International Journal Of Health Care Finance And Economics[JOURNAL]
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200 papers
The international transferability of human capital in nursing.
Huang SH
Int J Health Care Finance Econ · 2011 Sep · PMID 21779972 · Publisher ↗
This study examines the transferability of foreign human capital in nursing using the 1988-2004 National Sample Survey of Registered Nurses (NSSRN). In contrast with theoretical predictions and previous studies, this res...
This study examines the transferability of foreign human capital in nursing using the 1988-2004 National Sample Survey of Registered Nurses (NSSRN). In contrast with theoretical predictions and previous studies, this research finds evidence that foreign nursing education commands a higher return than U.S. education, even after controlling for a rich set of covariates. Consistent with the literature, the estimates illustrate foreign experience earns a lower return than domestic experience in nursing. Analysis across subsamples reveals the counter-intuitive foreign education premium is driven by foreign nurses educated in English-speaking countries and those working in hospitals. These estimates suggest future research should take into account the heterogeneity in the returns on foreign education across occupations.
Labor supply responses to government subsidized health insurance: evidence from kidney transplant patients.
Page TF
Int J Health Care Finance Econ · 2011 Jun · PMID 21567166 · Publisher ↗
Between 1993 and 1995 Medicare increased the coverage of immunosuppression medication for kidney transplant recipients from 1 to 3 years following transplantation. The universal Medicare eligibility among kidney transpla...
Between 1993 and 1995 Medicare increased the coverage of immunosuppression medication for kidney transplant recipients from 1 to 3 years following transplantation. The universal Medicare eligibility among kidney transplant patients provides a unique opportunity to explore labor supply responses to public insurance provision among a large number of men and women of prime working age and of all income levels. Although these patients are likely to be less healthy than the general population, upon receiving a kidney transplant, the main health problem of an individual with kidney failure, the lack of functioning kidneys, is removed. The income effects associated with the large transfer payment may discourage labor supply, while the potential health benefits of the coverage extension may promote labor supply. Results indicate that Medicare's increased medication coverage led to decreases in labor force participation among part time workers. These results suggest that potential labor supply reducing income effects should be taken into account when discussing the possibility of expanded public health insurance coverage, particularly for other groups of individuals with high expected medical expenditures, such as the elderly, or those with chronic conditions, such as diabetes. These results are useful considering the forthcoming expansion of government aid to purchase health insurance.
Market power and contract form: evidence from physician group practices.
Town R, Feldman R, Kralewski J
Int J Health Care Finance Econ · 2011 Jun · PMID 21562732 · Publisher ↗
We examine how the market power of physician groups affects the form of their contracts with health insurers. We develop a simple model of physician contracting based on 'behavioral economics' and test it with data from...
We examine how the market power of physician groups affects the form of their contracts with health insurers. We develop a simple model of physician contracting based on 'behavioral economics' and test it with data from two sources: a survey of physician group practices in Minnesota; and the physician component of the Community Tracking Survey. In both data sets we find that increases in groups' market power are associated with proportionately more fee-for-service revenue and less revenue from capitation.
The welfare gain from replacing the health insurance tax exclusion with lump-sum tax credits.
Liu L, Rettenmaier AJ, Saving TR
Int J Health Care Finance Econ · 2011 Jun · PMID 21461915 · Publisher ↗
This paper analyzes the welfare gain from replacing the tax exclusion of employer-provided health insurance with a lump-sum tax credit. It differs from earlier studies in that we look at the welfare cost of health insura...
This paper analyzes the welfare gain from replacing the tax exclusion of employer-provided health insurance with a lump-sum tax credit. It differs from earlier studies in that we look at the welfare cost of health insurance tax exclusion as coming directly from excessive health insurance rather than from overconsumption of medical care and that we account for the labor market effect of the tax exclusion on welfare. Both differences work to produce a smaller tax reform welfare gain. For a set of mid-range parameter values, the welfare gain is about 21% of current health insurance tax expenditures. In addition, government tax expenditures would fall by 38%, and health insurance spending would fall by 77% after the reform.
Determining factors of catastrophic health spending in Bogota, Colombia.
Amaya Lara JL, Ruiz Gómez F
Int J Health Care Finance Econ · 2011 Jun · PMID 21359837 · Publisher ↗
This study tests whether the low-income population in Bogota not insured under the General Social Security Health System is able to economically handle unexpected health problems or not. It used data from the Health Serv...
This study tests whether the low-income population in Bogota not insured under the General Social Security Health System is able to economically handle unexpected health problems or not. It used data from the Health Services Use and Expenditure Study conducted in Colombia in 2001, for which each household recorded its monthly out-of-pocket health expenditure during the year and the household income was measured as the sum of each member's contribution to the household. Payment capacity or available income and catastrophic health spending were based on the latest methodology proposed by the World Health Organization (WHO) in 2005. A probit model was adjusted to determine the factors that significantly influence the likelihood of a household having catastrophic health spending. The percentage of households with catastrophic health spending in Bogota was 4.9%; incidence was higher in low-income households where none of the members were affiliated to social security, where there had been an in-patient event, and where the heads of household were over 60 years of age. There is no statistical evidence for rejecting the hypothesis under study, which states that low-income households that have no health insurance are more likely to have catastrophic health spending than higher-income households with health insurance.
Premium growth and its effect on employer-sponsored insurance.
Vistnes J, Selden T
Int J Health Care Finance Econ · 2011 Mar · PMID 21331581 · Publisher ↗
We use variation in premium inflation and general inflation across geographic areas to identify the effects of downward nominal wage rigidity on employers' health insurance decisions. Using employer level data from the 2...
We use variation in premium inflation and general inflation across geographic areas to identify the effects of downward nominal wage rigidity on employers' health insurance decisions. Using employer level data from the 2000 to 2005 Medical Expenditure Panel Survey-Insurance Component, we examine the effect of premium growth on the likelihood that an employer offers insurance, eligibility rates among employees, continuous measures of employee premium contributions for both single and family coverage, and deductibles. We find that small, low-wage employers are less likely to offer health insurance in response to increased premium inflation, and if they do offer coverage they increase employee contributions and deductible levels. In contrast, larger, low-wage employers maintain their offers of coverage, but reduce eligibility for such coverage. They also increase employee contributions for single and family coverage, but not deductibles. Among high-wage employers, all but the largest increase deductibles in response to cost pressures.
Education and health: evidence on adults with diabetes.
Ayyagari P, Grossman D, Sloan F
Int J Health Care Finance Econ · 2011 Mar · PMID 21213044 · Full text
Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of resp...
Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.
The quality of medical care, behavioral risk factors, and longevity growth.
Lichtenberg FR
Int J Health Care Finance Econ · 2011 Mar · PMID 21188512 · Publisher ↗
The rate of increase of longevity has varied considerably across U.S. states since 1991. This paper examines the effect of the quality of medical care, behavioral risk factors (obesity, smoking, and AIDS incidence), and...
The rate of increase of longevity has varied considerably across U.S. states since 1991. This paper examines the effect of the quality of medical care, behavioral risk factors (obesity, smoking, and AIDS incidence), and other variables (education, income, and health insurance coverage) on life expectancy and medical expenditure using longitudinal state-level data. We examine the effects of three different measures of the quality of medical care. The first is the average quality of diagnostic imaging procedures, defined as the fraction of procedures that are advanced procedures. The second is the average quality of practicing physicians, defined as the fraction of physicians that were trained at top-ranked medical schools. The third is the mean vintage (FDA approval year) of outpatient and inpatient prescription drugs. Life expectancy increased more rapidly in states where (1) the fraction of Medicare diagnostic imaging procedures that were advanced procedures increased more rapidly; (2) the vintage of self- and provider-administered drugs increased more rapidly; and (3) the quality of medical schools previously attended by physicians increased more rapidly. States with larger increases in the quality of diagnostic procedures, drugs, and physicians did not have larger increases in per capita medical expenditure. We perform several tests of the robustness of the life expectancy model. Controlling for per capita health expenditure (the "quantity" of healthcare), and eliminating the influence of infant mortality, has virtually no effect on the healthcare quality coefficients. Controlling for the adoption of an important nonmedical innovation also has little influence on the estimated effects of medical innovation adoption on life expectancy.
The effects of residential proximity to bars on alcohol consumption.
Picone G, MacDougald J, Sloan F … +2 more , Platt A, Kertesz S
Int J Health Care Finance Econ · 2010 Dec · PMID 21076866 · Full text
A person's decision to drink alcohol is potentially influenced by both price and availability of alcohol in the local area. This study uses longitudinal data from 1985 to 2001 to empirically assess the impact of distance...
A person's decision to drink alcohol is potentially influenced by both price and availability of alcohol in the local area. This study uses longitudinal data from 1985 to 2001 to empirically assess the impact of distance from place of residence to bars on alcohol consumption in four large U.S. cities from 1985 to 2001. Density of bars within 0.5 km of a person's residence is associated with small increases in alcohol consumption as measured by: daily alcohol consumption (ml) drinks per week, and weekly consumption of beer, wine, and liquor. When person-specific fixed effects are included, the relationship between alcohol consumption and the number of bars within a 0.5 km radius of the person's place of residence disappears. Tests for endogeneity of the number of bars within the immediate vicinity of respondents' homes fail to reject the null hypothesis that the number of bars is exogenous. We conclude that bar density in the area surrounding the individuals' homes has at most a very small positive effect on alcohol consumption.
On decomposing the inequality and inequity change in health care utilization: change in means, or change in the distributions?
Zhong H
Int J Health Care Finance Econ · 2010 Dec · PMID 21046462 · Publisher ↗
Health care financing arrangements not only have strong implications for income distribution, but also affect health care utilization. Therefore, a comparison of the equity in health care utilization for those health sys...
Health care financing arrangements not only have strong implications for income distribution, but also affect health care utilization. Therefore, a comparison of the equity in health care utilization for those health systems with different financing arrangements has important policy implications for health care policymakers. The concentration index (CI) and the horizontal inequity index (HI) are commonly used to measure inequality and inequity in health care utilization. In this paper, we propose simple methods to decompose the difference between two CIs and two HIs into two factors: one factor reflects the difference between the means, and the other factor reflects the difference between the distributions. The proposed decomposition method might be useful since the means are likely to be caused by factors that do not constitute unfair inequalities (inequities). We also present two empirical applications of the decomposition methods for the purpose of illustration.
Assessing willingness to pay for cancer prevention.
Milligan MA, Bohara AK, Pagán JA
Int J Health Care Finance Econ · 2010 Dec · PMID 20635138 · Publisher ↗
Cancer is the second leading cause of death in the U.S. and its economic cost is very high. The objective of this study is to analyze the socioeconomic and demographic factors that are related to the willingness to pay (...
Cancer is the second leading cause of death in the U.S. and its economic cost is very high. The objective of this study is to analyze the socioeconomic and demographic factors that are related to the willingness to pay (WTP) for cancer prevention. Data from an experimental module in the 2002 Health and Retirement Study (HRS) were used to identify WTP differences across different population subgroups. Respondents were asked whether they were willing and able to pay different dollar amounts per month for a new cancer prevention drug. Years of age were negatively related to WTP whereas income and the probability of developing cancer were positively related to WTP. Risk-relevant numeracy skills were positively related to self-assessed cancer risk, which may suggest that adults with poor numeracy skills underestimate their cancer risk. This has consequences not only on the relative perceived value of different cancer treatments across different population subgroups but also on perceived value as captured by WTP.
The impact of new drug launches on the loss of labor from disease and injury: evidence from German panel data.
Bui V, Stolpe M
Int J Health Care Finance Econ · 2010 Dec · PMID 20623368 · Publisher ↗
We study the impact of new drug launches on early retirement due to disease and injury in the German labor force between 1988 and 2004. We show that new drug launches have substantially helped to reduce the loss of labor...
We study the impact of new drug launches on early retirement due to disease and injury in the German labor force between 1988 and 2004. We show that new drug launches have substantially helped to reduce the loss of labor at the disease-level over time. In Western Germany alone, each new chemical entity is estimated to have saved on average around 200 working years in every year of the observation period. Controlling for individual determinants of retirement, the 2001 reform of pension laws appears to have led to further reductions in the loss of labor from disease and injury.
Privatization of local public hospitals: effect on budget, medical service quality, and social welfare.
Aiura H, Sanjo Y
Int J Health Care Finance Econ · 2010 Sep · PMID 20552270 · Publisher ↗
We analyze a duopolistic health care market in which a rural public hospital competes against an urban public hospital on medical quality, by using a Hotelling-type spatial competition model extended into a two-region mo...
We analyze a duopolistic health care market in which a rural public hospital competes against an urban public hospital on medical quality, by using a Hotelling-type spatial competition model extended into a two-region model. We show that the rural public hospital provides excess quality for each unit of medical service as compared to the first-best quality, and the profits of the rural public hospital are lower than those of the urban public hospital because the provision of excess quality requires larger expenditure. In addition, we investigate the impact of the partial (or full) privatization of local public hospitals.
Health care costs during the last 12 months of life in Israel: estimation and implications for risk-adjustment.
Shmueli A, Messika D, Zmora I … +1 more , Oberman B
Int J Health Care Finance Econ · 2010 Sep · PMID 20495866 · Publisher ↗
Accumulating research shows that decedents' costs are high, they increase towards death, and they comprise a large proportion of total lifetime costs. The objectives of this paper are (i) to examine the Israeli pattern o...
Accumulating research shows that decedents' costs are high, they increase towards death, and they comprise a large proportion of total lifetime costs. The objectives of this paper are (i) to examine the Israeli pattern of medical care cost during the 12 months prior to death by gender, age, and chronic conditions, and (ii) to examine the implications of the results for the Israeli risk adjustment scheme. For the first objective, we used 12 month follow-up data on a cohort of decedents. For the second objective, we supplemented the data with a cross-section of enrollees (survivors and decedents in 2004). With regard to the first objective, we found that the broad Israeli patterns of cost match previous studies from other countries. With respect to the second objective, we argue that since the cost during the last 12 months of life is very high and is concentrated among relatively few persons, in order to prevent any adverse incentives caused by the combination of age-based risk adjustment and segmentation of end-of-life health care, death should be introduced into the existing retrospective risk-sharing arrangement.
Strategic costs and preferences revelation in the allocation of resources for health care.
Levaggi L, Levaggi R
Int J Health Care Finance Econ · 2010 Sep · PMID 20309636 · Publisher ↗
This article examines the resources allocation process in the internal market for health care in an environment characterised by asymmetry of information. We analyse the strategic behaviour of the provider and show how,...
This article examines the resources allocation process in the internal market for health care in an environment characterised by asymmetry of information. We analyse the strategic behaviour of the provider and show how, by misreporting its cost function and reservation utility, it might shift the allocation of resources away from the purchaser's objectives. Although the fundamental importance of equity, efficiency and risk aversion considerations which have been the traditional focus of the literature on allocation of resources should not be denied, this paper shows that contracts and internal markets are not neutral instruments and more research should be devoted to studying their effects.
The impact of decentralization of health care administration on equity in health and health care in Canada.
Zhong H
Int J Health Care Finance Econ · 2010 Sep · PMID 20217473 · Publisher ↗
In this paper, we examine the impact of decentralization of health care administration on inequity in health care access in Canada. We extend previous studies in two ways. First, to explore the spatial dimension of inequ...
In this paper, we examine the impact of decentralization of health care administration on inequity in health care access in Canada. We extend previous studies in two ways. First, to explore the spatial dimension of inequity, we adopt a perfect decomposable inequality measure--the Theil index--in our analysis. Secondly, we conduct a before and after comparison of a change in the degree of decentralization in Canada--the introduction of the CHST in 1996/1997. This may shed some lights on the casual relationship between decentralization and health-related inequity. The results of our analysis show that the overall inequity in health care utilization is mostly explained by variations within provinces in Canada. The increase in the degree of decentralization is related to lower degree of overall and within-province inequity in the use of GP and hospital services, and lower between-province inequity in the use of all the three health care variables examined in this paper.
Prescription drug coverage among elderly and disabled Americans: can Medicare-Part D reduce inequities in access?
Kanavos P, Gemmill-Toyama M
Int J Health Care Finance Econ · 2010 Sep · PMID 20213234 · Publisher ↗
This paper explores the determinants of demand for prescription drug coverage among the elderly population in the United States, using data from the Medical Expenditure Panel Survey (MEPS) and seeks to analyse the impact...
This paper explores the determinants of demand for prescription drug coverage among the elderly population in the United States, using data from the Medical Expenditure Panel Survey (MEPS) and seeks to analyse the impact that the Medicare prescription drug coverage bill (Medicare-Part D) has on Medicare beneficiaries. The results indicate that individuals who are Hispanic, black, or of another race or ethnicity, over the age of 74, not married, in poor health, fall into the low- to middle-income brackets, and have less than a high school degree are more likely to be covered through a public program, more likely to be uninsured for prescription medicine outlays, and less likely to have private prescription drug coverage. The paper concludes that there is cause for considerable concern for low income citizens who have significant prescription drug outlays, and, therefore, the greatest need because their prescription drug costs may not be covered beyond a certain limit unless they reach catastrophic proportions. This continues to raise equity in access concerns among elderly patients.
Do Medicare Advantage enrollees tend to be admitted to hospitals with better or worse outcomes compared with fee-for-service enrollees?
Friedman B, Jiang HJ
Int J Health Care Finance Econ · 2010 Jun · PMID 20140642 · Publisher ↗
The hospitals selected by or for Medicare beneficiaries might depend on whether the patient is enrolled in a Medicare Advantage (MA) plan. A theoretical model of profit maximization by MA plans takes into account the tra...
The hospitals selected by or for Medicare beneficiaries might depend on whether the patient is enrolled in a Medicare Advantage (MA) plan. A theoretical model of profit maximization by MA plans takes into account the tradeoffs of consumer preferences for annual premium versus outcomes of care in the hospital and other attributes of the plan. Hospital discharge databases for 13 states in 2006, maintained by the Agency for Healthcare Research and Quality, are the main source of data. Risk-adjusted mortality rates are available for all non-maternity adult patients in each of 15 clinical categories in about 1,500 hospitals. All-adult postoperative safety event rates covering 9 categories of events are calculated for surgical cases in about 900 hospitals. Instrumental variables are used to address potential endogeneity of the choice of a MA plan. The key findings are these: enrollees in MA plans tend to be treated in hospitals with lower resource cost and higher risk-adjusted mortality compared to Fee-for-Service (FFS) enrollees. The risk-adjusted mortality measure is about 1.5 percentage points higher for MA plan enrollees than the overall mean of 4%. However, the rate of safety events in surgical patients favors MA plan enrollees--the rate is 1 percentage point below the average of 3.5%. These discrepant results are noteworthy and are plausibly due to greater discretion by the health plan in approving patients for elective surgery and as well as selecting hospitals for surgical patients. Emergency patients are generally excluded for the safety outcome measures. In addition, the current mortality measures may not adequately represent all surgical patients. Such caveats should be prominently highlighted when presenting comparative data. With that proviso, the study justifies informing Medicare beneficiaries about the mortality and safety outcome measures for hospitals being used by a MA plan compared to hospitals used by FFS enrollees.
Medicare Part B reimbursement and the perceived quality of physician care.
Brunt CS, Jensen GA
Int J Health Care Finance Econ · 2010 Jun · PMID 19960245 · Publisher ↗
The maximum amount physicians can charge Medicare patients for Part B services depends on Medicare reimbursement rates and on federal and state restrictions regarding balance billing. This study evaluates whether Part B...
The maximum amount physicians can charge Medicare patients for Part B services depends on Medicare reimbursement rates and on federal and state restrictions regarding balance billing. This study evaluates whether Part B payment rates, state restrictions on balance billing beyond the federal limit, and physician balance billing influence how beneficiaries rate the quality of their doctor's care. Using nationally representative data from the 2001 to 2003 Medicare Current Beneficiary Survey, this paper finds strong evidence that Medicare reimbursement rates, and state balance billing restrictions influence a wide range of perceived care quality measures. Lower Medicare reimbursement and restrictions on physicians' ability to balance bill significantly reduce the perceived quality of care under Part B.
Economic evaluation of the direct healthcare cost savings resulting from the use of walking interventions to prevent coronary heart disease in Australia.
Zheng H, Ehrlich F, Amin J
Int J Health Care Finance Econ · 2010 Jun · PMID 19882347 · Publisher ↗
Coronary heart disease (CHD) is the leading cause of death in Australia. Direct healthcare costs of CHD exceed those of any other disease. The purpose of this study was to evaluate the direct healthcare cost savings resu...
Coronary heart disease (CHD) is the leading cause of death in Australia. Direct healthcare costs of CHD exceed those of any other disease. The purpose of this study was to evaluate the direct healthcare cost savings resulting from walking interventions to prevent CHD in Australia. A meta-analysis was performed to quantify the efficacy of walking interventions in preventing CHD. The etiologic fraction and other mathematical models were applied to quantify the cost savings resulting from walking interventions to prevent CHD. The net direct healthcare cost savings in CHD prevention resulting from 30 min of normal walking a day for 5-7 days a week by the sufficient walking population were estimated at AU$126.73 million in 2004. The cost savings could increase to $419.90 million if all the inactive adult Australians engaged in 1 h of normal walking a day for 5-7 days a week. Given its low injury risk and high adherence, walking should be advocated as a key population-based primary intervention strategy for CHD prevention and healthcare cost reduction.
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