Health Economics

doi: 10.1002/hec.4066pmid: N/A

No abstract is available for this article.

Serna, Natalia

doi: 10.1002/hec.4244pmid: 33733585

This paper measures consumer responsiveness to cost sharing in healthcare using a regression discontinuity design. I use a novel and detailed claims‐level dataset from the Colombian healthcare market, where the government exogenously determines a tier system for coinsurance rates and copays based on the enrollee's monthly income. I find that patients exposed to higher coinsurance rates demand fewer services relative to patients facing lower cost sharing. This reduction holds for both discretionary and preventive services. Lower utilization translates into lower costs, despite evidence that patients facing higher prices do not substitute away from more expensive providers.

Dalgaard, Carl‐Johan; Hansen, Casper Worm; Strulik, Holger

doi: 10.1002/hec.4231pmid: 33740283

The fetal origins hypothesis suggests that health and nutrition shocks in utero are causally related to health deficits in old age. It has received considerable empirical support, both within epidemiology and economics but so far it has not been integrated into a life cycle theory of human aging and longevity. The present study shows that the health deficit model, based on the frailty index developed in gerontology, generates shock amplification consistent with the hypothesis. In order to discuss human health over the life cycle from conception to death, we develop a theory of ontogenetic growth and health in utero and during childhood, unify it with the health deficit model of adult aging, and discuss the transmission of early‐life shocks to late‐life health deficit accumulation.

Genie, Mesfin G.; Krucien, Nicolas; Ryan, Mandy

doi: 10.1002/hec.4245pmid: 33740258

Multi‐attribute choices are commonly analyzed in economics to value goods and services. Analysis assumes individuals consider all attributes, making trade‐offs between them. Such decision‐making is cognitively demanding, often triggering alternative decision rules. We develop a new model where individuals aggregate multi‐attribute information into meta‐attributes. Applying our model to a choice experiment (CE) dataset, accounting for attribute aggregation (AA) improves model fit. The probability of adopting AA is greater for: homogenous attribute information; participants who had shorter response time and failed the dominance test; and for later located choices. Accounting for AA has implications for welfare estimates. Our results underline the importance of accounting for information processing rules when modelling multi‐attribute choices.

Cowan, Benjamin W.; Hao, Zhuang

doi: 10.1002/hec.4256pmid: 33740278

Reported mental health problems have risen dramatically among US college students over time, as has treatment for these problems. We examine the effect of state‐level Medicaid expansion following the 2014 implementation of the Affordable Care Act on the diagnosis of mental health conditions, psychotropic prescription drug use, and the mental health status of a national sample of college students. We find that students from disadvantaged backgrounds are more likely to report being on public insurance after 2014 in expansion states relative to non‐expansion states, while more advantaged students do not see this increase. Both diagnosis of common mental health conditions and psychotropic drug use increase following expansion for disadvantaged students relative to advantaged ones, which translates into an elimination of the pre‐expansion gap in these outcomes by family background in expansion states. However, in contrast to some recent work on Medicaid expansion and mental health, we do not find that these changes are associated with improvements in self‐reported mental health status. We also do not find that Medicaid expansion has affected risky health behaviors or academic outcomes.

Van Sandt, Anders; Carpenter, Craig Wesley; Dudensing, Rebekka; Loveridge, Scott

doi: 10.1002/hec.4242pmid: 33745144

We model the locational determinants of nine categories of healthcare services in the contiguous United States using restricted access federal establishment data. These data enable close examination of rural health services, which are subject to suppression in publicly published data sources. After reviewing differences in public and unsuppressed restricted data and testing underlying data generation processes for each healthcare industry, including the Poisson, negative binomial, and their zero‐inflated counterparts, we estimate marginal effects for four categories of independent variables: place‐based factors, financial access, characteristics of population, and industry interdependencies. Findings show establishments are less likely to be found with high concentrations of Medicare and Medicaid recipients, while agglomerations are associated with more establishments. Nonemployer establishments serve a broader spectrum of people, but the rural poor still experience less access to health care.

Whitmeyer, Mark

doi: 10.1002/hec.4254pmid: 33763902

This note studies the effect of the availability of a test for a virus on the public health of a population. It is shown by example that the existence of a freely available and moderately informative test for a virus may lower society's welfare in comparison to the case where no test exists or access to the test is restricted. In this setting, any test provided to any subset of agents who would find it optimal not to isolate absent the test improves welfare.

Zhang, Jonathan; Chen, Yiwei; Einav, Liran; Levin, Jonathan; Bhattacharya, Jay

doi: 10.1002/hec.4257pmid: 33764640

We use administrative data from Medicare to document the massive consolidation of primary care physicians over the last decade and its impact on patient healthcare utilization. We first document that primary care organizations have consolidated all over the United States between 2008 and 2014. We then show that regions that experienced greater consolidation are associated with greater decline in overall healthcare spending. Finally, in our primary exercise, we exploit transitions of patients across organizations that are driven by changes in the organizational affiliations of their primary care physicians to study the impact of organizational size on overall spending. Our preferred specification suggests that patients switching from small to large physician organizations reduce their overall healthcare spending by 16%, and that this reduction is primarily driven by a 13% reduction in primary care visits and 0.09 (21%) fewer inpatient admissions per year.

Japaridze, Irakli; Sayour, Nagham

doi: 10.1002/hec.4261pmid: 33786904

We hypothesize that when interpersonal comparisons, often referred to as “keeping up with the Joneses”, are operational, relative deprivation (income inequality) results in increased likelihood of morbidity among lower income households. Using a simple theoretical model, we show that the larger the income disparities between “the Joneses” and “the followers”, the higher is the followers' expenditure on conspicuous consumption and the lower is their expenditure on health. We empirically test our hypotheses using Canadian data from the Canadian Community Health Survey and the Survey of Household Spending and US data from the National Health Interview Survey. We find that, in peer groups defined by geographic proximity of residence or similar socio‐economic background, larger income disparities are associated with higher spending by the followers on conspicuous consumption, lower health expenditure, worse self‐reported health and younger age at death.

McManus, Emma; Elliott, Jack; Meacock, Rachel; Wilson, Paul; Gellatly, Judith; Sutton, Matt

doi: 10.1002/hec.4262pmid: 33786914

Despite widespread use, evidence is sparse on whether financial incentives in healthcare should be linked to structure, process or outcome. We examine the impact of different incentive types on the quantity and effectiveness of referrals made by general practices to a new national prevention programme in England. We measured effectiveness by the number of referrals resulting in programme attendance. We surveyed local commissioners about their use of financial incentives and linked this information to numbers of programme referrals and attendances from 5170 general practices between April 2016 and March 2018. We used multivariate probit regressions to identify commissioner characteristics associated with the use of different incentive types and negative binomial regressions to estimate their effect on practice rates of referral and attendance. Financial incentives were offered by commissioners in the majority of areas (89%), with 38% using structure incentives, 69% using process incentives and 22% using outcome incentives. Compared to practices without financial incentives, neither structure nor process incentives were associated with statistically significant increases in referrals or attendances, but outcome incentives were associated with 84% more referrals and 93% more attendances. Outcome incentives were the only form of pay‐for‐performance to stimulate more participation in this national disease prevention programme.