Journal of Health Economics最新文献_第2页

Impact of primary care market mergers on quality: Evidence from the English NHS 初级保健市场合并对质量的影响：来自英国NHS的证据。

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-27 DOI: 10.1016/j.jhealeco.2025.103050

Yuan Lyu , Zhaocheng Zhang

{"title":"Impact of primary care market mergers on quality: Evidence from the English NHS","authors":"Yuan Lyu , Zhaocheng Zhang","doi":"10.1016/j.jhealeco.2025.103050","DOIUrl":"10.1016/j.jhealeco.2025.103050","url":null,"abstract":"<div><div>The primary care market has experienced a growing trend of provider consolidation through mergers and acquisitions, yet the implications of this concentration remain unclear. This study addresses this gap by providing the first empirical evidence on the effects of provider mergers on quality, using evidence from the English primary care market. Examining all provider mergers from 2014 to 2018, we find that mergers improve certain aspects of clinical quality management, but they do not translate into broader population-level clinical quality gains, and patient satisfaction declines significantly. Importantly, the effects vary by merger motivation and the size of the merging parties, rather than their geographic proximity. Survival-driven mergers help sustain care quality and patient access, whereas efficiency-driven mergers lead to greater quality deterioration. Mergers between larger practices also lead to more negative outcomes than those involving smaller practices. In contrast, we find no significant difference between within-market and cross-market mergers. An exploration of the mechanism reveals that changes in market concentration do not explain the observed quality outcomes. Instead, shifts in workforce composition, driven by the underlying merger motivations, play a key role.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"104 ","pages":"Article 103050"},"PeriodicalIF":3.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Longevity, Education, and Income: How large is the triangle? 寿命、教育和收入：三角形有多大？

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-27 DOI: 10.1016/j.jhealeco.2025.103052

Hoyt Bleakley

引用次数: 0

Using stock price movements to estimate the harm from collusive drug patent litigation settlements 利用股价变动估算药品专利合谋诉讼和解的危害

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-22 DOI: 10.1016/j.jhealeco.2025.103054

Keith M. Drake , Thomas G. McGuire

{"title":"Using stock price movements to estimate the harm from collusive drug patent litigation settlements","authors":"Keith M. Drake , Thomas G. McGuire","doi":"10.1016/j.jhealeco.2025.103054","DOIUrl":"10.1016/j.jhealeco.2025.103054","url":null,"abstract":"<div><div>The tradeoff between incentives to invest in R&D and efficient pricing takes a special form in the pharmaceutical sector. Brand drugs command high prices until generic competition begins, the timing of which usually depends on the outcome of patent infringement litigation. One potential outcome is a collusive agreement between the brand and a potential generic competitor that delays competition, with the brand sharing the profits from the delay by paying the generic challenger. Collusive patent settlements have plagued competition in pharmaceutical markets globally and especially in the U.S., the world’s largest market. This paper estimates the cost of these collusive settlements to U.S. drug purchasers using stock price movements. If the brand firm’s increase in profits from collusion is capitalized into stock prices, the change in value upon a settlement announcement can be used to estimate the new profit flows from higher prices to purchasers. We assembled data on 64 settlements reached during 2014–2023 and used the announcement descriptions and information that surfaced later to identify 17 potentially collusive settlements. We applied event study methods and found, consistent with prior research, that settlement announcements with no indication of collusion had no significant effect on the stock prices of brand firms implying that they tended to meet traders’ expectations. Stock prices increased by approximately 3.5 %, on average, after settlements with an indication of collusion, implying they increased brand profits by delaying generic entry. These increases correspond to a total increase in U.S. purchaser spending of $3.1-$3.2 billion per year during 2014–2023. Factoring up our estimate to the entire industry implies the increase in spending may be closer to $12 billion per year.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103054"},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The effect of housing wealth on health care spending 住房财富对医疗支出的影响

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-21 DOI: 10.1016/j.jhealeco.2025.103019

Michael F. Lovenheim , Jun Hyun Yun

引用次数: 0

Nonlinear reimbursement rules for preventive and curative medical care 预防性和治疗性医疗保健的非线性报销规则

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-20 DOI: 10.1016/j.jhealeco.2025.103049

Helmuth Cremer , Jean-Marie Lozachmeur

{"title":"Nonlinear reimbursement rules for preventive and curative medical care","authors":"Helmuth Cremer , Jean-Marie Lozachmeur","doi":"10.1016/j.jhealeco.2025.103049","DOIUrl":"10.1016/j.jhealeco.2025.103049","url":null,"abstract":"<div><div>This study examines nonlinear reimbursement rules for secondary preventive and therapeutic care. Individuals may be healthy or ill, with illness severity determining their ex post type. Preventive care is chosen beforehand, while curative care is decided after health status is known.</div><div>In an ideal scenario where health status is observable, optimal insurance provides lump-sum payments unrelated to expenditures. However, when severity is unobservable (causing ex post moral hazard), this approach is not incentive-compatible. Instead, optimal insurance designs benefits that increase with both preventive and curative care, as higher expenditures reduce informational rents and align incentives.</div><div>Preventive care, though chosen before illness occurs, affects incentive constraints due to two factors: (1) it is more effective for severely ill individuals, and (2) they have lower marginal utility of income, meaning preventive expenditures impact them less. These effects shape the optimal reimbursement structure.</div><div>Additionally, when individuals misperceive preventive care benefits, the main results hold, but an extra corrective (Pigouvian) term appears in the reimbursement formula to adjust for this misperception.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103049"},"PeriodicalIF":3.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144906952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Firm quality and health maintenance 坚定品质和健康保养

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-20 DOI: 10.1016/j.jhealeco.2025.103045

Anikó Bíró , Péter Elek

引用次数: 0

Prescribing power and equitable access to care: Evidence from pharmacists in Ontario, Canada 处方权力和公平获得护理：来自加拿大安大略省药剂师的证据

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-09 DOI: 10.1016/j.jhealeco.2025.103051

Alex Hoagland, Guan Wang

{"title":"Prescribing power and equitable access to care: Evidence from pharmacists in Ontario, Canada","authors":"Alex Hoagland, Guan Wang","doi":"10.1016/j.jhealeco.2025.103051","DOIUrl":"10.1016/j.jhealeco.2025.103051","url":null,"abstract":"<div><div>Allowing pharmacists to directly treat patients may increase equitable access to healthcare and improve patient outcomes, but raises concerns about supply-side moral hazard or patient substitution away from regular physician-based care. We study the effects of a 2023 policy allowing pharmacists to prescribe for minor ailments in Ontario, Canada. We use Advan foot traffic data to measure how this policy affected visits to pharmacies and generated spillover effects on visits to non-pharmacy medical facilities (<span><span>Research, 2022</span></span>). Allowing pharmacists to prescribe led to a 16% increase in total visits to pharmacies and a 3% increase in visits to other providers. These increases were concentrated in materially deprived neighborhoods and benefited non-minority, non-immigrant populations the most. We use the policy as exogenous variation to identify substitution elasticities between pharmacy visits and traffic to other medical facilities. Overall, 20% of the increase in traffic to pharmacies spills over into increased use of outpatient-based care. Pharmacy traffic is a substitute for visits to hospitals and emergency departments, potentially as patients rely on pharmacists for triaging rather than emergency care.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103051"},"PeriodicalIF":3.6,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impacts of health checkup programs standardization on working-age self-employed and unemployed: Insights from Japan’s local government response to national policy 健康检查项目标准化对工作年龄个体经营者和失业者的影响：来自日本地方政府对国家政策回应的见解

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-08 DOI: 10.1016/j.jhealeco.2025.103046

Masato Oikawa , Takamasa Otake , Toshihide Awatani , Haruko Noguchi , Akira Kawamura

{"title":"Impacts of health checkup programs standardization on working-age self-employed and unemployed: Insights from Japan’s local government response to national policy","authors":"Masato Oikawa , Takamasa Otake , Toshihide Awatani , Haruko Noguchi , Akira Kawamura","doi":"10.1016/j.jhealeco.2025.103046","DOIUrl":"10.1016/j.jhealeco.2025.103046","url":null,"abstract":"<div><div>This study analyzes the effects of the expansion of municipal per capita expenses on health checkup programs, following the introduction of the Specific Health Checkups and Specific Health Guidance (SHC-SHG), on the health outcomes and behaviors of self-employed and unemployed populations, which have been largely overlooked by previous research. To address this, we applied a dosing difference-in-differences (DID) estimation method, exploiting variation in treatment intensity across municipalities. The DID estimation reveals that the SHC-SHG introduction led to a reduction in the proportion of people diagnosed with lifestyle-related diseases in the municipalities that required significant increases in per-capita health checkup program expenses to comply with the new program, with a more pronounced impact on those with multiple diagnoses compared to those with a single diagnosis. A subgroup analysis indicates that health improvements following the SHC-SHG introduction were observed among self-employed workers and homeowners, whereas such improvements were not evident among the unemployed and renters. Moreover, we identify significant behavioral changes among the population in the high-expansion municipalities following the policy introduction. A back-of-the-envelope calculation demonstrates the municipal response to the SHC-SHG introduction is cost-effective.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103046"},"PeriodicalIF":3.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees 养老院的工资补贴以及医疗补助计划参保者在人员配备和获得护理之间的权衡

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-07 DOI: 10.1016/j.jhealeco.2025.103042

Thomas A. Hegland

{"title":"Nursing home payroll subsidies and the trade-off between staffing and access to care for Medicaid enrollees","authors":"Thomas A. Hegland","doi":"10.1016/j.jhealeco.2025.103042","DOIUrl":"10.1016/j.jhealeco.2025.103042","url":null,"abstract":"<div><div>Payroll subsidies are a promising tool for increasing nursing home staffing levels. However, promoting increased staffing may come at the expense of access to care for Medicaid enrollees if it enables nursing homes to attract more lucrative, non-Medicaid residents. In this study, I examine a set of payroll subsidies offered by state Medicaid programs between 1998 and 2010, using nursing home-level variation in subsidy generosity to identify subsidy effects. I find that each additional (2010) dollar of subsidies offered per resident-day increased staffing by just over 10 min per resident-day, but decreased the Medicaid share of new nursing home admissions by about 1.8 percentage points. These figures translate into overall average treatment effects equivalent to an increase in staffing by approximately 7.4% of pre-subsidy average staffing, and a decrease in the Medicaid-share of admissions by 11.5% relative to the pre-subsidy baseline. The subsidies also increased nursing home resident turnover and decreased the average care needs of newly admitted residents. Overall, these results highlight that while nursing home payroll subsidies are effective tools for encouraging increased staffing levels, the subsidies also can lead to changes in nursing home admissions and the characteristics of admitted residents.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"103 ","pages":"Article 103042"},"PeriodicalIF":3.6,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The impact of nurse practitioner scope-of-practice laws on preventable hospitalizations 护士执业范围法对可预防住院治疗的影响

IF 3.6 2区经济学

Journal of Health Economics Pub Date : 2025-08-02 DOI: 10.1016/j.jhealeco.2025.103044

Benjamin J. McMichael

引用次数: 0