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At least 1,081 records · Page 60Linked to original sources
PubMed2003

The effect of urban hospital closure on markets.

We measure the effect of urban hospital closure on the operating efficiency of the remaining hospitals in the local market. Closure of a hospital other than the least efficient can be detrimental to social welfare because treatment costs will be higher at surviving hospitals. The results show that hospital closure has led to an evolutionary increase in efficiency in urban markets. The hospitals that closed were less efficient at baseline, and after closure their competitors realized lower costs per adjusted admission through an increase in inpatient admissions and emergency room visits. Overall, we estimate that costs per adjusted admission declined by 2-4% for all patients and about 6-8% for patients who would have been treated at the closed hospital.

Catchment Area, Health↗
PubMed1996

Employment, unemployment, and problem drinking.

The misuse of alcohol is estimated to result in enormous economic costs, composed largely of reduced labor market productivity. However, there has been debate on this issue. The purpose of this paper is to help to resolve this debate by presenting sound structural estimates of the relationship between measures of problem drinking and of employment and unemployment. The analysis is based on the 1988 Alcohol Supplement of the National Health Interview Survey. We find that for both men and women, problem drinking results in reduced employment and increased unemployment.

Alcoholism↗
PubMed1996

Alcohol policies and highway vehicle fatalities.

This study investigates the impact of beer taxes and a variety of alcohol-control policies on motor vehicle fatality rates. Special attention is paid to omitted variables biases resulting from failing to adequately control for grassroots efforts to reduce drunk driving, the enactment of other laws which simultaneously operate to reduce highway fatalities, and the economic conditions existing at the time the legislation is passed. In the preferred models, most of the regulations have little or no impact on traffic mortality. By contrast, higher beer taxes are associated with reductions in crash deaths and this result is relatively robust across specifications.

Accidents, Traffic↗
PubMed1996

Mathematical programming for the efficient allocation of health care resources.

Previous discussions of methods for the efficient allocation of health care resources subject to a budget constraint have relied on unnecessarily restrictive assumptions. This paper makes use of established optimization techniques to demonstrate that a general mathematical programming framework can accommodate much more complex information regarding returns to scale, partial and complete indivisibility and program interdependence. Methods are also presented for incorporating ethical constraints into the resource allocation process, including explicit identification of the cost of equity.

Budgets↗
PubMed1996

The effect of Medicaid abortion funding restrictions on abortions, pregnancies and births.

This paper considers whether state Medicaid abortion funding restrictions affect the likelihood of getting pregnant, having an abortion and bearing a child. We exploit a natural experiment afforded by Supreme Court decisions and employ more traditional multivariate models with alternative fixed effect specifications. An analysis of 12 years of state-level data indicate that restrictions are associated with a reduction in abortions and either no change or a reduction in births, implying fewer pregnancies. Subsequent analysis of the National Longitudinal Survey of Youth (NLSY) is consistent with these findings and show the response is concentrated among the low-income population.

Abortion, Legal↗
PubMed1996

Health insurance: the tradeoff between risk pooling and moral hazard.

Choosing optimal health insurance coverage involves a trade-off between the gain from risk reduction and the deadweight loss from moral hazard. This paper examines this trade-off empirically by estimating both the demand for health insurance and the demand for health services. It relies on data from a randomized controlled trial of cost-sharing's effects on the use of health services and on the health status for a general, non-elderly population.

Actuarial Analysis↗
PubMed1996

Economies of scale and scope as an explanation of merger and output diversification activities in the health maintenance organization industry.

This paper tests for the existence and magnitude of economies of scale and scope as possible explanations for the recent observed trends in increasing health maintenance organization (HMO) scale (through merger and acquisition) and scope (through greater participation in public enrollee markets) using firm level data from a sample of California HMOs for the time period 1986-1992. The results suggest that economies of scale provide a strong justification for mergers only in the case of relatively small HMOs (i.e. those with fewer than 115,000 enrollees), and economies of scope do not explain the increasing HMO enrollment of public enrollees.

California↗
PubMed1997

Economic foundations of cost-effectiveness analysis.

To address controversies in the applications of cost-effectiveness analysis, we investigate the principles underlying the technique and discuss the implications for the evaluation of medical interventions. Using a standard von Neumann-Morgenstern utility framework, we show how a cost-effectiveness criterion can be derived to guide resource allocation decisions, and how it varies with age, gender, income level, and risk aversion. Although cost-effectiveness analysis can be a useful and powerful tool for resource allocation decisions, a uniform cost-effectiveness criterion that is applied to a heterogeneous population level is unlikely to yield Pareto-optimal resource allocations.

Cost-Benefit Analysis↗
PubMed1997

Genetic information and investment in human capital.

In a game of incomplete information we analyze the consequences of giving an employer access to imperfect genetic information about his employees. The employer chooses whether to invest in the employee and the employee chooses a life style. We derive the condition for markets of information services to exist and the conditions for when it is beneficial to the various parties. In one specification of the game, the mere introduction of the information service may change the employee's choice of health behavior, which means that the value of genetic information may be negative to the employer.

Bayes Theorem↗
PubMed1997

Do fee descriptors influence treatment choices in general practice? A multilevel discrete choice model.

Before 1990 Australian general practitioners (GPs) were remunerated according to consultation length. This was assumed to encourage GPs to prescribe more, counsel less and provide fewer treatments than were 'appropriate'. In an attempt to change this behaviour, the remuneration system was altered to reflect the content of consultations. This paper analyses, through the use of multilevel modelling, the effect of content-based descriptors on the discrete choice behaviour of GPs while controlling for patient, GP and practice characteristics. GPs who used content-based descriptors were just as likely to prescribe, counsel and treat compared to GPs who used time-based descriptors.

Australia↗
PubMed1997

Willingness to pay for poison control centers.

We used the willingness-to-pay (WTP) method to value the benefits of poison control centers when direct access was blocked, comparing WTP among: (1) blocked callers (n = 396), (2) callers after access was restored (n = 418), and (3) the general population (n = 119). Mean monthly WTP was $6.70 (blocked callers), $6.11 (non-blocked callers), and $2.55 (general population). Blocked and non-blocked callers had a significantly higher WTP than general population respondents (p < 0.001). We conclude that the WTP method measured benefits that are difficult to quantify; however, WTP surveys need to be carefully conducted to minimize bias. We discuss how this approach could be useful for other health care services.

Cost-Benefit Analysis↗
PubMed1997

Taxation, smuggling and demand for cigarettes in Canada: evidence from time-series data.

This study analyzes Canadian cigarette consumption and taxation between 1980 and 1994, a period in which there have been large price rises and declines, and a dramatic increase in the consumption of contraband tobacco products. We examine elasticities of legal cigarette sales and total sales (including contraband) with respect to the price of legal cigarettes and various other factors. The growth of the contraband market since 1987 appears to have created two classes of cigarette--taxed and untaxed--with responses to changes in the legal price that are respectively higher, and lower, than was previously the case. The sensitivity of total cigarette sales to the taxation instrument is much lower than it would appear from sales of taxed cigarettes alone.

Canada↗
PubMed1997

The effect of price on switching among health plans.

A recent policy change by the University of California (UC) provides a unique natural experiment for investigating the sensitivity of consumers to health plan premiums. When the UC moved to a policy of limiting its contribution to the cost of the least expensive plan, out-of-pocket premiums increased for roughly one-third of UC employees. We examine the extent to which UC employees switched plans in response to this change in premiums. Our results indicate a strong response. Individuals facing premium increases of less than $10 were roughly 5 times as likely to switch plans as those whose premiums remained constant.

California↗
PubMed1997

Is health care really a luxury?

Much of the work which has led to a widely held view that the income elasticity of health care spending exceeds one has been based on international cross-section data, or on pooled cross-sections and time series. In this paper we re-examine this view in the context of long-run equilibrium relationships between non-stationary time series, possibly including autonomous trends. Our results cast doubt upon the usefulness of pooling and upon the notion of an elasticity above one.

Canada↗