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Does physician-hospital vertical integration signal care-coordination? Evidence from mover-stayer analysis of commercially insured enrollees 医院垂直整合是否预示着护理协调？来自商业参保人的动态分析的证据
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-03-31 DOI: 10.1016/j.jhealeco.2025.102997
William Encinosa , Avi Dor
{"title":"Does physician-hospital vertical integration signal care-coordination? Evidence from mover-stayer analysis of commercially insured enrollees","authors":"William Encinosa ,&nbsp;Avi Dor","doi":"10.1016/j.jhealeco.2025.102997","DOIUrl":"10.1016/j.jhealeco.2025.102997","url":null,"abstract":"<div><div>The sharp growth in physician groups being purchased by hospitals has sparked extensive policy debate, with little evidence on the merits of such integration. We fill the gap by examining care-coordination under integration. We exploit the fact that integration varies across MSAs and focus on PPO patients with employment-based moves between MSAs. We develop a mover-stayer model with heterogenous effects to examine whether vertically integrated practices treat patients differently, or whether they just treat different patients. Moving to a more integrated market causes an increase in care coordination indices. Specifically, moving to an area with more specialty care integration causes an increase in team referrals between primary and specialty care, less lab and imaging use, less out-of-network care, and reductions in spending. That is, systems are able to narrow the scope of specialty services overall, hence creating greater social efficiencies. Moving to a market with more integrated primary care causes an increase in preventive care, decreased inpatient use by women, but an increase in spending. JEL I11, L14, C22.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102997"},"PeriodicalIF":3.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820780","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
COVID-19 and mortality among infants: Evidence from India COVID-19与婴儿死亡率：来自印度的证据
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-03-28 DOI: 10.1016/j.jhealeco.2025.102991
Erdal Asker , Shatakshee Dhongde , Abu S. Shonchoy
{"title":"COVID-19 and mortality among infants: Evidence from India","authors":"Erdal Asker ,&nbsp;Shatakshee Dhongde ,&nbsp;Abu S. Shonchoy","doi":"10.1016/j.jhealeco.2025.102991","DOIUrl":"10.1016/j.jhealeco.2025.102991","url":null,"abstract":"<div><div>We present the first survey-based evidence on infant mortality in a developing country during the COVID-19 pandemic. Employing high-quality, nationally representative data from India, our analyses document a significant rise in mortality rates among infants during a six month period in 2020 covering the pandemic and the ensuing lockdown. The difference-in-differences estimates show that mortality among infants at ages 1, 3, and 6 months increased by about 9, 13, and 16 deaths per 1000 births, corresponding to an increase of 30, 42, and 44 percent, respectively. Since COVID-19 had minimal direct impact on infant mortality, our estimates likely capture some of the indirect effects on infant mortality through income shocks, reduced healthcare access, and behavioral changes such as avoidance of hospitals for maternal care during this period.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102991"},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783684","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
Disability insurance screening and worker health 残疾保险筛选和工人健康
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-03-26 DOI: 10.1016/j.jhealeco.2025.102986
Alexander Ahammer , Analisa Packham
{"title":"Disability insurance screening and worker health","authors":"Alexander Ahammer ,&nbsp;Analisa Packham","doi":"10.1016/j.jhealeco.2025.102986","DOIUrl":"10.1016/j.jhealeco.2025.102986","url":null,"abstract":"<div><div>We provide new evidence on the returns to more targeted disability insurance (DI) programs in terms of labor force participation, program spillovers, and worker health. To do so, we analyze Austrian workers after a workplace injury that experience differential levels of application screening. We find that when workers face stricter screening, they are more likely to remain in the labor force. However, we estimate no statistical differences in any physical or mental health outcomes, and can rule out large effects on overall healthcare utilization. Our findings imply that imposing stricter DI screening can yield large fiscal benefits, on the margin.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102986"},"PeriodicalIF":3.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effects of Vietnam-era military service on the long-term health of veterans: A bounds analysis 越战时期服兵役对退伍军人长期健康的影响：一个界限分析
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-03-19 DOI: 10.1016/j.jhealeco.2025.102984
Xintong Wang , Carlos A. Flores , Alfonso Flores-Lagunes
{"title":"The effects of Vietnam-era military service on the long-term health of veterans: A bounds analysis","authors":"Xintong Wang ,&nbsp;Carlos A. Flores ,&nbsp;Alfonso Flores-Lagunes","doi":"10.1016/j.jhealeco.2025.102984","DOIUrl":"10.1016/j.jhealeco.2025.102984","url":null,"abstract":"<div><div>We analyze the short- and long-term effects of the U.S. Vietnam-era military service on veterans’ health outcomes using a restricted version of the National Health Interview Survey 1974–2013 and employing the draft lotteries as an instrumental variable. We conduct inference on the health effects of military service for individuals who comply with the draft-lotteries assignment (the “compliers”), as well as for those who volunteer for enlistment (the “always takers”). The causal analysis for volunteers, who represent over 70% of veterans, is novel in this literature that typically focuses on the compliers. Since the effect for volunteers is not point-identified, we employ sharp nonparametric bounds that rely on a mild mean weak monotonicity assumption. We examine a large array of health outcomes and behaviors, including mortality, up to 38 years after the end of the Vietnam War. We do not find consistent statistical evidence of detrimental health effects on compliers, in line with prior literature. For volunteers, however, we document that their estimated bounds show statistically significant detrimental health effects that appear around 10 years after the end of the conflict. As a group, veterans experience similar statistically significant detrimental health effects from military service. These findings have implications for policies regarding compensation and health care of veterans after service.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102984"},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143814955","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
How do we age? A decomposition of Gompertz law 我们是如何变老的？Gompertz定律的分解
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-03-19 DOI: 10.1016/j.jhealeco.2025.102988
Casper Worm Hansen , Holger Strulik
{"title":"How do we age? A decomposition of Gompertz law","authors":"Casper Worm Hansen ,&nbsp;Holger Strulik","doi":"10.1016/j.jhealeco.2025.102988","DOIUrl":"10.1016/j.jhealeco.2025.102988","url":null,"abstract":"<div><div>A strong regularity of human life is Gompertz’s law, which predicts a near-perfect exponential increase in mortality with age. In this paper, we take into account that chronological age is not a cause of death and decompose Gompertz’s law into two equally strong laws: (i) an exponential increase in health deficits as measured by the frailty index, and (ii) a power law association between the frailty index and the mortality rate. We show how the increase in the frailty index can be derived from the feature of self-productivity of health deficits. We explore the robustness of the Gompertz decomposition across countries, sex, and over time and show how information about mortality rates can be used to infer the state of health of an age-structured population. Finally, we use this method to infer the biological ages of past populations, such as Australians in 1940 and Swedes in 1770.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102988"},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of income on infant health: Evidence from the expanded child tax credit and pandemic stimulus checks 收入对婴儿健康的影响：来自扩大的儿童税收抵免和流行病刺激检查的证据
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-03-14 DOI: 10.1016/j.jhealeco.2025.102989
Wei Lyu , George L. Wehby , Robert Kaestner
{"title":"Effects of income on infant health: Evidence from the expanded child tax credit and pandemic stimulus checks","authors":"Wei Lyu ,&nbsp;George L. Wehby ,&nbsp;Robert Kaestner","doi":"10.1016/j.jhealeco.2025.102989","DOIUrl":"10.1016/j.jhealeco.2025.102989","url":null,"abstract":"<div><div>During the COVID-19 pandemic, the federal government issued stimulus checks and expanded the child tax credit. These payments varied by marital status and the number of children in the household. We exploit this plausibly exogenous variation in income during pregnancy to obtain estimates of the effect of income on infant health. Data are from birth certificates and the sample focuses on mothers with high school or less education. The main estimates indicate that pandemic cash payments had virtually no statistically significant, or clinically or economically meaningful effects on infant health (birth weight, gestational age, and fetal growth outcomes), at least for the range of payments received by most mothers.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102989"},"PeriodicalIF":3.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143654666","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 team-based primary care on quality-related healthcare services and access to primary care: Norway's primary healthcare teams pilot program 基于团队的初级保健对与质量相关的保健服务和获得初级保健的影响：挪威初级保健团队试点方案
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-03-04 DOI: 10.1016/j.jhealeco.2025.102987
Øyvind Snilsberg, Tor Iversen
{"title":"The impact of team-based primary care on quality-related healthcare services and access to primary care: Norway's primary healthcare teams pilot program","authors":"Øyvind Snilsberg,&nbsp;Tor Iversen","doi":"10.1016/j.jhealeco.2025.102987","DOIUrl":"10.1016/j.jhealeco.2025.102987","url":null,"abstract":"<div><div>This study evaluates Norway's Primary Healthcare Teams (PHT) pilot program, which introduced team-based care in general practice clinics to improve care for patients with complex conditions. Practices hired nurses and chose between an activity-based or block funding model. This analysis examines the activity-based funding model, which incorporated fee-for-service (FFS) for nurses. Using a difference-in-differences (DID) approach, the study assesses the program's impact on quality-related primary care services, out-of-hours care, hospitalizations, general practitioners’ (GPs’) working hours, and patient list length. The findings show that PHTs increased quality-related services for target groups (primarily provided by nurses) without affecting GP working hours or list length, suggesting that added nurse capacity was used to enhance care for target patients, not expand primary care access. There is little evidence of changes in healthcare utilization outside primary care, except a possible reduction in hospitalizations for type 2 diabetes patients with ambulatory care-sensitive conditions.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102987"},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Taking the competitor’s pill: When combination therapies enter pharmaceutical markets 服用竞争对手的药片：当联合疗法进入制药市场
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-03-03 DOI: 10.1016/j.jhealeco.2025.102976
Kurt R. Brekke , Dag Morten Dalen , Odd Rune Straume
{"title":"Taking the competitor’s pill: When combination therapies enter pharmaceutical markets","authors":"Kurt R. Brekke ,&nbsp;Dag Morten Dalen ,&nbsp;Odd Rune Straume","doi":"10.1016/j.jhealeco.2025.102976","DOIUrl":"10.1016/j.jhealeco.2025.102976","url":null,"abstract":"<div><div>We study the competitive effects of combination therapies in pharmaceutical markets, which crucially hinge on the additional therapeutic value of combinatory use of drugs and the therapeutic substitutability with the most relevant monotherapy. If the therapeutic value is sufficiently large, the introduction of combination therapies leads to higher prices and, somewhat paradoxically, may reduce the health plan’s surplus, defined as total health benefits net of drug expenditures. If the firms are allowed to coordinate their price setting, this will lead to higher prices under uniform pricing but lower prices under indication-based pricing. Allowing for the latter type of pricing scheme might increase allocational efficiency, but only at the expense of higher drug expenditures.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102976"},"PeriodicalIF":3.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The long term benefits of the measles vaccine in Mexico 麻疹疫苗在墨西哥的长期效益
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-02-19 DOI: 10.1016/j.jhealeco.2025.102974
Alicia Atwood, Sarah Pearlman
{"title":"The long term benefits of the measles vaccine in Mexico","authors":"Alicia Atwood,&nbsp;Sarah Pearlman","doi":"10.1016/j.jhealeco.2025.102974","DOIUrl":"10.1016/j.jhealeco.2025.102974","url":null,"abstract":"<div><div>We investigate the impacts on education and employment of a reduction in measles stemming from a nationwide immunization program in Mexico. The program lead to significant improvements in childhood health as measles causes “immune amnesia”, leaving individuals susceptible to illness from other diseases. We find the measles vaccine led to large increases in educational attainment for both men and women, with the effects being concentrated in lower secondary school for women and split between lower and upper secondary school for men. Labor market outcomes also improved with women experiencing large increases in employment and men seeing significant gains in income.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102974"},"PeriodicalIF":3.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552136","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 budget cuts on individual patient health: Causal evidence from hospital closures 预算削减对个体患者健康的影响：来自医院关闭的因果证据
IF 3.4 2区 经济学
Journal of Health Economics Pub Date : 2025-02-15 DOI: 10.1016/j.jhealeco.2025.102975
Simone Ghislandi , Anna-Theresa Renner , Nirosha Elsem Varghese
{"title":"The impact of budget cuts on individual patient health: Causal evidence from hospital closures","authors":"Simone Ghislandi ,&nbsp;Anna-Theresa Renner ,&nbsp;Nirosha Elsem Varghese","doi":"10.1016/j.jhealeco.2025.102975","DOIUrl":"10.1016/j.jhealeco.2025.102975","url":null,"abstract":"<div><div>Public finance constraints following the 2008 financial crisis in Europe often affected the hospital sector. This paper investigates i) the causal health impacts of reduced hospital supply, and ii) possible mechanisms to explain these. Using a staggered difference-in-differences framework, we study the effects of hospital closures on outcomes of all heart attack patients admitted to an Italian hospital between 2008 and 2015. Results show that closures increased in-hospital mortality by 10 % and length-of-stay by 0.3 days, but had no impact on readmissions. We explore potential mechanisms using different estimation approaches, and show that increased travel time following closures explains most of the mortality effect.</div></div>","PeriodicalId":50186,"journal":{"name":"Journal of Health Economics","volume":"101 ","pages":"Article 102975"},"PeriodicalIF":3.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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