Health Economics

doi: 10.1002/hec.3855pmid: N/A

No abstract is available for this article.

Lau, Krystal; Hauck, Katharina; Miraldo, Marisa

doi: 10.1002/hec.3834pmid: 30338588

Influenza pandemics considerably burden affected health systems due to surges in inpatient admissions and associated costs. Previous studies underestimate or overestimate 2009/2010 influenza A/H1N1 pandemic hospital admissions and costs. We robustly estimate overall and age‐specific weekly H1N1 admissions and costs between June 2009 and March 2011 across 170 English hospitals. We calculate H1N1 admissions and costs as the difference between our administrative data of all influenza‐like‐illness patients (seasonal and pandemic alike) and a counterfactual of expected weekly seasonal influenza admissions and costs established using time‐series models on prepandemic (2004–2008) data.

Simcoe, Timothy; Catillon, Maryaline; Gertler, Paul

doi: 10.1002/hec.3836pmid: 30345722

Disease management programs aim to reduce cost by improving the quality of care for chronic diseases. Evidence of their effectiveness is mixed. Reducing health care spending sufficiently to cover program costs has proved particularly challenging. This study uses a difference in differences design to examine the impact of a diabetes disease management program for high risk patients on preventive tests, health outcomes, and cost of care. Heterogeneity is examined along the dimensions of severity (measured using the proxy of poor glycemic control) and preventive testing received in the baseline year. Although disease management programs tend to focus on the sickest, the impact of this program concentrates in the group of people who had not received recommended tests in the preintervention period. If confirmed, such findings are practically important to improve cost‐effectiveness in disease management programs by targeting relevant subgroups defined both based on severity and on (missing) test information.

French, Declan; Brink, Jonathan; Bärnighausen, Till

doi: 10.1002/hec.3837pmid: 30345572

This study examines whether labour outcomes of HIV‐infected workers treated with antiretrovirals are associated with the stage of the disease when commencing therapy. We use data on employment separation and absenteeism from the workplace health programme of South Africa's largest coal mining company over the period of January 2009 to March 2017 in a Cox proportional hazards model. When treatment was initiated at a CD4+ T cell count above 350 cells/μl, the risk of separating from the company was 37% lower and the risk of absence was 20%t lower than initiating at a CD4 count below 200 cells/μl, and these differences persist over time. Also, we find that workers initiating antiretroviral therapy at CD4  ≥  350 have an 8% lower risk of absence prior to treatment. Although many companies and the South African government have adopted universal test‐and‐treat policies aiming to initiate all HIV‐infected people as early as possible, most HIV patients still start treatment late in the disease course when their CD4 counts have fallen to low levels. Our results indicate early HIV detection and treatment could have large productivity gains.

Cotti, Chad; Nesson, Erik; Tefft, Nathan

doi: 10.1002/hec.3838pmid: 30444007

A motivation for increasing health insurance coverage is to improve health outcomes for impacted populations. However, health insurance coverage may alternatively increase risky health behaviors due to ex ante moral hazard, and past research on this issue has led to mixed conclusions. This paper uses a panel of household purchases to estimate the effects of the recent state‐level Medicaid expansions resulting from the Affordable Care Act (ACA) on consumption goods that present adverse health risks. We utilize within‐household variation to identify whether increases in Medicaid availability impacted household purchase patterns of alcohol, nicotine‐related, snack food, and carbonated beverage products. Overall, we find little evidence that the ACA Medicaid expansion led to ex ante moral hazard across any of these products, but we find compelling evidence that the Medicaid expansions reduced cigarette consumption and increased smoking cessation product use among the Medicaid‐eligible population.

Shin, Eunhae

doi: 10.1002/hec.3839pmid: 30443962

Under the prospective payment system (PPS), hospitals receive a bundled payment for an entire episode of treatment based on diagnosis‐related groups (DRG). Although there is ample evidence regarding the impact of the introduction of the PPS, there is little research on the effects of the ensuing changes in payment levels under the PPS. In 2005, the Medicare PPS changed its definition of payment areas from the Metropolitan Statistical Areas to the Core‐Based Statistical Areas, generating substantial area‐specific price shocks. Using these exogenous price variations, this study examines hospital responses to price changes under the PPS. The results demonstrate that, while the average payment amount significantly increases in the affected areas, no parallel trend is observed in admission volume, treatment intensity, and quality of services. Conversely, hospitals facing a price increase are more liable to the perverse incentives that the PPS is known to encourage, namely, selecting or shifting patients into higher‐paying DRGs. These results suggest that paying a higher price for a given service may not induce hospitals to offer services of better quality, but can rather prompt even higher payments through other behavioral responses.

Einav, Liran; Lee, Stephanie; Levin, Jonathan

doi: 10.1002/hec.3840pmid: 30450769

Workplace wellness programs have become increasingly common in the United States, although there is not yet consensus regarding the ability of such programs to improve employees' health and reduce health care costs. In this paper, we study a program offered by a large U.S. employer that provides substantial financial incentives directly tied to employees' health. The program has a high participation rate among eligible employees, around 80%, and we analyze the data on the first 4 years of the program, linked to health care claims. We document robust improvements in employee health and a correlation between certain health improvements and reductions in health care cost. Despite the latter association, we cannot find direct evidence causally linking program participation to reduced health care costs, although it seems plausible that such a relationship will arise over longer horizons.

Brown, Timothy Tyler; Atal, Juan Pablo

doi: 10.1002/hec.3841pmid: 30450623

The evaluation of policies that are not randomly assigned on outcomes generated by nonlinear data generating processes often requires modeling assumptions for which there is little theoretical guidance. This paper revisits previously published difference‐in‐differences results of an important example, the introduction of reference pricing to common outpatient procedures, to assess the robustness of the estimated impacts by using different matching, and reweighting techniques to preprocess the data. These techniques improve covariate balance and reduce model dependence. Specifically, we examine the robustness of the effect of reference pricing on patient site‐of‐care choice, total expenditures, and complication rates. We apply three preprocessing methods: propensity score reweighting, exact matching, and genetic matching. Propensity score reweighting is a technique for achieving covariate balance but does not balance higher‐order moments and may lead to bias and inefficiency in estimating treatment effects in the context of nonlinear data generating processes. In contrast, exact matching and genetic matching are designed to balance higher‐order moments. We find that although the use of the preprocessing techniques is a valuable robustness check showing that some results are sensitive to the method used, the three approaches generally yield results that do not statistically differ from the published results.

Bessho, Shun‐ichiro; Ibuka, Yoko

doi: 10.1002/hec.3845pmid: 30511394

Economic theory predicts that vaccination policies at the local level can be negatively affected by the policies of neighboring regions because of free‐riding motives, whereas positive dependency may exist due to policy diffusions among localities. By using the unique variations in the provision of vaccination subsidies in Japan, we assess how vaccination policies in a local government are affected by the decisions of neighboring governments. We find that the provision of vaccination subsidies is positively correlated with the decisions of neighboring localities. Moreover, a correlation is found with neighboring municipalities within the same prefecture but not with those in surrounding prefectures, indicating that the correlations are likely to arise because of mimicking behavior among localities within a prefecture. Our results show that vaccination policies tend to be formed following neighboring municipalities and do not necessarily aim to optimize community health, thus questioning the autonomy of local government authorities regarding vaccination policies.

Fujii, Tomoki

doi: 10.1002/hec.3844pmid: 30450615

Absenteeism of health workers in developing countries is common and can severely undermine the reliability of the health system. Therefore, it is important to understand where the prevalence of absenteeism is high. We develop a simple imputation method that combines a Service Delivery Indicators survey and a Service Provision Assessment survey to estimate the prevalence of absenteeism of health workers at the level of regions in Tanzania. The resulting estimates allow one to identify the regions in which the prevalence of absenteeism is significantly higher or lower than the national average and help policymakers determine priority areas for intervention.