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Long-Term Care Partnership Effects on Medicaid and Private Insurance 长期护理伙伴关系对医疗补助和私人保险的影响。
IF 2 3区 医学
Health economics Pub Date : 2025-03-15 DOI: 10.1002/hec.4949
Joan Costa-Font, Nilesh Raut
{"title":"Long-Term Care Partnership Effects on Medicaid and Private Insurance","authors":"Joan Costa-Font,&nbsp;Nilesh Raut","doi":"10.1002/hec.4949","DOIUrl":"10.1002/hec.4949","url":null,"abstract":"<p>We examine the impact of the Long-Term Care Insurance Partnership (LTCIP) program—a collaborative initiative between the state-level Medicaid programs and private health insurance companies designed to promote private long-term care insurance (LTCI)—on insurance ownership and Medicaid utilization. We draw on individual-level longitudinal data and employ a difference-in-differences (DD) design adjusted for the staggered implementation of the program between 2005 and 2018. Our results suggest that the rollout of the LTCIP program led to a 1.54 percentage point (pp) (14.7%) increase in LTCI ownership and a 0.82 pp (13.3%) reduction in Medicaid uptake. Our estimates suggest that these combined effects led to an approximate average cost saving of $74 per 65-year-old participant. These findings are explained by a certain degree of substitution between LTCIP and traditional LTCI contracts, ultimately postponing the use of Medicaid benefits.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 6","pages":"1171-1187"},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Social Connections and COVID19 Vaccination 社会关系与covid - 19疫苗接种。
IF 2 3区 医学
Health economics Pub Date : 2025-03-15 DOI: 10.1002/hec.4953
Arnab K. Basu, Nancy H. Chau, Oleg Firsin
{"title":"Social Connections and COVID19 Vaccination","authors":"Arnab K. Basu,&nbsp;Nancy H. Chau,&nbsp;Oleg Firsin","doi":"10.1002/hec.4953","DOIUrl":"10.1002/hec.4953","url":null,"abstract":"<div>\u0000 \u0000 <p>This paper unpacks the effects of social networks on county-level COVID19 vaccinations in the US. We jointly assess the contemporaneous and dynamic network ef-fects of vaccination exposure, to distinguish between network-mediated contemporane-ous effects (e.g., “vaccine-hunter” Facebook groups crowd-source information about ac-cess and efficacy) and longer-term effects (e.g., vaccine exposure chips away vaccine hesi-tancy). Accounting for possible correlated shocks, socio-economic/spatial confounders, and pandemic-related shifters, we find positive stage-of-pandemic dependent contempo-raneous friendship network effects, and null dynamic network effect, thus sharply dis-tinguishing COVID19 vaccination from other infection-mitigating practices in terms of openness to social-learning over time.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 6","pages":"1188-1213"},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Copayments for Prescription Drugs: The Drivers of Demand Responses 处方药的共同支付:需求反应的驱动因素。
IF 2 3区 医学
Health economics Pub Date : 2025-03-09 DOI: 10.1002/hec.4955
Jouko Verho, Jarkko Harju
{"title":"Copayments for Prescription Drugs: The Drivers of Demand Responses","authors":"Jouko Verho,&nbsp;Jarkko Harju","doi":"10.1002/hec.4955","DOIUrl":"10.1002/hec.4955","url":null,"abstract":"<div>\u0000 \u0000 <p>We study the demand responses of the drug copayment threshold in Finland using detailed prescription drug purchase data. The analysis reveals that the average drug costs increase discontinuously by 17% at the threshold above which out-of-pocket drug costs decrease substantially. Our results suggest an average price elasticity of −0.17, which indicates evident moral hazard costs. Approximately 80% of the overall effect is due to individuals buying drugs in larger quantities rather than purchasing higher-priced drugs. The heterogeneity analysis suggests that the responses are largest for drug categories taken on an as-needed rather than a regular basis.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 6","pages":"1160-1170"},"PeriodicalIF":2.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
For Better or Worse? Subjective Expectations and Cost-Benefit Trade-Offs in Health Behavior: An Application to Lockdown Compliance in the United Kingdom 是好是坏?健康行为的主观期望和成本效益权衡:在英国的封锁合规应用。
IF 2 3区 医学
Health economics Pub Date : 2025-03-07 DOI: 10.1002/hec.4942
Gabriella Conti, Pamela Giustinelli
{"title":"For Better or Worse? Subjective Expectations and Cost-Benefit Trade-Offs in Health Behavior: An Application to Lockdown Compliance in the United Kingdom","authors":"Gabriella Conti,&nbsp;Pamela Giustinelli","doi":"10.1002/hec.4942","DOIUrl":"10.1002/hec.4942","url":null,"abstract":"<p>We study the determinants of voluntary compliance in the early phase of the COVID-19 pandemic. Using rich data on subjective expectations we collected during the spring 2020 lockdown in the UK, we estimate a simple model of compliance choice with uncertain costs and benefits whose estimates quantify the utility trade-offs underlying compliance. Using these estimates, we decompose group differences in compliance into components due to preferences vis-à-vis expectations and compute the monetary compensation required for different groups to comply. We find citizens face intuitive trade-offs between costs and benefits of noncompliance, with the largest costs being the disutility of passing away from COVID-19 and the psychological cost of being caught transgressing, and the largest benefit being preserving own mental health. Significant heterogeneity exists across groups, with women's higher compliance being explained by gender differences in both preferences and expectations, while vulnerables' higher compliance being mainly driven by differences in preferences. The response of individual behavior to others' behavior, too, varies across personal characteristics and circumstances. Our findings underscore the importance for public health policies to take into account behavior-relevant heterogeneity in citizens' preferences, expectations, and responses to others.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 5","pages":"992-1012"},"PeriodicalIF":2.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4942","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Do Physicians Respond to Additional Capitation Payments in Mixed Remuneration Schemes? 在混合薪酬计划中,医生对额外的人头支付有反应吗?
IF 2 3区 医学
Health economics Pub Date : 2025-03-06 DOI: 10.1002/hec.4954
Line Planck Kongstad, Nicolai Damslund, Jens Søndergaard, Geir Godager, Kim Rose Olsen
{"title":"Do Physicians Respond to Additional Capitation Payments in Mixed Remuneration Schemes?","authors":"Line Planck Kongstad,&nbsp;Nicolai Damslund,&nbsp;Jens Søndergaard,&nbsp;Geir Godager,&nbsp;Kim Rose Olsen","doi":"10.1002/hec.4954","DOIUrl":"10.1002/hec.4954","url":null,"abstract":"<p>Mixed remuneration schemes with capitation and fee-for-service (FFS) payments hold financial incentives to add patients to the list and provide services to listed patients. However, as patients with complex needs tend to require longer consultations there is a risk of inequality in access if fees are not adjusted to patient characteristics. In this paper, we assess a natural experiment introducing additional capitation for GPs with a high share of complex patients (moderate scheme) and for GPs in certain geographical areas (intensive scheme). GPs are eligible if the complexity of their listed patients exceeds a threshold, but as the scheme is subject to a national budget constraint, some eligible general practitioners (GPs) are left without additional payment. For the most favored GPs, the reform distributed additional capitation at 8% of the total baseline income. We study the effects on the number of patients per GP and the number of services per patient, applying difference-in-difference (DiD) models. For both schemes (moderate and intensive), we find tendencies of reductions in the number of patients served and the level of service provision per patient. This also holds for complex patients indicating that the reform did not improve equity in access. The effect on income showed a 2.5% increase in the first follow-up year but the effect became insignificant in the second year after the reform. We interpret this result as a sign that GPs trade income increases with leisure as suggested by the target income hypothesis.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 6","pages":"1143-1159"},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4954","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Healthcare Quality by Specialists Under a Mixed Compensation System: An Empirical Analysis 混合薪酬制度下专科医生的医疗质量:实证分析
IF 2 3区 医学
Health economics Pub Date : 2025-03-03 DOI: 10.1002/hec.4943
Damien Echevin, Bernard Fortin, Aristide Houndetoungan
{"title":"Healthcare Quality by Specialists Under a Mixed Compensation System: An Empirical Analysis","authors":"Damien Echevin,&nbsp;Bernard Fortin,&nbsp;Aristide Houndetoungan","doi":"10.1002/hec.4943","DOIUrl":"10.1002/hec.4943","url":null,"abstract":"<p>We analyze the effects of a mixed compensation (MC) scheme for specialists on the quality of their healthcare services. We exploit a reform implemented in Quebec (Canada) in 1999. The government introduced a payment mechanism combining a per diem with a reduced fee per clinical service. Using a large patient/physician panel dataset, we estimate a multi-state multi-spell hazard model analogous to a difference-in-differences approach. We compute quality indicators from our model. Our results suggest that the reform reduced the quality of MC specialist services measured by the risk of rehospitalization and mortality after discharge.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 5","pages":"972-991"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4943","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Economic Shocks and Infant Health: The Intergenerational Effects of Import Competition in the U.S. 经济冲击与婴儿健康:美国进口竞争的代际效应
IF 2 3区 医学
Health economics Pub Date : 2025-02-24 DOI: 10.1002/hec.4946
Patralekha Ukil
{"title":"Economic Shocks and Infant Health: The Intergenerational Effects of Import Competition in the U.S.","authors":"Patralekha Ukil","doi":"10.1002/hec.4946","DOIUrl":"10.1002/hec.4946","url":null,"abstract":"<div>\u0000 \u0000 <p>This paper investigates the intergenerational health impacts of a persistent negative economic shock faced by individuals residing in the United States. Specifically, the paper examines the impact of economic shocks in local labor markets on infant health by exploiting the increasing import competition from China between 2005 and 2015 on U.S. commuting zones as a plausibly exogenous source of variation in household economic conditions. Using yearly restricted-access data from the Natality Vital Statistics and yearly measures of the U.S local labor markets' exposure to import competition at the per capita level, this paper provides evidence that negative shocks in the form of worsening local labor market conditions are associated with a negative impact on infant health outcomes. Results indicate that increased import penetration from China in U.S commuting zones led to a reduction in the average birthweight and an increase in the incidence of low birthweight. Analyses of transmission mechanisms suggest worsening household economic circumstances as a result of negative labor market outcomes in the form of reduced wages, reduced household income per capita and increased reliance on food stamps, reduced access to healthcare and an increase in mental health declines among women of childbearing age.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 6","pages":"1121-1142"},"PeriodicalIF":2.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Tobacco-21 Laws on Maternal Smoking Behavior 《21世纪烟草法》对孕产妇吸烟行为的影响
IF 2 3区 医学
Health economics Pub Date : 2025-02-23 DOI: 10.1002/hec.4951
Tim Bersak, Makayla Lavender, Lyudmyla Sonchak-Ardan
{"title":"Impact of Tobacco-21 Laws on Maternal Smoking Behavior","authors":"Tim Bersak,&nbsp;Makayla Lavender,&nbsp;Lyudmyla Sonchak-Ardan","doi":"10.1002/hec.4951","DOIUrl":"10.1002/hec.4951","url":null,"abstract":"<div>\u0000 \u0000 <p>This study employs a logit difference-in-differences model to estimate the extent to which raising the tobacco purchasing age to 21 (T-21) reduced the prevalence of smoking among mothers aged 18–20 both before and during their pregnancies. Using United States Vital Statistics data from 2012 to 2019, we estimate that counties which adopted T-21, whether individually or as part of a state-level policy, experienced small but statistically significant decreases in maternal smoking prior to and during their pregnancies. Our estimates also suggest that the decline in smoking during pregnancy is driven by fewer women smoking prior to pregnancy rather than increased quit rates during pregnancy. Finally, our estimation strategy also allows us to focus on the expansions in New York City and California, which are the locations with the largest number of impacted births in our sample. We estimate T-21 decreased maternal smoking both prior to and during pregnancy in California by up to 14% from baseline. Other studies which examined T-21 on a broader set of young adults have found larger reductions in smoking rates, suggesting that the subpopulation of young mothers who choose to smoke may be relatively less responsive to policies that raise the minimum purchase age of tobacco products.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 6","pages":"1103-1120"},"PeriodicalIF":2.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
There Is No Place Like Home: The Impact of Public Home-Based Care on the Mental Health and Well-Being of Older People 没有地方像家:公共家庭护理对老年人心理健康和福祉的影响。
IF 2 3区 医学
Health economics Pub Date : 2025-02-20 DOI: 10.1002/hec.4948
Ludovico Carrino, Erica Reinhard, Mauricio Avendano
{"title":"There Is No Place Like Home: The Impact of Public Home-Based Care on the Mental Health and Well-Being of Older People","authors":"Ludovico Carrino,&nbsp;Erica Reinhard,&nbsp;Mauricio Avendano","doi":"10.1002/hec.4948","DOIUrl":"10.1002/hec.4948","url":null,"abstract":"<p>Despite a significant policy shift from institutional to home-based care for older adults, evidence on the effectiveness of policies incentivizing home care is limited. This study provides novel evidence on the causal effect of public home-based care on the mental health and well-being of older people. To address endogenous selection, we implement a novel instrumental variable approach that exploits eligibility rules for long-term care as defined in national legislations. We link longitudinal data from the Survey of Health, Aging &amp; Retirement in Europe (SHARE, 2004–2017) to national LTC eligibility rules in France, Germany, Spain and Belgium (disaggregated for Wallonia and Flanders regions) and examine how exogenous variation in the use of long-term care caused by varying eligibility rules impacts depressive symptoms (EURO-D scale), quality of life (CASP scale) and loneliness (R-UCLA scale). We find that receiving formal home-based care significantly reduces depressive symptom scores by 2.6 points (large effect size measured by Cohen's d) and the risk of depression by 13 percentage points. The use of home-based formal care also increases quality of life as measured by the CASP scale, particularly by increasing feelings of control over life. We show that one potential mechanism involves the impact of home-based care on loneliness: we estimate that receiving formal home-based care reduces the risk of loneliness by 6.7 percentage points. Our results provide evidence that an increase in home-based care coverage is justified in terms of improved mental health and well-being outcomes for older people.</p>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 6","pages":"1085-1102"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.4948","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Understanding the Demand-Side of an Illegal Market: A Case Study of the Prohibition of Menthol Cigarettes 了解非法市场的需求方:薄荷香烟禁令案例研究》。
IF 2 3区 医学
Health economics Pub Date : 2025-02-19 DOI: 10.1002/hec.4937
Don Kenkel, Alan Mathios, Grace Phillips, Revathy Suryanarayana, Hua Wang, Sen Zeng
{"title":"Understanding the Demand-Side of an Illegal Market: A Case Study of the Prohibition of Menthol Cigarettes","authors":"Don Kenkel,&nbsp;Alan Mathios,&nbsp;Grace Phillips,&nbsp;Revathy Suryanarayana,&nbsp;Hua Wang,&nbsp;Sen Zeng","doi":"10.1002/hec.4937","DOIUrl":"10.1002/hec.4937","url":null,"abstract":"<div>\u0000 \u0000 <p>Economic research has long focused on illegal markets and the consequences of prohibitions. We provide a case study of the proposed prohibition of menthol cigarettes, which are smoked by almost 19 million people in the U.S. Illegal markets for menthol cigarettes could not only blunt the prohibition's intended consequence to reduce smoking but could also lead to unintended consequences. We use data from a discrete choice experiment. Our mixed logit model predicts a substantial potential consumer demand for illegal menthol cigarettes, especially if menthol e-cigarettes are also illegal.</p>\u0000 </div>","PeriodicalId":12847,"journal":{"name":"Health economics","volume":"34 5","pages":"956-971"},"PeriodicalIF":2.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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