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on Health Economics |
| By: | Sarah Croake; Jonathan D. Brown; Dean Miller; Nathan Darter; Milesh M. Patel; Junqing Liu; Sarah Hudson Scholle |
| Abstract: | This study examined whether characteristics of Medicaid beneficiaries were associated with receipt of follow-up care after discharge from the emergency department (ED) following a visit for mental or substance use disorders. |
| Keywords: | Medicaid beneficiaries, emergency department, Mental disorder, substance use disorder, health |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:f08df962a79f4b2fa21456e4b268c38c&r=hea |
| By: | Elizabeth Weigensberg; Derekh Cornwell; Lindsey Leininger; Matthew Stagner; Sarah LeBarron; Jonathan Gellar; Sophie MacIntyre; Richard Chapman; Erin J. Maher; Peter J. Pecora; Kirk O’Brien |
| Abstract: | Mathematica and Casey Family Programs have published the final report from a project linking child welfare and Medicaid data to conduct analyses to understand types of high service use and to identify factors predictive of high service use among children in foster care. |
| Keywords: | superutilization, child welfare, Medicaid, foster care, data linking, predictive analytics |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:caaff77fa722452aa241ace4b218e353&r=hea |
| By: | Kamil Jod\'z |
| Abstract: | The EU Solvency II directive recommends insurance companies to pay more attention to the risk management methods. The sense of risk management is the ability to quantify risk and apply methods that reduce uncertainty. In life insurance, the risk is a consequence of the random variable describing the life expectancy. The article will present a proposal for stochastic mortality modeling based on the Lee and Carter methodology. The maximum likelihood method is often used to estimate parameters in mortality models. This method assumes that the population is homogeneous and the number of deaths has the Poisson distribution. The aim of this article is to change assumptions about the distribution of the number of deaths. The results indicate that the model can get a better match to historical data, when the number of deaths has a negative binomial distribution. |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:arx:papers:1803.11233&r=hea |
| By: | Jonathan Gruber; Thomas P. Hoe; George Stoye |
| Abstract: | The emergency department (ED) is a complex node of healthcare delivery that is facing market and regulatory pressure across developed economies to reduce wait times. In this paper we study how ED doctors respond to such incentives, by focussing on a landmark policy in England that imposed strong incentives to treat ED patients within four hours. Using bunching techniques, we estimate that the policy reduced affected patients’ wait times by 19 minutes, yet distorted a number of medical decisions. In response to the policy, doctors increased the intensity of ED treatment and admitted more patients for costly inpatient care. We also find a striking 14% reduction in mortality. To determine the mechanism behind these health improvements, we exploit heterogeneity in patient severity and hospital crowding, and find strongly suggestive evidence that it is the reduced wait times, rather than the additional admits, that saves lives. Overall we conclude that, despite distorting medical decisions, constraining ED doctors can induce cost-effective reductions in mortality. |
| JEL: | I11 I18 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:24445&r=hea |
| By: | FUKAI Taiyo; ICHIMURA Hidehiko; KANAZAWA Kyogo |
| Abstract: | We first show (1) the importance of investigating health expenditure processes using the order two Markov chain model, rather than the standard order one model, which is widely used in the literature. The Markov chain of order two is a minimal framework that is capable of distinguishing those who experience a certain health expenditure level for the first time from those who have been experiencing that or other levels for some time. In addition, using the model, we show (2) that the probability of encountering a health shock first decreases until around age 10, and then increases with age, particularly, after age 40, (3) that health shock distributions among different age groups do not differ until their percentiles reach the median range, but that above the median, the health shock distributions of older age groups gradually start to first-order dominate those of younger groups, and (4) that the persistence of health shocks also shows a U-shape in relation to age. |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:eti:dpaper:18014&r=hea |
| By: | Gabueva, Larisa (Russian Presidential Academy of National Economy and Public Administration (RANEPA)); Pavlova, Nina (Russian Presidential Academy of National Economy and Public Administration (RANEPA)) |
| Abstract: | Today, at the highest level, both the leadership of our country and the scientific community stress the need to support and develop the human capital of Russians. But in connection with the transformation of the model of the economy of our country, which caused a series of reforms in various sectors, certain difficulties arose in this area in new dimensions of the effectiveness of managing these processes. The health of the population and the issues of its maintenance can be represented in two aspects. On the one hand, - as one of its main elements - a resource for the formation and development of other components of human capital (knowledge and skills). On the other hand, as a quantitative and qualitative indicator of their potential functioning, expressed in the potential work capacity of citizens and the duration of their healthy and active life. In this regard, services that enrich the methodological aspects of healthy lifestyles (HLS) and the practice of healthy lifestyles can appear in government programs for health development, as well as in targeted programs of a number of other agencies that coordinate aspects of social security, education, sports and recreation of Russians. |
| Keywords: | quality of a healthy life, communication platforms "doctor-patient", healthy way of life of children, adolescents and youth |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:rnp:wpaper:031827&r=hea |
| By: | Dower, Castaneda; Markevich, Andrei; Weber, Shlomo |
| Abstract: | We examine the value of a statistical life (VSL) in inter-war Soviet Union. Our approach requires to address the preferences of Stalin. We model these on the basis of the policy of statistical repression, which was an integral part of the Great Terror. We use regional variation in the victims generated by this policy to structurally estimate the value that Stalin would have been willing to accept for a reduction in citizens' fatality risk. Our estimate of this value is $43,151, roughly 6% of the VSL estimate in 1940's US and 29% of the VSL estimate in modern India. |
| Keywords: | Autocracy; Dictatorship; Great Terror; Stalin; Value of a Statistical Life |
| JEL: | I30 J17 N44 P51 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:12814&r=hea |
| By: | Hinnosaar, Marit |
| Abstract: | When a policy gives temporary incentives for healthy behaviors, how long does the impact last? I study the U.S. Special Supplemental Nutrition Program for Women, Infants, and Children, which gives vouchers for healthy foods. Using household-level scanner data, I find that the effect of the program diminishes when households become ineligible. Demand model estimates show that price differences between healthy and unhealthy foods play a large role in the decrease of the program's impact. The estimates imply that the program has a persistent effect, in that it increases the impact of subsequent policies like subsidies on healthy foods. |
| Keywords: | Consumer behavior; dietary choices; long-term policy effects |
| JEL: | D12 I12 I38 L66 |
| Date: | 2018–03 |
| URL: | http://d.repec.org/n?u=RePEc:cpr:ceprdp:12815&r=hea |
| By: | Dhruv Grover (University of California, San Diego); Sebastian Bauhoff (Center for Global Development); Jed Friedman (World Bank) |
| Abstract: | Independent verification is a critical component of performance-based financing (PBF) in health care, in which facilities are offered incentives to increase the volume of specific services but the same incentives may lead them to over-report. We examine alternative strategies for targeted sampling of health clinics for independent verification. Specifically, we empirically compare several methods of random sampling and predictive modeling on data from a Zambian PBF pilot that contains reported and verified performance for quantity indicators of 140 clinics. Our results indicate that machine learning methods, particularly Random Forest, outperform other approaches and can increase the cost-effectiveness of verification activities. |
| Keywords: | performance-based financing, performance verification, audits, machine learning, health care finance, health care providers |
| JEL: | C20 C52 I15 I18 |
| Date: | 2018–04–11 |
| URL: | http://d.repec.org/n?u=RePEc:cgd:wpaper:481&r=hea |
| By: | Antonio Di Paolo (AQR-IREA, University of Barcelona (UB). Tel.: +34-934021825; Fax.: +34-934021821. Department of Econometrics, Statistics and Applied Economics, University of Barcelona, Diagonal 690, 08034 Barcelona, Spain); Joan Gil Trasfi (Department of Economics and BEAT, University of Barcelona); Athina Raftopoulou (Roma Department of Economics and CAEPS, University of Barcelona.) |
| Abstract: | This paper aims to contribute to the debate on the North–South health divide, by disentangling the conditioning factors that account for regional differences in BMI. Based on the Spanish data of the European Health Survey of 2014, we first decompose the average BMI gap between the North and the South of Spain into the contribution of the explained and unexplained factors, using the Oaxaca-Blinder decomposition. We also carry out a distributional analysis by applying the Recentered Influence Function (RIF) Regression and the corresponding decomposition, to analyse BMI differentials along its unconditional distribution. We consider the case of Spain, which is a country characterized by important geographical disparities in BMI and other health outcomes, as well as by the decentralized structure of the Spanish National Health System (NHS). Indeed, this is the first paper that estimates and decomposes the underlying factors responsible for regional BMI variation in European countries. Our findings indicate that North to South differences in mean BMI are significant only for women and a large share (64%) of this gap is explained by differences in endowments (basically years of schooling) to the detriment of women living in the South. Moreover, the explained (unexplained) portion of the gap steadily increases (decreases) along the BMI distribution, revealing that what really matters to deal with the obesity epidemic among overweight women is focusing attention on regional disparities in endowments, human capital being the main driver. |
| Keywords: | Obesity, Regional BMI variation, Decomposition analysis,Spain. JEL classification: |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:ira:wpaper:201808&r=hea |
| By: | C. Dannemann (University of Oldenburg, Department of Economics); Erkan Goeren (University of Oldenburg, Department of Economics) |
| Abstract: | This paper hypothesizes and empirically establishes the educational burden of the ADHD-related behavioral symptoms inattention and/or hyperactivity-impulsivity on aggregate cognitive achievement outcomes. We use a novel compilation of the 2- and 7-repeat allele variants of the human DRD4 exon III gene that candidate gene association studies have identified as an important biomarker in the etiology of childhood ADHD. The main results show a negative and statistically significant association between aggregate international student achievement test scores and the DRD4 exon III 2- and 7-repeat allele frequency measure in a cross-section of 81 countries. This finding is robust to the inclusion of additional country-specific historical, cultural, socioeconomic, biogeographic, health-related, educational, genetic, and diversity factors. Additional estimates suggest the predictive power of the country-level DRD4 exon III 2- and 7-repeat allele frequency measure on cross-country differences of estimated ADHD prevalence rates, confirming the reliability of the proposed biomarker for the measurement of ADHD-related behavioral symptoms in the general population. |
| Keywords: | Human Capital, Cognitive Ability, Cognitive Skills, International Student Achievement Tests, Education Production Function, ADHD, DRD4 Exon III, Genetic Diversity |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:old:dpaper:408&r=hea |
| By: | Marielle Non (CPB Netherlands Bureau for Economic Policy Analysis) |
| Abstract: | We study the effect of a policy change in co-payments on the use of long-term home care in The Netherlands. The change increased co-payments for persons with considerable household financial assets. For identification we apply a difference-in-difference analysis with matched treatment and control groups. We find a significant effect at the extensive margin: persons affected by the policy change are less likely to take up care. The magnitude of the response increases over time, corresponding with an average annual price elasticity of demand of -0.14 and a price elasticity of -0.26 for episodes of care one year after the change. We do not find a significant effect at the intensive margin: persons who take up care do not use less hours of care. |
| JEL: | I12 I13 C23 D12 H51 |
| Date: | 2017–11 |
| URL: | http://d.repec.org/n?u=RePEc:cpb:discus:363&r=hea |
| By: | Rudy Douven (CPB Netherlands Bureau for Economic Policy Analysis); Ron van der Heijden (CPB Netherlands Bureau for Economic Policy Analysis); Thomas McGuire; Erik Schut |
| Abstract: | In health care systems with a competitive health insurance market, governments or other sponsors (e.g. employers) often subsidize premiums to encourage enrolment. These subsidies are typically independent of plan choice leaving the absolute premium differences in place so as not to distort consumer choice of plan. Such subsidies do, however, change the relative premium differences across plans, which, according to theories from behavioral economics, can affect choice. Consumers might be sensitive to differences relative to a reference premium (“relative thinking”). Furthermore, consumers might be particularly sensitive to a reference premium of zero (“zero-price effect”), a relevant range for some subsidized health insurance markets. This paper tests these ideas with two sources of evidence. We argue that observed equilibria in Germany and the U.S. Medicare Advantage markets are consistent with a powerful zero-price effects, resulting in an equilibrium focal pricing at zero. This contrasts with the Netherlands where equilibrium premiums are well above zero. In an empirical test using hypothetical questions in a web-based survey in these three countries, we also find evidence for both a relative thinking and a zero-price effect in the demand for health insurance. Our findings imply that well-designed subsidies can leverage relative thinking to increase demand elasticity for health plans. Creation of a powerful reference price (e.g., at zero), however, risks subverting price competition. |
| JEL: | D91 H21 I13 |
| Date: | 2017–10 |
| URL: | http://d.repec.org/n?u=RePEc:cpb:discus:366&r=hea |
| By: | Minke Remmerswaal (CPB Netherlands Bureau for Economic Policy Analysis); Jan Boone (CPB Netherlands Bureau for Economic Policy Analysis); Michiel Bijlsma (CPB Netherlands Bureau for Economic Policy Analysis); Rudy Douven (CPB Netherlands Bureau for Economic Policy Analysis) |
| Abstract: | Since 2006, the Dutch population has faced two different cost-sharing schemes in health insurance for curative care: a mandatory rebate of 255 euros in 2006 and 2007, and since 2008 a mandatory deductible. Using administrative data for the entire Dutch population, we compare the effect of both cost-sharing schemes on healthcare consumption between 2006 and 2013. We use a regression discontinuity design which exploits the fact that persons younger than eighteen years old neither face a rebate nor a deductible. Our fixed effect estimate shows that for individuals around the age of eighteen, a one euro increase of the deductible reduces healthcare expenditures 18 eurocents more than a euro increase of the rebate. These results demonstrate that differences in the design of a cost-sharing scheme can lead to substantial different effects on total healthcare expenditure. |
| JEL: | I12 I13 C23 D12 H51 |
| Date: | 2017–12 |
| URL: | http://d.repec.org/n?u=RePEc:cpb:discus:367&r=hea |
| By: | Wang, Jian (Department of Health Management and Health Economics); Iversen, Tor (Department of Health Management and Health Economics); Hennig-Schmidt, Heike (Department of Health Management and Health Economics); Godager, Geir (Department of Health Management and Health Economics) |
| Abstract: | When implementing a payment reform, policy makers face the challenge of assessing the effects on health care providers’ behavior. Empirical evidence most often relies on field studies, register- or survey data characterized by the absence of a control group. In this paper, we conduct a controlled laboratory experiment to assess the effect of a change in the payment system using the parameters of Hennig-Schmidt, Selten, and Wiesen (2011). We focus on the two payment systems fee-forservice (ffs) and capitation (cap). Participants are either practicing medical doctors or medical students. They are confronted with two different payment mechanisms, transitioning either from ffs to cap or vice versa. We also analyze whether the effect of financial incentives is dependent on cultural context by comparing German and Chinese medical students’ provision behavior. In line with previous evidence, both doctors and medical students provide fewer medical services under cap than under ffs. Patient benefit deviates significantly from the patient optimum under both payment systems, even though subjects do not maximize their profits. Whether cap or ffs is beneficial for the patient depends on the patient type. We find that doctors provide less patient benefit and less frequently choose benefit-maximizing treatments. We find that the sequence of payment schemes affects physician provision behavior. Under cap, more benefit is provided when cap follows ffs as compared to the opposite order. Under ffs, we observe no such effect. The interpretation is that provider behavior under a payment schemes can depend not only on the current payment scheme, but also on the payment scheme that was implemented in the past. Comparing medical students from Germany and China, we do not find any difference in behaviour under the same payment scheme. |
| Keywords: | health care providers; payment system; payment mechanisms; fee-forservice; capitation |
| JEL: | C91 H40 I11 J33 |
| Date: | 2017–10–23 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2017_002&r=hea |
| By: | Hennig-Schmidt, Heike (Department of Health Management and Health Economics); Jürges, Hendrik (Schumpeter School of Business and Economics); Wiesen, Daniel (Department of Business Administration and Health Care Management) |
| Abstract: | We introduce a controlled behavioral experiment framed in a neonatal care context to analyze the effect of introducing a random audit and fines on individuals' honesty in a simple reporting task. Our behavioral data provide new evidence on dishonesty and upcoding in health care. We find that introducing audits combined with a fine significantly reduces dishonesty on aggregate. The effect is driven by a significant reduction in upcoding. At the same time, dishonest choices that cannot be detected as fraudulent by an audit (partial dishonesty) increase. We also find evidence that individual characteristics such as gender, medical background, and integrity are related to dishonest behavior. |
| Keywords: | Dishonesty; audits and fines; neonatology; medically framed experiment; reporting of birth weights |
| JEL: | D03 I11 I18 |
| Date: | 2018–04–04 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:oslohe:2018_003&r=hea |
| By: | Manuela Alcañiz (Risckcenter Research group–IREA. Av. Diagonal 696; 08034 Barcelona ,Spain); Aïda Solé-Auró (DemoSoc Research Group, Department of Political and Social Sciences Universitat Pompeu Fabra; Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.) |
| Abstract: | (Background) Reaching advanced old age is more common now than ever. The sustained growth in longevity raises questions about why some people can feel in good quality of life until the last stages, while others seem to accuse the natural deterioration to a larger extent. The self-perceived quality of life has a subjective component, but is also mediated by some easily measurable factors such as sociodemography, health, functioning and lifestyles. (Methods) This study uses nationally representative data for Catalonia (Spain) to explain the health-related quality of life (HRQL) of the population aged 80 and above. Cross-sectional data from 2011 to 2016 was provided by an official face-to-face survey. HRQL was measured through the EuroQol-5D, consisting of a 5-question descriptive system (EQ-5D), plus a visual analogue scale (EQ-VAS) that summarizes the current self-perceived health. Linear regression was used to identify variables influencing the EQ-VAS score. Results: The dimensions of the EQ-5D that more severily disturbed the HRQL were mobility problems, pain/discomfort and anxiety/depression. Self-care or usual activity problems had a milder impact. Other variables were significantly associated with HRQL. Adjusting for age and sex, low education, low social class, being underweighted or obese, having chronic conditions and disabilities, the presence of hospitalizations or visits to the emergency department, taking prescription drugs and limitations in sensory-related abilites were predictors of a poor HRQL. (Conclusions) Our study identified the impact of several social, health and healthcare variables on the HRQL on 80-plus population. The multidimensional nature of the results suggests the need for a comprehensive approach to HRQL. Health prevention and promotion policies must address the old age as a specially sensitive stage of life. |
| Keywords: | longevity, health-related quality of life, EuroQol-5D, Spain. JEL classification:I14. |
| Date: | 2018–01 |
| URL: | http://d.repec.org/n?u=RePEc:ira:wpaper:201802&r=hea |
| By: | Nakajima, Makoto (Federal Reserve Bank of Minneapolis); Telyukova, Irina A. (Intensity Corporation) |
| Abstract: | Many U.S. households have significant wealth late in life, contrary to the predictions of a simple life-cycle model. In this paper, we document stark differences between U.S. and Sweden regarding out-of-pocket medical and long-term-care expenses late in life, and use them to investigate their role in discouraging the elderly from dissaving. Using a consumption-saving model in retirement with significant uninsurable expense risk, we find that medical expense risk accounts for a quarter of the U.S.-Sweden difference in retirees' dissaving patterns. Furthermore, medical expense risk affects primarily financial assets, while its impact on housing is limited. |
| Keywords: | Household finance; Aging; Retirement saving; Health; Cross-country analysis |
| JEL: | D14 E21 J14 J26 |
| Date: | 2018–04–10 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedmoi:0008&r=hea |
| By: | Zack Cooper (School of Public Health, Yale University); Amanda E. Kowalski (Cowles Foundation, Yale University); Eleanor Neff Powell (University of Wisconsin-Madison); Jennifer Wu (Department of Political Science, Yale University) |
| Abstract: | This paper examines the link between legislative politics, hospital behavior, and health care spending. When trying to pass sweeping legislation, congressional leaders can attract votes by adding targeted provisions that steer money toward the districts of reluctant legislators. This targeted spending provides tangible local benefits that legislators can highlight when fundraising or running for reelection. We study a provision - Section 508 – that was added to the 2003 Medicare Modernization Act (MMA). Section 508 created a pathway for hospitals to apply to get their Medicare payment rates increased. We find that hospitals represented by members of the House of Representatives who voted ‘Yea’ on the MMA were significantly more likely to receive a 508 waiver than hospitals represented by members who voted ‘Nay.’ Following the payment increase generated by the 508 program, recipient hospitals treated more patients, increased payroll, hired nurses, added new technology, raised CEO pay, and ultimately increased their spending by over $100 million annually. Section 508 recipient hospitals formed the Section 508 Hospital Coalition, which spent millions of dollars lobbying Congress to extend the program. After the vote on the MMA and before the vote to reauthorize the 508 program, members of Congress with a 508 hospital in their district received a 22% increase in total campaign contributions and a 65% increase in contributions from individuals working in the health care industry in the members’ home states. Our work demonstrates a pathway through which the link between politics and Medicare policy can dramatically affect US health spending. |
| JEL: | I10 I18 H51 D72 P16 |
| Date: | 2017–08 |
| URL: | http://d.repec.org/n?u=RePEc:cwl:cwldpp:2106&r=hea |
| By: | Ray C. Fair (Cowles Foundation, Yale University); Christopher Champa (Yale University) |
| Abstract: | Injury rates in twelve U.S. men’s college sports and five U.S. boys’ high school sports are examined in this paper. The sports are categorized as “contact” or “non-contact,” and differences in injury rates between the two are examined. Injury rates in the contact sports are considerably higher than those in the non-contact sports and they are on average more severe. Estimates are presented of the injury savings that would result if the contact sports were changed to have injury rates similar to those in the non-contact sports. The estimated college savings are 49,600 fewer injuries per year and 6,000 fewer years lost-to-injury per year. The estimated high school savings are 601,900 fewer injuries per year and 96,000 fewer years lost-to-injury per year. For concussions the savings are 6,900 per year for college and 161,400 per year for high school. The estimated dollar value (in 2015 dollars) of the total injury savings is between $446 million and $1.5 billion per year for college and between $5.4 billion and $19.2 billion per year for high school. Section 11 speculates on how the contact sports might be changed to have their injury rates be similar to those in the non-contact sports. |
| Keywords: | Sports injuries, Collegiate sports |
| JEL: | I18 I20 |
| Date: | 2017–08 |
| URL: | http://d.repec.org/n?u=RePEc:cwl:cwldpp:2101r&r=hea |
| By: | OECD |
| Abstract: | People with higher levels of education report less prevalence of depression in all OECD countries with data. A greater share of women than men report suffering from depression, but the share decreases more steeply for women than for men as educational attainment increases.Employment is associated with a lower share of self-reported depression, especially among low-educated adults. Given that mental illness has its onset in childhood or adolescence, these findings highlight the important role education systems play in ensuring students complete their education and successfully transition into the workplace. |
| Date: | 2018–04–20 |
| URL: | http://d.repec.org/n?u=RePEc:oec:eduaaf:60-en&r=hea |
| By: | Victoria Baranov (University of Melbourne); Sonia Bhalotra (University of Essex); Pietro Biroli (University of Zurich); Joanna Maselko (University of North Carolina) |
| Abstract: | We evaluate the medium-term impacts of treating maternal depression on women’s financial empowerment and parenting decisions. We leverage experimental variation induced by a cluster-randomized control trial that provided psychotherapy to perinatally depressed mothers in rural Pakistan. It was one of the largest psychotherapy interventions in the world and highly successful at reducing depression. We locate mothers seven years after the end of the intervention to evaluate its longer run effects. We find that the intervention improved women’s financial empowerment, increasing their control over household spending. Additionally, the intervention increased both time- and monetary-intensive parental investments. |
| Keywords: | mental health, maternal depression, women's labor supply, empowerment, early life, parenting, Child Development, randomized control trials, Pakistan |
| JEL: | I15 I30 O15 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:hka:wpaper:2018-021&r=hea |
| By: | Domenico Lisi; Luigi Siciliani; Odd Rune Straume |
| Abstract: | Health outcomes, such as mortality and readmission rates, are commonly used as indicators of hospital quality and as a basis to design pay-for-performance (P4P) incentive schemes. We propose a model of hospital behaviour under P4P where patients differ in severity and can choose hospital based on quality. We assume that risk-adjustment is not fully accounted for and that unobserved dimensions of severity remain. We show that the introduction of P4P which rewards lower mortality and/or readmission rates can weaken or strengthen hospitals’ incentive to provide quality. Since patients with higher severity have a different probability of exercising patient choice when quality varies, this introduces a selection bias (patient composition effect) which in turn alters quality incentives. We also show that this composition effect increases with the degree of competition. Critically, readmission rates suffer from one additional source of selection bias through mortality rates since quality affects the distribution of survived patients. This implies that the scope for counterproductive effects of P4P is larger when financial rewards are linked to readmission rates rather than mortality rates. We also show that our results are robust in the presence of public reporting, and discuss welfare implications. |
| Keywords: | quality; pay-for-performance; health outcomes; performance indicators; heterogeneous severity; selection bias. |
| JEL: | I12 I18 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:yor:yorken:18/03&r=hea |
| By: | Kiyoka Akimoto (Graduate School of Economics, Osaka University) |
| Abstract: | Mortality and fertility rates have an important in uence on economic devel- opment, while corruption also plays a role. This study examines the relationships among corruption, fertility and mortality rates, and economic development. The model is based on a three-period overlapping generations model in which agents are divided into two groups, households and bureaucrats. Households decide the number of children and bureaucrats supply public health services. All agents face mortality rates in the second period. As the empirical evidence indicates, we show that mortality and fertility rates affect development. We emphasize that corrup- tion determines the mortality rate and that the mortality rate affects corruption. Moreover, a two-way causal relationship exists between corruption and economic development. Therefore, three steady states can arise: the steady state of the early stage of development is characterized by a high level of corruption and high mortality and fertility rates; the steady state of the late stage is characterized by no corruption and low mortality and fertility rates; and the steady state of the middle stage is characterized by bureaucrats' mixed strategy whether they engage in corruption. |
| Keywords: | Bureaucratic corruption, Economic development, Mortality, Fertility |
| JEL: | D73 J18 O11 |
| Date: | 2018–04 |
| URL: | http://d.repec.org/n?u=RePEc:osk:wpaper:1810&r=hea |
| By: | Jane Ahn; Christopher Fleming; Cyrus Jadun; Sean Kirk; Rebecca Lester; Jenna Libersky; Debra Lipson; Christine O'Malley; Susan Williams |
| Abstract: | The data and information presented in this report were collected directly from all states, the District of Columbia, and US territories. |
| Keywords: | Medicaid managed care, primary care case management, primary care provider, enrollment data, Medicare-Medicaid eligibles, dual eligibles, MLTSS, managed long-term services and supports, Section 1115, Section 1902, Section 1905, Affordable Care Act, ACA, behavioral health organization, fee-for-service, Medicaid waivers, mental health |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:b60c6bb041e4483facb389d8469d1cef&r=hea |
| By: | Alexander Brand; Daan Bollinger; Peter de Jong; Theo van der Voordt |
| Abstract: | Due to structural changes in laws and regulations and ways of financing, Dutch health care organisations are in a phase of reorientation and transition. As such, many strategical issues have to be solved that will influence their corporate real estate strategy. In such a dynamic context real estate represents a high risk. The transition requires increased transparency and understanding of performance. The current Dutch situation can be described as:Increased vacancy arouses. Hypothesis: Health care organisations prevent vacancy by disposing of or reinvestments in existing locations, with improved quality of the remaining real estate.Lower rates and increased uncertainty. Hypothesis: The response will consists of increased focus, demanding a proper preparation.A growing dilemma of lower budget for real estate and high need for investments. Hypothesis: The level of available financial resources for the renewal of the stock and guaranteed sound management is questionable.The purpose of the research is to test these hypotheses in order to gain a better understanding of the qualitative and quantitative (financial) mutations in health care real estate and to bridge the gap between the current supply and the future demand.To which extent are Dutch health care organisations ready to realise the transition by the introduction of new concepts, in order to meet the future demand of health care real estate?Based on a survey, relevant real estate related data including performance parameters has been collected by AAG, a consultancy firm and shared service centre for health and care, in 2015 and 2016. This database is the starting point for benchmark analyses on the resilience and flexibility of health care organisations to provide the required transition.The data include qualitative data about the location, building, and user experience, and quantitative information (financial, physical, features). Mapping the current situation (IST) generates a better understanding of the (im)possibilities of the health care real estate in the Netherlands (1). In order to forecast the effects of the transition it is necessary to use future scenarios (SOLL) to reveal resilience and flexibility (2). Such scenarios are qualitative as well as quantitative – determining the possible maximum investment and improvement (3). These scenarios will be hold against the actual plans of the health care organisation (4). |
| Keywords: | Flexibility; Health care real estate; Match between demand and supply; Performance; Transition |
| JEL: | R3 |
| Date: | 2017–07–01 |
| URL: | http://d.repec.org/n?u=RePEc:arz:wpaper:eres2017_65&r=hea |
| By: | Herve Cazeneuve (TASDA - Technopôle Alpes, Santé à Domicile et Autonomie (Grenoble Alpes Communauté - Université Grenoble Alpes (UGA) - AEPI - ECCAMI )); Yannick Fouquet (TASDA - Technopôle Alpes, Santé à Domicile et Autonomie (Grenoble Alpes Communauté - Université Grenoble Alpes (UGA) - AEPI - ECCAMI )); Véronique Chirier (TASDA - Technopôle Alpes, Santé à Domicile et Autonomie (Grenoble Alpes Communauté - Université Grenoble Alpes (UGA) - AEPI - ECCAMI )) |
| Abstract: | In this article, we establish that patients home information System(IS) assessment in a home-based hospital care (HBHC) setting is dependent upon the understanding of actors’ rationality and of the HBHC setting. We rely on a qualitative study of two HBHC programs to describe workflow and identify the IS needs of professionals when interacting with the patient’s home. We conclude that the individual satisfaction of professionals regarding information exchange can be revealing of alternative information exchange processes that they may rely instead of the Information system provided by the HBHC unit and need to be compared with actual use of the HBHC information system. Based on this conclusion we surmise that the use of the Delone and McLean model can be the basis of the assessment of the information system as it relies on both satisfaction and use to assess the quality of service, IS and information in relation with the success regarding actual use of the IS and its benefits for the organization. |
| Abstract: | Nous avons pu établir que l’évaluation d’un système d’information au domicile du patient passait par la prise en compte de sa valeur d’usage, ce qui induisait la prise en compte des rationalités des acteurs et du contexte de l’HAD. Nous avons montré comment, à partir d’une enquête qualitative portant sur deux HAD, nous pouvions rendre compte des usages du SI au domicile en faisant émerger les processus ainsi que les attentes des professionnels, usagers du SI, à partir d’entretiens. A partir de ces éléments, nous avons pu pointer que les objectifs du SI n’était pas synonyme avec les attentes des professionnels et que ceux-ci étaient susceptibles d’opter pour des solutions alternatives, parfois informelles, susceptibles de faciliter la conduite de leurs objectifs. Cette tendance au contournement appelle à décoreller l’usage du SI et la satisfaction quant aux échanges d’information lors d’une évaluation d’un SI. A partir de ce constat, nous proposons de faire usage du modèle Delone et McLean en mettant au centre de l’évaluation la relation entre usage et satisfaction pour la qualité du SI, la qualité du support et le transfert d’informations entre les acteurs de la prise en charge du patient au domicile et la structure HAD. |
| Keywords: | Hospital At Home,Use,Information System,Assessment,Home,HAD,domicile,système d’information,évaluation,usage,système d'information,évaluation,usage Key-words: Hospital At Home |
| Date: | 2016–07–11 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:halshs-01706664&r=hea |