Essays on Health Economics and Public Policy
Essays on Health Economics and Public Policy

Author: Bokyung Kim (Ph. D. Economics)

Publisher:

Published: 2023

Total Pages: 0

ISBN-13:

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Substance use disorders (SUDs) are a major public health concern both in the United States and worldwide. The three chapters of this dissertation examine the intended and unintended consequences of public policies designed to tackle SUDs. Chapter 1 explores the short- and long-run impacts of SUD treatment on human capital accumulation and labor market outcomes among at-risk adolescents. Specifically, I study the effect of treatment center schools, which provide residential SUD treatment and have a school on site. Using administrative data that link individual-level records across multiple government agencies in Texas, I examine within-individual changes in outcomes around the time of SUD treatment with a difference-in-differences design. I find that treated students experience declines in chronic absenteeism, disciplinary action, and course failure in the first two years following SUD treatment relative to a matched comparison group. I also find positive long-term impacts on college enrollment and employment at ages 17-20. My findings suggest that SUD treatment among adolescents may have lasting consequences and is a promising tool to promote human capital development among at-risk youth. Chapter 2, previously published in the Journal of Health Economics, investigates the consequences of "mandatory access" prescription drug monitoring programs (MA PDMPs). MA PDMPs legally require providers to access a state-level database with a patient's prescription history before prescribing controlled substances under certain circumstances. Using a difference-in-differences specification, I find strong evidence that MA PDMPs have increased heroin death rates. My results suggest that even if MA PDMPs reduce prescription opioid deaths, the decrease is offset by a large increase in illegal opioid deaths. Chapter 3, coauthored with David Beheshti, examines the effect of MA PDMPs on non-opioid-related outcomes. While many policies exclusively target prescription opioid misuse, PDMPs are designed to monitor the use of a wider range of prescription drugs. Using a difference-in-differences design, we show that MA PDMPs led to decreases in stimulant prescribing. In contrast, we find suggestive evidence that these policies resulted in increases in benzodiazepine prescriptions. Our findings highlight that MA PDMPs do have effects on non-opioid drug prescribing, but these effects differ substantially across drug types

Essays in Health Economics and Public Finance
Essays in Health Economics and Public Finance

Author: Boris Viktorovich Vabson

Publisher:

Published: 2015

Total Pages: 394

ISBN-13:

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This dissertation focuses on topics in health economics and public finance. I deal with questions that have importance for health policy, and that are simultaneously of general economic interest; in particular, I consider the efficiency impact of privatization, the effects of competition in health care markets, and the effects of incomplete contracting and imperfect competition on rates of pass-through to consumers and governments. In Chapter One, I examine the extent to which contracting out by governments yields efficiency improvements, by looking to Medicaid contracting in New York State. To identify the efficiency impact of private, relative to public Medicaid, I exploit involuntary switching between the two; primarily, I leverage age-based rules forcing individuals to switch from private to public Medicaid at 65. I also leverage unique administrative data, which longitudinally tracks individual utilization across the public and private Medicaid settings. I find evidence that private Medicaid yields efficiency improvements, but find no evidence that these improvements are passed on to either governments or patients. Instead, I find that pass-through is substantially limited by incomplete contracting, with plans shifting costs to medical services that remain under government provision. In Chapter Two, I examine the effects of cost-sharing among a previously understudied population-those dually enrolled in Medicaid and Medicare. I leverage an exogenous court ruling that resulted in loss of Medicaid coverage in Tennessee, among 25,000 individuals who had previously been dually-enrolled. This disenrollment resulted in an increase in average cost-sharing rates, from around 0% to around 20%. I find that this cost-sharing increase resulted in a utilization reduction of about 30%, implying an arc-elasticity in spending of about -.2. In Chapter Three, with Mark Duggan and Amanda Starc, we examine how contracts are affected by their generosity, by looking to the Medicare Advantage program. In doing so, we exploit a substantial policy-induced increase in MA reimbursement in metropolitan areas with a population of 250,000 or more relative to MSAs below this threshold. Our findings also reveal that about one-eighth of the additional reimbursement is passed through to consumers in the form of better coverage.

Essays in Health Economics and Health Policy
Essays in Health Economics and Health Policy

Author: Eun Young Kim

Publisher:

Published: 2011

Total Pages: 101

ISBN-13:

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This dissertation is a compilation of three essays. The first essay critiques a recent paper by Wilper et al. (2009) for its inappropriate model calibration in analyzing the association of health insurance and mortality. Using the individual-level data from a nationwide survey with more recent mortality follow-up information, it shows that the privately-insured do not significantly fare better in mortality risk compared to the uninsured. Moreover, hazard ratio estimate for the Medicaid suggests that public provision of insurance increases mortality. The second essay addresses the role of income in explaining the differential public health outcomes across developed countries. Noting that the growing arguments for socioeconomic gradient in health are based mostly on cross-sectional studies, panel analyses of five different public health outcomes are conducted. Results demonstrate that economic development remains critical in explaining health improvements at the aggregate level. The third essay analyzes the association of income and health care spending at the aggregate level. Using a large panel data from 24 industrialized nations for more than three decades, the close relationship between income and health care spending is established. In contrast to earlier cross-sectional studies, the panel analysis suggests that health expenditure growth is not as rapid as income growth in almost all nations.

Essays on Health Economics
Essays on Health Economics

Author: Iga Rudawska

Publisher: Young Writers

Published: 2009

Total Pages: 111

ISBN-13: 9780956247100

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This book explores the problems of market mechanisms in health care from the perspective of changes in the Polish health care system. The principal goal of the book is to present possibilities, methods and outcomes of introduction into health care of the market mechanisms, rules and instruments. This book is predominantly theoretical but to illustrate changes examples are given from European health care systems. The book is addressed in particular to: students of economics, students of postgraduate courses in health care management and health policy, graduates of medical universities, health and social politicians and health care practitioners, in particular managerial staff of health care institutions.

Essays in Health Economics
Essays in Health Economics

Author:

Publisher:

Published: 2015

Total Pages: 0

ISBN-13:

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This dissertation consists of three essays in health economics related issues. In the first chapter, I estimated health insurance expansion's effects on young adults' employment using MEPS. In 2010 young adults were allowed to stay on their parent's health insurance plan until the age of 26 by a policy change under the ACA. I used a difference-in-differences model to estimate labor supply effects of this policy on young adults. 23-25-year-olds are in the treatment group, and 26-30-year-olds are in the control group. Additionally, I estimated heterogeneity of the policy's labor supply effect by socio-economic groups. I found that extensive and intensive labor supply decreased among males. The effect is greater among men in higher socio-economic group. In the second chapter, I analyzed whether internet use has an effect on patients' mental health using BRFSS data. Over the last decade internet use has become universal. It provides various health related tools and information sources which may affect patients' distress levels in several ways, and health related distress can have large impacts on quality of life. I used variation across states' "right of way" policies during the broadband boom period of 2001-2005. Using rights of way rules' easiness as a proxy for broadband penetration rates, I investigated whether patients' mental health levels changed differently in states with more lenient rights of way rules. I found that among men internet use improves patients' mental health. In the third chapter, I studied labor market effects of the early Medicaid expansions under the ACA in 2010 using data from Current Population Survey. The ACA extends public insurance coverage to low income childless adults, yet we know very little about the effect of a public health insurance extension on childless adults' labor supply. The ACA allowed states to extend Medicaid and a number of states opted in early and extended Medicaid in 2010. I utilized this variation among states to evaluate whether the policy had any effect on childless adults' employment. I found that the policy had no effect on labor supply of the overall population. I found evidence that the policy mainly affected near-retirement-aged childless