respectively. Declines in reported domestic violence crimes mirror drops in total reported crimes; however, the reduction for domestic violence crimes is around 5 times smaller than the decline in overall crime rates.

新冠肺炎导致在家的时间突然改变，许多城市和州实施了官方的居家（SAH）或“封锁”政策。利用芝加哥市的手机封锁级别的活动数据、行政911和犯罪数据，我们估计了伊利诺伊州州长的SAH命令对报警电话、警方记录的犯罪以及与家庭暴力有关的逮捕的影响。我们发现，SAH命令的宣布增加了在家的时间，导致报警电话总数减少，但随后与家庭暴力相关的报警电话增加。然而，我们发现，警察的官方报告和对家庭暴力犯罪的逮捕分别下降了6.8%和26.4%。报告的家庭暴力犯罪的下降反映了报告的犯罪总数的下降；然而，家庭暴力犯罪的减少幅度大约是整体犯罪率下降幅度的5倍。

引用次数: 56

THE EVOLVING CONSEQUENCES OF OXYCONTIN REFORMULATION ON DRUG OVERDOSES. 奥施康定重新配方对药物过量造成的不断变化的后果。

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2021-01-01 Epub Date: 2020-12-22 DOI: 10.1086/711723

David Powell, Rosalie Liccardo Pacula

Recent evidence suggests that the short-term transition of the opioid crisis from prescription opioids to heroin can be attributed to the reformulation of OxyContin, which substantially reduced access to abusable prescription opioids. In this paper, we find that over a longer time horizon, reformulation stimulated illicit drug markets to grow and evolve. We compare overdose trajectories in areas more exposed to reformulation, defined as states with higher rates of nonmedical OxyContin use before reformulation, to less exposed areas. More exposed areas experienced disproportionate increases in fatal overdoses involving synthetic opioids (fentanyl) and nonopioid substances like cocaine, suggesting that these new epidemics are related to the same factors driving the rise in heroin deaths. Instead of just short-term substitution from prescription opioid to heroin overdoses, the transition to illicit markets spurred by reformulation led to growth in the overall overdose rate to unprecedented levels.

最近的证据表明，阿片类药物危机从处方阿片类药物向海洛因的短期过渡可归因于奥施康定（OxyContin）的重新配制，这大大减少了可滥用处方阿片类药物的获取途径。在本文中，我们发现在更长的时间跨度内，重新配方刺激了非法药物市场的增长和发展。我们比较了受改制影响较大的地区与受影响较小的地区的用药过量轨迹，前者是指在改制前非医用奥施康定使用率较高的州，后者是指在改制前非医用奥施康定使用率较低的州。接触较多的地区涉及合成阿片类药物（芬太尼）和非阿片类药物（如可卡因）的致命过量用药量出现了不成比例的增长，这表明这些新的流行病与推动海洛因死亡人数上升的相同因素有关。从处方类阿片到海洛因过量的短期替代，而不是重新配制刺激向非法市场的过渡，导致总体过量率增长到前所未有的水平。

引用次数: 0

Improving the Performance of Risk Adjustment Systems: Constrained Regressions, Reinsurance, and Variable Selection. 提高风险调整系统的性能：限制回归、再保险和变量选择》（Constrained Regressions, Reinsurance, and Variable Selection.

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2021-01-01 Epub Date: 2021-10-04 DOI: 10.1086/716199

Thomas G McGuire, Anna L Zink, Sherri Rose

Modifications of risk-adjustment systems used to pay health plans in individual health insurance markets typically seek to reduce selection incentives at the individual and group levels by adding variables to the payment formula. Adding variables can be costly and lead to unintended incentives for upcoding or service utilization. While these drawbacks are recognized, they are hard to quantify and difficult to balance against the concrete, measurable improvements in fit that may be achieved by adding variables to the formula. This paper takes a different approach to improving the performance of health plan payment systems. Using the HHS-HHC V0519 model from the Marketplaces as a starting point, we constrain fit at the individual and group level to be as good or better than the current payment model while reducing the number of variables in the model. We introduce three elements in the design of plan payment: reinsurance, constrained regressions, and machine learning methods for variable selection. The fit performance of our alternative formulas with many fewer variables is as good or better than the current HHS-HHC V0519 formula.

对用于支付个人医疗保险市场医疗计划的风险调整系统进行修改，通常是通过在支付公式中增加变量来减少个人和团体层面的选择动机。增加变量的成本可能会很高，而且会导致无意中的激励措施，如向上编码或服务利用。虽然这些弊端已得到认可，但它们很难量化，也很难与通过在公式中添加变量而实现的具体、可衡量的改善相平衡。本文采用不同的方法来提高医疗计划支付系统的绩效。我们以市场平台中的 HHS-HHC V0519 模型为起点，在减少模型中变量数量的同时，限制个人和团体层面的匹配度，使其与当前的支付模型一样好或更好。我们在计划支付的设计中引入了三个要素：再保险、约束回归和用于变量选择的机器学习方法。变量数量减少后，我们的替代公式的拟合性能与当前的 HHS-HHC V0519 公式一样好，甚至更好。

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引用次数: 0

Substance Use Disorder Treatment Centers and Residential Property Values 物质使用障碍治疗中心与住宅物业价值

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2020-12-15 DOI: 10.1086/713033

Brady P. Horn, Aakrit Joshi, J. Maclean

Substance use disorders (SUDs) are a major social concern. There is an extensive economic literature estimating the social costs associated with SUDs in terms of health care, labor market outcomes, and crime. However, beyond anecdotal claims that SUD treatment centers (SUDTCs), settings in which patients receive care, reduce residential property values, there is little empirical work on this question. We apply a spatial difference-in-differences model and administrative data to test this relationship. We find that SUDTCs sort into lower-value areas, but once SUDTC selection is addressed, we find no evidence that SUDTCs influence residential property values.

物质使用障碍是一个主要的社会问题。有大量的经济文献从医疗保健、劳动力市场结果和犯罪等方面估计了与SUD相关的社会成本。然而，除了传闻中患者接受护理的SUD治疗中心（SUDTC）会降低住宅物业价值之外，关于这个问题的实证研究很少。我们应用差异中的空间差异模型和管理数据来检验这种关系。我们发现SUDTC分为价值较低的区域，但一旦解决了SUDTC的选择问题，我们就没有发现SUDTC影响住宅物业价值的证据。

引用次数: 6

Insurance Coverage, Provider Contact, and Take-Up of the HPV Vaccine HPV疫苗的保险范围、提供者联系和接种

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2020-12-15 DOI: 10.1086/713037

Brandyn F. Churchill

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and the single biggest cause of cervical cancer, as well as certain cancers of the head and throat, anus, vulva, vagina, and penis. Between 2008 and 2012 nearly 40,000 people annually were diagnosed with an HPV-related cancer. Despite these staggering numbers and the existence of a highly effective vaccine, HPV vaccination rates remain low. In this paper, I show that state Medicaid expansions as part of the Affordable Care Act were associated with a 3–4 percentage point increase in the probability that a teenager initiated the HPV vaccine. This relationship appears to have been driven in part by increases in Medicaid coverage, the probability of having a recent checkup, and knowledge about the HPV vaccine. Supporting this pathway, I show that Medicaid expansion states saw increased searches for “pediatrician,” “Gardasil” (a trade name of the HPV vaccine), and “HPV cancer.”

人乳头瘤病毒(HPV)是美国最常见的性传播感染，也是宫颈癌的最大单一原因，以及某些头咽癌、肛门癌、外阴癌、阴道癌和阴茎癌。2008年至2012年间，每年有近4万人被诊断出患有hpv相关癌症。尽管有这些惊人的数字和高效疫苗的存在，HPV疫苗接种率仍然很低。在这篇论文中，我表明，作为《平价医疗法案》的一部分，国家医疗补助计划的扩张与青少年接种HPV疫苗的可能性增加了3-4个百分点有关。这种关系似乎在一定程度上是由医疗补助覆盖面的增加、最近进行体检的可能性以及对HPV疫苗的了解所推动的。为了支持这一途径，我表明，在医疗补助扩大的州，“儿科医生”、“Gardasil”(HPV疫苗的商标)和“HPV癌症”的搜索量增加了。

引用次数: 2

Immigration Enforcement and Infant Health 移民执法和婴儿健康

IF 3.7 2区经济学 Q1 ECONOMICS

American Journal of Health Economics

Pub Date : 2020-12-07 DOI: 10.1086/718510

Catalina Amuedo‐Dorantes, Brandyn F. Churchill, Yang Song

The past two decades were characterized by an unprecedented increase in interior immigration enforcement and heightened stress due to fears of family separation and loss of income among undocumented immigrants. Using vital statistics on infant births from the National Center for Health Statistics for the 2003 through 2016 period and a difference-in-differences design, we compare the health outcomes of infants with likely undocumented mothers before and after the intensification of immigration enforcement within US counties. We find that intensified enforcement, especially during the third trimester, increases the likelihood of low birth weight (<2,500 grams). We also present suggestive evidence that the effect could be driven by heightened stress and fears associated with police-based enforcement during pregnancy. The findings underscore the importance of current immigration policies in shaping the birth outcomes of many American children.

过去二十年的特点是，国内移民执法空前增加，由于担心家庭分离和无证移民失去收入，压力加剧。利用国家卫生统计中心2003年至2016年期间婴儿出生的重要统计数据和差异中的差异设计，我们比较了美国各县加强移民执法之前和之后婴儿与可能无证母亲的健康结果。我们发现，加强执法，特别是在妊娠晚期，增加了低出生体重(< 2500克)的可能性。我们还提出了暗示性的证据，表明这种影响可能是由怀孕期间与警察执法相关的压力和恐惧加剧造成的。这些发现强调了当前移民政策在影响许多美国儿童出生结果方面的重要性。

引用次数: 4

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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