journal
https://read.qxmd.com/read/38447245/pricing-above-value-selling-to-a-market-with-selection-problems
#1
JOURNAL ARTICLE
Jan Boone
This paper shows that selection incentives in downstream markets distort upstream prices. It is possible for inputs to be priced above the value that the good has for final consumers. We apply this idea to pharmaceutical companies selling drugs to a health insurance market with selection problems. We specify the conditions under which drugs are sold at prices exceeding treatment value. Another feature of the model is an excessive private incentive to reduce market size, e.g. in the form of personalized medicine...
March 5, 2024: Journal of Health Economics
https://read.qxmd.com/read/38461677/safer-sex-the-effect-of-aids-risk-on-birth-rates
#2
JOURNAL ARTICLE
Melissa K Spencer
Behavioral adjustments to mitigate increasing risk of STIs can increase or decrease the likelihood of pregnancy. This paper measures the effects of the arrival and spread of AIDS across U.S. cities in the 1980s and 1990s on births and abortions. I show that the AIDS epidemic increased the birth rate by 0.55 percent and the abortion rate by 1.77 percent. I find support for two underlying mechanisms to explain the increase in pregnancies. Some women opted into monogamous partnerships in response to the AIDS epidemic, with a corresponding increase in the marriage rate and improvement in infant health...
March 1, 2024: Journal of Health Economics
https://read.qxmd.com/read/38367452/optimal-intertemporal-curative-drug-expenses-the-case-of-hepatitis-c-in-france
#3
JOURNAL ARTICLE
Pierre Dubois, Thierry Magnac
We study intertemporal tradeoffs that health authorities face when considering the control of an epidemic using innovative curative medical treatments. We set up a dynamically controlled susceptible-infected-recovered (SIR) model for an epidemic in which patients can be asymptomatic, and we analyze the optimality conditions of the sequence of cure expenses decided by health authorities at the onset of the drug innovation process. We show that analytical conclusions are ambiguous because of their dependence on parameter values...
February 16, 2024: Journal of Health Economics
https://read.qxmd.com/read/38401249/a-new-look-at-physicians-responses-to-financial-incentives-quality-of-care-practice-characteristics-and-motivations
#4
JOURNAL ARTICLE
Jeannette Brosig-Koch, Heike Hennig-Schmidt, Nadja Kairies-Schwarz, Johanna Kokot, Daniel Wiesen
There is considerable controversy about what causes (in)effectiveness of physician performance pay in improving the quality of care. Using a behavioral experiment with German primary-care physicians, we study the incentive effect of performance pay on service provision and quality of care. To explore whether variations in quality are based on the incentive scheme and the interplay with physicians' real-world profit orientation and patient-regarding motivations, we link administrative data on practice characteristics and survey data on physicians' attitudes with experimental data...
February 15, 2024: Journal of Health Economics
https://read.qxmd.com/read/38359587/the-causal-effect-of-a-health-treatment-on-beliefs-stated-preferences-and-memories
#5
JOURNAL ARTICLE
Alberto Prati, Charlotte Saucet
The paper estimates the causal effect of a health treatment on patients' beliefs, preferences and memories about the treatment. It exploits a natural experiment which occurred in the United Kingdom during the COVID-19 vaccination campaign. UK residents could choose to opt into the vaccination program, but not which vaccine they received. The assignment to a vaccine offered little objective information for learning about its qualities, but triggered strong psychological demand for reassuring beliefs. We surveyed a sample of UK residents about their beliefs on the different COVID-19 vaccines before and after receiving their jab...
February 6, 2024: Journal of Health Economics
https://read.qxmd.com/read/38341937/estimating-the-effects-of-tobacco-21-on-youth-tobacco-use-and-sales
#6
JOURNAL ARTICLE
Rahi Abouk, Prabal K De, Michael F Pesko
We examine the effect of raising the minimum legal sale age of tobacco to 21 (i.e., "T21"). We estimate difference-in-differences models using the Monitoring the Future (MTF) survey data and Nielsen Retail Scanner data from 2012 to 2019. Outcomes include cigarette and e-cigarette use and sales. We find sizable reductions in e-cigarette and cigarette use for 12th graders. T21 also reduced cigarette sales by 12.4 % and e-cigarette sales by 69.3 % in counties with the highest percent quartile of individuals under 21 years of age...
February 2, 2024: Journal of Health Economics
https://read.qxmd.com/read/38266377/aversion-to-health-inequality-pure-income-related-and-income-caused
#7
JOURNAL ARTICLE
Matthew Robson, Owen O'Donnell, Tom Van Ourti
We design a novel experiment to identify aversion to pure (univariate) health inequality separately from aversion to income-related and income-caused health inequality. Participants allocate resources to determine health of individuals. Identification comes from random variation in resource productivity and information on income and its causal effect. We gather data (26,286 observations) from a sample of UK adults (n = 337) and estimate pooled and participant-specific social preferences while accounting for noise...
January 23, 2024: Journal of Health Economics
https://read.qxmd.com/read/38280239/immigration-enforcement-and-the-institutionalization-of-elderly-americans
#8
JOURNAL ARTICLE
Abdulmohsen Almuhaisen, Catalina Amuedo-Dorantes, Delia Furtado
This paper examines the relationship between immigration enforcement and institutionalization rates of the elderly. Exploiting the staggered implementation of the Secure Communities (SC) immigration enforcement program across U.S. counties from 2008 through 2014, we show that SC led to a 0.26 percentage points (6.8 percent) increase in the likelihood that Americans aged 65 and above live in an institution. Supportive of supply shocks in the household services market as a central mechanism, we find that the elderly who are most likely to purchase domestic worker services are also the most likely to move into nursing homes following the implementation of SC...
January 19, 2024: Journal of Health Economics
https://read.qxmd.com/read/38241795/regulating-ethical-experimentation-impacts-of-the-breakthrough-therapy-designation-on-drug-r-d
#9
JOURNAL ARTICLE
Manuel Hermosilla
This article investigates patterns of pharmaceutical development activity around the 2012 creation of the FDA's Breakthrough Therapy Designation (BTD). The BTD introduced regulatory flexibility and support to avoid ethical challenges created by experimental therapies of exceptional performance in early stage clinical trials. We argue that the program's design indirectly created substantial incentives for the industry to pursue the designation. Consistent with this hypothesis, our evidence links the creation of the program with a substantial increase in the number of new drug indications entering the clinical trial process...
January 18, 2024: Journal of Health Economics
https://read.qxmd.com/read/38232446/the-impact-of-medicaid-expansion-and-travel-distance-on-access-to-transplantation
#10
JOURNAL ARTICLE
Bethany Lemont
Most transplant centers require candidates be insured before they can join the waitlist for a deceased donor organ. After the Affordable Care Act, many uninsured Americans gained improved access to Medicaid. I examine the effect of this increase in access to insurance and find that Medicaid expansions significantly increase Medicaid-insured waitlist registrations by 39% and deceased donor transplants received by 44%, but the increase in registrations is larger for candidates who live closer to a transplant center...
January 14, 2024: Journal of Health Economics
https://read.qxmd.com/read/38232447/risk-preferences-over-health-empirical-estimates-and-implications-for-medical-decision-making
#11
JOURNAL ARTICLE
Karen Mulligan, Drishti Baid, Jason N Doctor, Charles E Phelps, Darius N Lakdawalla
Mainstream health economic theory implies that an expected gain in health-related quality of life (HRQoL) produces the same value for consumers, regardless of baseline health. Several strands of recent research call this implication into question. Generalized Risk-Adjusted Cost-Effectiveness (GRACE) demonstrates theoretically that baseline health status influences value, so long as consumers are not risk-neutral over health. Prior empirical literature casts doubt on risk-neutral expected utility-maximization in the health domain...
January 9, 2024: Journal of Health Economics
https://read.qxmd.com/read/38219527/the-impact-of-scope-of-practice-restrictions-on-access-to-medical-care
#12
JOURNAL ARTICLE
Jiapei Guo, Angela E Kilby, Mindy S Marks
We study the impact of scope-of-practice laws in a highly regulated and important policy setting, the provision of medication-assisted treatment for opioid use disorder. We consider two natural experiments generated by policy changes at the state and federal level that allow nurse practitioners more practice autonomy. Both experiments show that liberalizations of prescribing authority lead to large improvements in access to care. Further, we use rich address-level data to answer key policy questions. Expanding nurse practitioner prescribing authority reduces urban-rural disparities in health care access...
January 5, 2024: Journal of Health Economics
https://read.qxmd.com/read/38183949/do-responses-to-news-matter-evidence-from-interventional-cardiology
#13
JOURNAL ARTICLE
Daniel Avdic, Stephanie von Hinke, Bo Lagerqvist, Carol Propper, Johan Vikström
We examine physician responses to a global information shock and how these impact their patients. We exploit international news over the safety of an innovation in healthcare, the drug-eluting stent. We use data on interventional cardiologists' use of stents to define and measure cardiologists' responsiveness to the initial positive news and link this to their patients' outcomes. We find substantial heterogeneity in responsiveness to news. Patients treated by cardiologists who respond slowly to the initial positive news have fewer adverse outcomes...
January 5, 2024: Journal of Health Economics
https://read.qxmd.com/read/38428266/effects-of-nurse-visit-copayment-on-primary-care-use-do-low-income-households-pay-the-price
#14
JOURNAL ARTICLE
Tapio Haaga, Petri Böckerman, Mika Kortelainen, Janne Tukiainen
Nurses are increasingly providing primary care, yet the literature on cost-sharing has paid little attention to nurse visits. We employ a staggered difference-in-differences design to examine the effects of adopting a 10-euro copayment for nurse visits on the use of public primary care among Finnish adults. We find that the copayment reduced nurse visits by 9%-10% during a one-year follow-up. There is heterogeneity by income in absolute terms, but not in relative terms. The spillover effects on general practitioner (GP) use are negative but small, with varying statistical significance...
March 2024: Journal of Health Economics
https://read.qxmd.com/read/38359586/the-value-of-improving-insurance-quality-evidence-from-long-run-medicaid-attrition
#15
JOURNAL ARTICLE
Ajin Lee, Boris Vabson
The US government increasingly provides public health insurance coverage through private firms. We examine associated welfare implications for beneficiaries, using a 'revealed preference' framework based on beneficiaries' program attrition rates. Focusing on the Medicaid program in New York State, we exploit quasi-random variation in the initial assignment at birth to public versus private Medicaid based on birth weight. We find that infants assigned to private Medicaid at birth are less likely to subsequently leave Medicaid...
March 2024: Journal of Health Economics
https://read.qxmd.com/read/38354657/financial-incentives-and-private-health-insurance-demand-on-the-extensive-and-intensive-margins
#16
JOURNAL ARTICLE
Nathan Kettlewell, Yuting Zhang
In countries with dual public and private healthcare systems, individuals are often incentivized to purchase private health insurance through subsidies and penalty. We use administrative data from Australia to study how high-income earners respond on both the intensive and extensive margins to the simultaneous withdrawal of a premium subsidy, and the increase of a tax penalty. We estimate regression discontinuity models by exploiting discontinuous changes in the penalty and subsidy rates. Our setting is particularly interesting because means testing creates different incentives at the extensive and intensive margins...
March 2024: Journal of Health Economics
https://read.qxmd.com/read/38113755/socioeconomic-status-and-access-to-mental-health-care-the-case-of-psychiatric-medications-for-children-in-ontario-canada
#17
JOURNAL ARTICLE
Janet Currie, Paul Kurdyak, Jonathan Zhang
We examine differences in the prescribing of psychiatric medications to lower-income and higher-income children in the Canadian province of Ontario using rich administrative data that includes diagnosis codes and physician identifiers. Our most striking finding is that conditional on diagnosis and medical history, low-income children are more likely to be prescribed antipsychotics and benzodiazepines than higher-income children who see the same doctors. These are drugs with potentially dangerous side effects that ideally should be prescribed to children only under narrowly proscribed circumstances...
January 2024: Journal of Health Economics
https://read.qxmd.com/read/38113754/pharmaceutical-demand-response-to-utilization-management
#18
JOURNAL ARTICLE
Oren Sarig
Prescription drug insurance increasingly imposes prior authorization (requiring providers to request coverage before claim approval) to manage utilization. Prior authorization has been criticized because of its administrative burden on providers. The primary alternative to managing utilization is imposing out-of-pocket (OOP) payment to incentivize beneficiaries to seek lower-cost care, effectively providing beneficiaries with partial insurance. Would beneficiaries prefer indirectly paying for prior authorization through higher premiums; or would they prefer prior authorization was replaced by higher OOP costs? This tradeoff depends on how much OOP costs could be displaced by prior authorization, which depends on their relative impact on demand...
January 2024: Journal of Health Economics
https://read.qxmd.com/read/38211459/sibling-spillovers-and-the-choice-to-get-vaccinated-evidence-from-a-regression-discontinuity-design
#19
JOURNAL ARTICLE
Maria Knoth Humlum, Marius Opstrup Morthorst, Peter Rønø Thingholm
We investigate the effects of introducing population-wide free-of-charge Human Papillomavirus (HPV) vaccination programs on the targeted adolescent cohorts and their siblings. For identification, we rely on regression discontinuity designs and high-quality Danish administrative data to exploit that date of birth determines program eligibility. We find that the programs increased the HPV vaccine take-up of both the targeted children (53.2 percentage points for girls and 36.0 percentage points for boys) and their older same-sex siblings (4...
December 27, 2023: Journal of Health Economics
https://read.qxmd.com/read/38154202/distributionally-sensitive-measurement-and-valuation-of-population-health
#20
JOURNAL ARTICLE
Shaun Da Costa, Owen O'Donnell, Raf Van Gestel
We introduce a measure of population health that is sensitive to inequality in both age-specific health and lifespan and can be calculated from a health-extended period life table. By allowing for inequality aversion, the measure generalises health-adjusted life expectancy without requiring more data. A transformation of change in the (life-years) measure gives a distributionally sensitive monetary valuation of change in population health and disease burden. Application to Sub-Saharan Africa between 1990 and 2019 reveals that the change in population health is sensitive to allowing for lifespan inequality but is less sensitive to age-specific health inequality...
December 15, 2023: Journal of Health Economics
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