International Journal of Health Economics and Management最新文献

{"title":"The effect of medicaid expansion on hospital finances: evidence from Washington and Idaho.","authors":"Erica H Johnson","doi":"10.1007/s10754-025-09404-8","DOIUrl":"https://doi.org/10.1007/s10754-025-09404-8","url":null,"abstract":"<p><p>The study aims to analyze the impact of Medicaid Expansion on hospital finances. Medicaid eligibility may increase hospital reimbursements and lower uncompensated care costs if patients are moving from no insurance coverage to Medicaid. However, if patients taking up Medicaid are moving from a private insurance plan to Medicaid, then it is also possible that hospital reimbursements may be lower under Medicaid expansion. Medicaid expansion increased the eligibility for Medicaid coverage to a broader group of people and raised the income threshold to 138% of the federal poverty level. Some states chose to expand Medicaid while others did not. Using a natural experiment, I compare hospital revenues and uncompensated care costs in Eastern Washington, which chose to expand Medicaid in 2014, and in Idaho, which chose not to expand until 2020. Medicaid expansion may be associated with lower net revenues, higher Medicaid received, and lower uncompensated care costs per hospital bed, ceteris paribus. I find no significant impact on operating margins. This study adds to the current literature looking at Medicaid Expansion and hospital finances by looking at a different region than has been previously studied. This region offers similar demographic and economic situations in both states. These areas are more rural areas and have less populated cities, which allows for a unique perspective and contributes to the understanding of how Medicaid Expansion may impact hospital finances.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bad times make mothers depressed.","authors":"Chung-Liang Lin, Te-Fen Lo","doi":"10.1007/s10754-025-09400-y","DOIUrl":"https://doi.org/10.1007/s10754-025-09400-y","url":null,"abstract":"<p><p>This research conducts the first comprehensive analysis of how prenatal economic fluctuations affect postpartum depression and documents its counter-cyclicality. Using population-based claims data, we examine outpatient utilization related to mental disorders among women in Taiwan during the six-month, nine-month, and one-year postpartum periods from 1998 to 2012. The results indicate that medical utilization for postpartum depression within the six-month and nine-month postpartum periods is influenced by economic conditions during the second trimester of pregnancy. This study also aims to understand the mediating channels behind the relationship between postpartum depression and prenatal economic activity. We find that negative prenatal economic shocks lead to higher outpatient expenses for conditions such as excessive weight gain, nutritional deficiency, depressive disorders, hypertension, and sleep disorders during pregnancy, all of which can deteriorate maternal postpartum mental health. Furthermore, our study highlights that postpartum depression medical utilization among low-income mothers is particularly sensitive to prenatal economic fluctuations. These findings suggest that low-income mothers, who may have limited resilience and fewer resources during economic downturns, are more likely to experience nutritional deficiencies and increased maternal stress, ultimately leading to a deterioration in postpartum mental health.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the impact of occupational accidents on value-added labor productivity in Korea.","authors":"Myung-Joong Kim, Sunyoung Park","doi":"10.1007/s10754-025-09403-9","DOIUrl":"https://doi.org/10.1007/s10754-025-09403-9","url":null,"abstract":"<p><p>This study applies econometric methodologies to conduct a quantitative assessment of the overall impact of occupational accidents on changes in firms' labor productivity. In particular, it examines whether the magnitude of this impact varies according to the technological intensity required for production and further explores the mechanisms through which occupational accidents affect productivity, as well as the duration of these effects. The empirical results demonstrate that increases in occupational accident rates are significantly associated with declines (1%p increase in the accident rate reduces 3.9% in the average labor productivity) in labor productivity, with such adverse effects evident in both very low- and very high-technology firms. Moreover, the analysis identifies a self-reinforcing vicious cycle for approximately 3 to 4 years, wherein higher accident rates lead to productivity deterioration, exacerbating accident incidence. The findings also indicate that a substantial period (about 2 to 3 years) is required for firms to recover from productivity losses attributable to occupational accidents. Our findings catalyze firms to undertake proactive and voluntary measures to prevent occupational accidents and will provide an empirical foundation for policy interventions targeting vulnerable groups that are disproportionately affected by productivity losses resulting from such incidents.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Publish or Perish - do French hospitals disclose their greenhouse gas emissions for vertical differentiation?","authors":"Nathalie Clavel, Laurie Marrauld, Myriam Lescher-Cluzel, Estelle Baurès, Nicolas Sirven","doi":"10.1007/s10754-025-09402-w","DOIUrl":"https://doi.org/10.1007/s10754-025-09402-w","url":null,"abstract":"<p><p>French legislation requires large and medium-sized hospitals to publicly report their greenhouse gas (GHG) emissions. Yet, many hospitals fail to comply with this regulation, while others report voluntarily. The organizational drivers behind this behavior remain underexplored. This study examines whether hospitals disclose their GHG emissions as part of a broader strategy to differentiate themselves-similar to how they report patient satisfaction scores to signal quality. We explore whether carbon reporting is used as a vertical differentiation strategy in the French healthcare system. We used a mixed-methods approach. First, we analyzed national administrative data to test whether reporting GHG emissions is associated with reporting patient satisfaction scores. Second, we conducted semi-structured interviews with hospital managers to understand the motivations behind emissions reporting. Quantitatively, we found no significant association between the two types of reporting. Hospitals do not appear to use GHG emissions disclosure and patient satisfaction scores as part of the same signaling strategy. Qualitative findings confirmed that GHG reporting is primarily driven by internal factors such as executive leadership, process improvement, and organizational values, rather than external differentiation or patient demand. Carbon reporting in French hospitals is not currently used as a differentiation strategy. Stronger regulatory enforcement is needed to ensure compliance. In addition, hospitals require support-through methodological guidance, training, and the development of dedicated sustainability roles-to integrate environmental performance into their management systems and contribute meaningfully to healthcare decarbonization.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic inequities impacting complete continuum of maternal healthcare service utilisation over time in Ethiopia.","authors":"Ayal Debie, Molla M Wassie, Annabelle Wilson, Claire T Roberts, Jacqueline H Stephens","doi":"10.1007/s10754-025-09401-x","DOIUrl":"https://doi.org/10.1007/s10754-025-09401-x","url":null,"abstract":"<p><strong>Objective: </strong>To quantify socioeconomic inequities of complete continuity of maternal healthcare service over time using Ethiopian Demography and Health Survey data from 2011 to 2019.</p><p><strong>Methods: </strong>A total of 10,768 women who had at least one antenatal care visit during their most recent childbirth were included for the analysis. Concentration index and concentration curve were used to assess wealth-based inequities. A generalized linear model with binomial distribution and a logit link function was used to decompose the Erreygers concentration index and measure each determinant's contribution.</p><p><strong>Results: </strong>Complete continuum of maternal health service utilization in 2011, 2016, and 2019 among the wealthiest women were 25.9%, 33.7%, and 50.8%, respectively. In contrast, the corresponding continuum of maternal health service utilisation was 3.0%, 6.1%, and 11.2% among the lowest wealth categories. The Erreygers concentration indices of complete continuum of maternal health service utilization in 2011, 2016, and 2019 surveys were 0.203, 0.195, and 0.311, respectively, with the highest inequity observed in 2019. Concentration curves in each survey showed a pro-rich distribution of complete continuum of maternal health service utilisation. A unit percentage change in women's education, early initiation of antenatal care, being informed about pregnancy-related complications, and blood pressure monitoring during pregnancy increased their probability of completing continuum of maternal health service utilization. Specifically, a 1% increase in the proportion of secondary or higher education corresponded to a 0.02%, 0.01%, and 0.07% increase in the probability of completing continuum of maternal health service utilisation in 2011, 2016, and 2019, respectively. Conversely, in 2011, a 1% increase in the proportion of rural women and those with more than four parities led to a 0.11% and 0.05% decrease in the probability of completing continuum of maternal health service utilisation, respectively.</p><p><strong>Conclusion: </strong>Complete continuum of maternal health service utilization was more likely amongst women without disadvantage, demonstrating wealth-based inequities in continuum of maternal health service utilization continue in Ethiopia. In this analysis, continuum of maternal health service utilisation remains inelastic across all surveys highlightsits the service is an essential form of care for women. Provision of maternal healthcare services targeting women from low household wealth status, residing in rural communities, and uneducated women must be prioritised by policymakers.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fee cuts for radiology and low-value imaging.","authors":"David H Howard, Michal Horný, Marcus Dillender","doi":"10.1007/s10754-025-09398-3","DOIUrl":"https://doi.org/10.1007/s10754-025-09398-3","url":null,"abstract":"<p><p>Based on the belief that fee-for-service reimbursement contributes to the overuse of costly medical procedures, policymakers have sought to cut payments for low-value services. Using a difference-in-differences model and Medicare claims linked with cancer registry records, we evaluate the impact of a large payment reduction for an imaging procedure commonly used in prostate cancer patients. We find that the payment cut did not affect imaging use, even in low-risk patients for whom imaging is not recommended. Our results suggest that supply may be relatively insensitive to fee levels when decisions about the use of a service are made exclusively by referring physicians, not the physicians who deliver and receive payment for it.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a link between self-reported unmet needs and healthcare expenditure?","authors":"Liliane Bonnal, Pascal Favard, Thomas Laurent","doi":"10.1007/s10754-025-09399-2","DOIUrl":"https://doi.org/10.1007/s10754-025-09399-2","url":null,"abstract":"<p><p>This study aims to investigate the factors associated with self-reported unmet healthcare needs among individuals aged 65 and older in France, as well as to determine whether healthcare expenditure and its determinants differ based on self-reported unmet needs. We use data from the 2012 Health and Welfare Survey, matched with health insurance records. Healthcare expenditure for ambulatory care-excluding inpatient care-is modeled using a regime-switching regression approach. Our findings highlight that social and behavioral disparities are the primary factors influencing self-reported unmet needs. The determinants of healthcare expenditure are generally similar, regardless of whether individuals report unmet needs, except for pre-frailty and the number of medical conditions. Surprisingly, we do not find a significant marginal effect of self-reported unmet needs on healthcare expenditure. In our view, this challenges the use of self-reported unmet needs as an indicator of access to care.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predicted impact of the proposed alcohol production deregulation policy on consumption in Thailand.","authors":"Sukampon Chongwilaikasaem, Eva Ayaragarnchanakul, Chaleampong Kongcharoen, Chalermpat Pongajarn, Jürgen Rehm","doi":"10.1007/s10754-025-09395-6","DOIUrl":"10.1007/s10754-025-09395-6","url":null,"abstract":"<p><p>Alcohol deregulation has recently been a topic of debate in Thailand, with policymakers weighing the potential economic benefits against public health harms and social concerns. This study estimates the impact on alcohol consumption levels in Thailand if barriers to producing alcoholic beverages are removed. Since the deregulation has not yet been implemented, we employed a randomized survey design for a Volumetric Choice Experiment administered to 1220 individuals, both drinkers and non-drinkers. The \"treatment\" group (with deregulation) was compared to the \"control\" group (without deregulation). While respondents in the control group were presented with existing drinks supplied by large producers, respondents in the treatment group were presented with new drinks supplied by small local producers alongside the existing options. Deregulation would introduce a wider variety of drinks, including cheaper local craft beer, white spirits, and brown spirits. Various scenarios of product availability and pricing were validated by experts. Our analysis reveals a 19.93% rise in total annual alcohol per capita consumption (APC), with a statistically significant difference between the treatment and control groups at a 90% confidence level. Further exploration into cross-price elasticities of demand suggests new drinks would partly substitute current options. Policymakers should carefully consider the public health implications, including increased risks of alcohol-related harms, as well as potential economic benefits from market liberalization. Regulatory measures, such as taxation, age restrictions, and public awareness campaigns, may be necessary to mitigate the projected consumption increase and associated social costs.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"271-292"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demand side financing for promoting institutional delivery: experiences of Janani Suraksha Yojana in Indian states.","authors":"J Krishna Nair, Pulak Mishra","doi":"10.1007/s10754-025-09391-w","DOIUrl":"10.1007/s10754-025-09391-w","url":null,"abstract":"<p><p>Public expenditure for the improvement of maternal health is crucial in addressing the major social and demographic challenges in developing countries like India. Accordingly, the Government of India initiated the Janani Suraksha Yojana (JSY) in 2005 as a flagship conditional cash transfer scheme to encourage institutional delivery in the country. While the provisions under the JSY remain uniform throughout the country, there are apprehensions that the impact would differ across the states as well as between the rural and urban setups depending on varied socio-economic conditions and local level dynamics. Besides, households' choice of the type of institution (i.e., government versus private healthcare centres) may also change following the implementation of the JSY. This paper examines these two critical but interrelated aspects. Using secondary data compiled mainly from the last two rounds of the National Family Health Survey and estimating panel data econometric models, the paper finds that interactions with health facilitators during pregnancy, and per capita income contribute positively to the increase in institutional delivery in India irrespective of whether the households are located in rural or urban areas. Importantly, the paper does not find any significant role of the JSY in this regard. On the contrary, the JSY encourages households to prefer public to private hospitals in both rural and urban areas, whereas preference for private hospitals is positively associated with the household head literacy rate in urban area and health insurance coverage and per capita income in rural areas. The findings suggest greater emphasis on quality enhancement of the government healthcare centres. Besides, active engagement of the health workers should also be encouraged, particularly in mobilising the community towards institutional delivery and linking them effectively with the related initiatives of the government.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"245-270"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physicians' incentives, patients' characteristics, and quality of care: a systematic experimental comparison of performance-pay systems.","authors":"Jeannette Brosig-Koch, Mona Groß, Heike Hennig-Schmidt, Nadja Kairies-Schwarz, Daniel Wiesen","doi":"10.1007/s10754-025-09390-x","DOIUrl":"10.1007/s10754-025-09390-x","url":null,"abstract":"<p><p>How performance pay affects physicians' medical service provision and the quality of care is relevant for researchers and policy-makers alike. This paper systematically studies how performance pay, complementing either fee-for-service or capitation, affects physicians' medical service provision and the quality of care for heterogeneous patients. Using a series of controlled behavioral experiments with physicians and students, we test the incentive effect of performance pay at a within-subject level. We consider a performance pay scheme which grants a discrete bonus if a quality threshold is reached, which varies with the patients' severity of illness. We find that performance pay significantly reduces non-optimal service provision and enhances the quality of care. Effect sizes depend on the patients' severity of illness and whether performance pay is blended with fee-for-service or capitation. Health policy implications, including a cost benefit analysis of introducing performance pay, are discussed.</p>","PeriodicalId":44403,"journal":{"name":"International Journal of Health Economics and Management","volume":" ","pages":"217-243"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}