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At least 1,117 records · Page 62Linked to original sources
PubMed1998

The demand for cocaine by young adults: a rational addiction approach.

This paper applies the rational addiction model to the demand for cocaine by young adults in the Monitoring the Future panel. The price of cocaine is added to this survey from the Drug Enforcement Administration's System to Retrieve Information from Drug Evidence. Results suggest that annual participation and frequency of use given participation are negatively related to the price of cocaine. In addition, current participation (frequency) is positively related to past and future participation (frequency). The long-run price elasticity of total consumption (participation multiplied by frequency given participation) of -1.35 is substantial.

Adolescent↗
PubMed1998

Physician response to Medicare fee reductions: changes in the volume of coronary artery bypass graft (CABG) surgeries in the Medicare and private sectors.

The demand inducement hypothesis predicts that physicians will respond to reductions in their income by increasing the volume of their services when the income effect is strong and negative. I test for such inducement in the market for coronary artery bypass grafting (CABG), using a longitudinal panel of physicians in New York and Washington states. The results show that physicians whose incomes were reduced the most by Medicare fee cuts performed higher volumes of CABGs, and they did so in both the Medicare and private markets.

Coronary Artery Bypass↗
PubMed1998

Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

Belgium↗
PubMed1999

Modeling risk using generalized linear models.

Traditionally, linear regression has been the technique of choice for predicting medical risk. This paper presents a new approach to modeling the second part of two-part models utilizing extensions of the generalized linear model. The primary method of estimation for this model is maximum likelihood. This method as well as the generalizations quasi-likelihood and extended quasi-likelihood are discussed. An example using medical expense data from Washington State employees is used to illustrate the methods. The model includes demographic variables as well as an Ambulatory. Care Group variable to account for prior health status.

Adolescent↗
PubMed1999

Consumer information and competition between nonprofit and for-profit nursing homes.

This paper develops implications of Arrow's hypothesis that nonprofit organizations are prevalent in health care because of quality uncertainty. The model analyzes the ability of nonprofits to mitigate market failures created by asymmetric information in an environment characterized by potential competition from both explicitly for-profit firms and for-profits in disguise (profit-motivated firms who obtain nonprofit status in order to exploit the perceived trustworthiness of the nonprofit sector). Under certain conditions, it is shown that nonprofit status can serve as a credible signal of quality and that nonprofits can decrease the underprovision of quality both by providing high quality services and indirectly via a spillover effect on quality in the for-profit sector. Applicability to long-term care and implications for empirical research and policy towards nonprofits in health care are discussed.

Benchmarking↗
PubMed1999

Medical savings accounts: microsimulation results from a model with adverse selection.

This paper examines medical savings accounts combined with high-deductible catastrophic health plans (MSA/CHPs), exploring the possible consequences of making tax preferred MSA/CHPs available to the entire employment-related health insurance market. The paper uses microsimulation methods to examine the equilibrium effects of MSA/CHPs on health care and non-health care expenditures, tax revenues, insurance premiums, and exposure to risk. If MSA/CHPs are offered alongside comprehensive plans, biased MSA/CHP enrollment can lead to premium spirals that drive out comprehensive coverage. Our estimates also raise concerns about equity, insofar as those who stand to lose the most tend to be poorer and in families with infant children.

Demography↗
PubMed1999

The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies.

The literature which considers the statistical properties of cost-effectiveness analysis has focused on estimating the sampling distribution of either an incremental cost-effectiveness ratio or incremental net benefit for classical inference. However, it is argued here that rules of inference are arbitrary and entirely irrelevant to the decisions which clinical and economic evaluations claim to inform. Decisions should be based only on the mean net benefits irrespective of whether differences are statistically significant or fall outside a Bayesian range of equivalence. Failure to make decisions in this way by accepting the arbitrary rules of inference will impose costs which can be measured in terms of resources or health benefits forgone. The distribution of net benefit is only relevant to deciding whether more information is required. A framework for decision making and establishing the value of additional information is presented which is consistent with the decision rules in CEA. This framework can distinguish the simultaneous but conceptually separate steps of deciding which alternatives should be chosen, given existing information, from the question of whether more information should be acquired. It also ensures that the type of information acquired is driven by the objectives of the health care system, is consistent with the budget constraint on service provision and that research is designed efficiently.

Bayes Theorem↗
PubMed1999

Price and profit.

Explore the source record for details and available documents.

Antitrust Laws↗
PubMed1999

The redistributive effect of health care finance in twelve OECD countries.

The OECD countries finance their health care through a mixture of taxes, social insurance contributions, private insurance premiums and out-of-pocket payments. The various payment sources have very different implications for both vertical and horizontal equity and on redistributive effect which is a function of both. This paper presents results on the income redistribution consequences of the health care financing mixes adopted in twelve OECD countries by decomposing the overall income redistributive effect into a progressivity, horizontal inequity and reranking component. The general finding of this study is that the vertical effect is much more important than horizontal inequity and reranking in determining the overall redistributive effect but that their relative importance varies by source of payment. Public finance sources tend to have small positive redistributive effects and less differential treatment while private financing sources generally have (larger) negative redistributive effects which are to a substantial degree caused by differential treatment.

Cross-Cultural Comparison↗
PubMed1999

Capitation contracts: access and quality.

The implications of competition amongst providers in both private and public systems for the quality of service and the number of care providers are analysed. Strong conditions must be imposed on preferences and cost conditions for quality to be efficiently supplied. In a median voter model of a public system the capitation fee and quality are lower than under competitive market equilibria and the number of practices inefficiently small. Entry control by a union which maximises gross provider income reduces the number of practices until the market is only just covered.

Capitation Fee↗
PubMed1999

The value of health insurance: the access motive.

Why do people purchase health insurance? Many economists would answer that it permits purchasers to avoid risk of financial loss. This note suggests that health insurance is also demanded because it represents a mechanism for gaining access to health care that would otherwise be unaffordable. For example, although a US$300,000 procedure is unaffordable to a person with US$50,000 in net worth, access is possible through insurance because the annual premium is only a fraction of the procedure's cost. The value of insurance for coverage of unaffordable care is derived from the value of the medical care that insurance makes accessible.

Community Participation↗
PubMed1999

On aggregating QALYs: a comment on Dolan.

Dolan [Dolan, P., 1998, The measurement of individual utility and social welfare. Journal of Health Economics, Vol. 17, pp. 39-52] in a recent paper suggested an empirical method for estimating the shape of the social welfare function. Using a simple theoretical model it is shown that Dolan's proposed empirical method has no theoretical foundation. The main problem with the approach is that it measures only the altruistic values that individuals attach to other peoples' health status and ignores the utility that individuals attach to their own health status.

Altruism↗
PubMed1999

On the use of survival analysis techniques to estimate medical care costs.

Measurement of treatment costs is important in the evaluation of medical interventions. Accurate cost estimation is problematic, when cost records are incomplete. Methods from the survival analysis literature have been proposed for estimating costs using available data. In this article, we clarify assumptions necessary for validity of these techniques. We demonstrate how assumptions needed for valid survival analysis may be violated when these methods are applied to cost estimation. Our observations are confirmed through simulations and empirical data analysis. We conclude that survival analysis approaches are not generally appropriate for the analysis of medical costs and review several valid alternatives.

Costs and Cost Analysis↗
PubMed1999

Addiction and discounting.

In 1988, Becker and Murphy [Becker, G.S., Murphy, K.M., 1988. A theory of rational addiction. Journal of Political Economy, 96, 675-700.] launched a theory in which they proposed that the perspective of rational decision-making could be applied also to cases of addictive behaviour. This paper discusses the theory's assumptions of interpersonal variation and stability in time preferences on the basis of estimates derived from three groups of people with different consumption levels of illegal intoxicants. We find that active injectors of heroin and amphetamine have a higher discount rate than a group reporting that they have never used the substances. Of greater interest, though not in accordance with Becker and Murphy's assumption of stability, we also find that the discount rate among active and former users differs significantly. These findings raise the question of whether a high time-preference rate leads to addiction or whether the onset of an addiction itself alters people's inter-temporal equilibrium.

Budgets↗
PubMed1999

Firm behavior in a market with addiction: the case of cigarettes.

This paper investigates firm behavior when demand is linked over time. Among other things, the theoretical section shows that if firms are forward-looking, anticipated future events can affect current consumption of an 'addictive' good even when consumers are completely myopic. The empirical part of the paper reports a simulation of the 1983 federal cigarette excise tax increase. Both myopic and rational models of consumer demand give roughly the same predictions for per capita consumption, but neither model does very well predicting actual consumption. The problem appears to lie in the prediction of price, suggesting that supply considerations are important.

Choice Behavior↗