Essays on Information in Health Economics

Essays on Information in Health Economics
Author: Ethan Marc Jared Lieber
Publisher:
Total Pages: 157
Release: 2013
Genre:
ISBN: 9781303228926

A central feature of the market for health care is imperfect information. I study three different aspects of information in health care in this dissertation. First, I show how health insurance affects consumer search and the prices paid for health care. Second, I show how online health information has changed the demand for physician visits and estimate how much people value online health information. And third, I show how a physician's medical liability affects where she chooses to practice medicine, but that states with liability laws favorable to physicians attract lower quality physicians.

Essays on the Economics of Information Sharing in Healthcare

Essays on the Economics of Information Sharing in Healthcare
Author: Yeongin Kim
Publisher:
Total Pages:
Release: 2018
Genre: Game theory
ISBN:

Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act to reform the U.S. healthcare system, health information technology (IT) has attracted much attention from researchers, care practitioners, patients, and policy makers. Among various aspects of IT use in healthcare, information sharing has been considered as a key component in improving U.S. healthcare. In spite of numerous efforts to meaningfully use IT for information sharing, inefficiency issues still remain. This dissertation studies the economics of information sharing in healthcare and provides insights to formulate the right mechanisms to achieve the goal of IT-driven healthcare reform. The first essay examines the contract issues between a policy maker and care providers that can cooperate by implementing health information exchanges (HIEs). Using a gametheoretical model, we show that neither the traditional fee-for-service (FFS) payment model nor the pay-for-performance (P4P) models induce socially optimal outcomes, while an episodebased payment (EBP) model we identified induces the socially desirable effort levels and HIEs adoption. We further show that the value of an HIE is the highest under the FFS model and the lowest under the P4P models. Our findings imply that as payment models evolve over time, there is a real need to reevaluate the value of information sharing though HIE and the government policies that induce providers to adopt an HIE. The second essay studies the role of information sharing in formulation of policy instruments under the new risks of providers’ medical ligation owing to health IT. Specifically, we examine the role of information sharing in formulation of policies on healthcare operations in the presence of physicians’ liability concerns by using a game-theoretic model. We find when litigation is a concern, an underprovisioning policy may become optimal under the litigation risk, depending on the benefit and cost of the health service. We further show that strategically controlling the sharing of risk information restores the optimality of a standard policy (non-underprovisioning). The results of this study imply that the widespread practice of information sharing may induce underutilization of care resources to mitigate the medico-legal risks due to health IT. In the last essay, we study the impact of patient portals on treatment outcomes in the context of kidney allocation for transplant. Using a longitudinal data set of kidney transplant cases, we empirically show that with the implementation of patient portals for information sharing, patients are more likely to use care resources (donated kidneys) that are underutilized without access to a patient portal. However, the impact could be heterogeneous on sub-populations. This indicates that the efforts to bridge the digital divide may benefit some groups of patients at the expense of other groups, leading to further service disparities in the care service.

Essays in the Economics of Health and Medical Care

Essays in the Economics of Health and Medical Care
Author: Victor R. Fuchs
Publisher: New York : National Bureau of Economic Research distributed by Columbia University Press
Total Pages: 272
Release: 1972
Genre: Medical
ISBN:

Collection of essays on the economics of health and health services in the USA - covers supply and demand, budgetary resources, cost and objectives with regard to medical care, and considers wages and income distribution among medical personnel, effects of health care on labour productivity, etc. References and statistical tables.

Three Essays in Health Economics

Three Essays in Health Economics
Author: Touchanun Komonpaisarn
Publisher:
Total Pages: 250
Release: 2011
Genre:
ISBN:

This dissertation consists of three studies in the field of health economics. The first chapter studies the market situation of the U.S. nursing home industry. It uses the most recent data available from the Annual Survey of Nursing Homes conducted in Wisconsin. In this study, we derive theoretical predictions from an optimization problem of a representative nursing home under various assumptions. We introduce a new measure, a home's bed-utilization rate, in our empirical strategy and find evidence of excess demand from Medicaid patients in Wisconsin. A positive relationship between Medicaid payment rates and private-pay prices is found in homes with high bed utilization. Additionally, we find strong adverse effects of higher reimbursement rates on quality measures. These findings prove there is an excess demand from Medicaid patients in Wisconsin. This conclusion has direct implications for the quality of care that a nursing home provides for its patients. The second study takes advantage of the "natural experiment" features of the major health care reform in Thailand in 2002 in order to estimate the price elasticity of health care demand among Thai citizens. We use the difference-in-difference technique to capture the pure effect of the reform on the health care utilization behavior of those who were directly affected by the reform. In order to capture any secular trend in health care utilization, we use data from a group of people who were not affected by the reform. We find that the reduction in health care price immediately induced those who lacked health insurance coverage to increase their visits to a public health care facility, although similar trends were not found a few years after the reform. The estimated change in visits is used to calculate the price elasticity of demand, which falls in the range of -1.36 to -0.58. The last study examines the relationship between risky behaviors among Americans aged 50-65 and their health insurance coverage. Despite the fact that moral hazard behaviors are predicted by economic theory, the study finds that health insurance has no significant effect on certain risky behaviors such as smoking. Surprisingly, we find a significantly positive relationship between health insurance coverage and healthy behaviors such as exercising regularly. This finding reflects the importance of health insurance companies in providing its customers with more health information that could encourage health-oriented attitudes.

Essays in Health Economics

Essays in Health Economics
Author: Chiara Serra
Publisher:
Total Pages: 155
Release: 2021
Genre: Medical economics
ISBN:

In the chapters of this thesis, I empirically investigate four distinct research questions, spanning from the detrimental impact of very early shocks - at birth and even before birth - on children medium-term health, to the mediation role of social interactions in altering the effect of weather conditions on the spread of the Sars-CoV-2, and to ED nurses' leniency in assigning priority and the impact of waiting time on health. Although each chapter focuses on different questions, they all investigate different instances of the (unintended) consequences of individuals' actions on others - with a focus on vulnerable categories, and they all share an approach oriented at unveiling policyrelevant causal relations in natural experiment settings. In the first chapter, joint with Simone Ferro and Alessandro Palma, I investigate the health effects of a relatively higher prenatal exposure to Particulate Matter. Although the detrimental effects of air pollution on health are already well documented, in our study, we try to innovate on two relevant aspects. First, by matching birth certificates to individual consumption of subsidised pharmaceutical and hospitalisation records of Tuscany, our data allows going beyond the effects detected at birth to investigate for the first time medium-term morbidity at the individual level. Second, by documenting a permanent health loss associated with higher in-utero exposure to air pollution in a setting characterised by non-extreme levels of air pollution, our findings challenge the existing consensus on whether such levels of concentration of PM should be considered healthy. In the second chapter, I first show that Emergency Department patients arriving just after a shift change have a substantially lower probability of being assigned a higher priority with respect to patients arriving just before a shift change. As such distortion in the assignment of priority will only affect them by altering their relative position in the waiting list, I employ this quasi-experimental variation in the assigned priority to investigate the immediate and the longer-term consequences of waiting time on visits' outcomes and patients' future demand for emergency health care. I find that in the short-run, patients who are assigned a lower priority (and thus who presumably wait less time before being examined by a physician) are more likely to leave the ED before being visited. Furthermore, in the longer run, they are significantly less likely to return to the ED with the same condition. In the third chapter, Simone Ferro and I investigate the role of weather conditions on the spread of the Sars-CoV-2 in the US while taking into account the mediation role of social interactions. Our findings suggest that the endogenous response of social interaction to weather conditions play a major role in shaping the overall total effect of weather on the spread of the virus. This may contribute to rationalise the paradox between the results of laboratory experiments showing that the virus is susceptible to temperature, and the fact that the seasonal increases in temperature did not slow down the spread of the virus. In the fourth and final chapter, jointly with Gabriel Facchini and Matilde Machado, I investigate the relationship between being born by cesarean section and health outcomes for children. Such relation is confounded by different dimensions of selection in the choice of birth mode and to overcome the issue we employ an individual specific, purely exogenous measure of crowding at the precise time of admission at the maternity ward. We find that higher crowding leads to a significant decrease in the total probability of cesarean section. This effect is larger for patients with a higher ex-ante probability of delivering via cesarean section. We then use such relation to identify a causal relationship between the delivery method and the consumption of drugs for children up to age three. We find a positive and significant effect on the consumption of antiinfectives (antibiotics in particular) from the first year of life on - both looking at the quantity and at an indicator for abnormal use of this type of pharmaceuticals. This points to an adverse effect on children health, which is in line with the medical literature results on the importance of delivery method on the development of the immune system.

Medicine and Social Justice

Medicine and Social Justice
Author: Rosamond Rhodes
Publisher: Oxford University Press
Total Pages:
Release: 2012-07-16
Genre: Medical
ISBN: 0199930813

Because medicine can preserve life, restore health and maintain the body's functions, it is widely acknowledged as a basic good that just societies should provide for their members. Yet, there is wide disagreement over the scope and content of what to provide, to whom, how, when, and why. In this unique and comprehensive volume, some of the best-known philosophers, physicians, legal scholars, political scientists, and economists writing on the subject discuss what social justice in medicine should be. Their contributions deepen our understanding of the theoretical and practical issues that run through the contemporary debate. The forty-two chapters in this reorganized second edition of Medicine and Social Justice update and expand upon the thirty-four chapters of the 2002 first edition. Eighteen chapters from the original volume are revised to address policy changes and challenging issues that have emerged in the intervening decade. Twenty-two of the chapters in this edition are entirely new. The treatment of foundational theory and conceptual issues related to access to health care and rationing medical resources have been expanded to provide a more comprehensive and nuanced discussion of the background concepts that underlie distributive justice debates, with global perspectives on health and well-being added. New additions to the section on health care justice for specific populations include chapters on health care for the chronically ill, soldiers, prisoners, the severely cognitively disabled, and the LGBT population. The section devoted to dilemmas and priorities addresses an array of topics that have recently become especially pressing because of new technologies or altered policies. New chapters address questions of justice related to genetics, medical malpractice, research on human subjects, pandemic and disaster planning, newborn screening, and justice for the brain dead and those with profound neurological injury. Reviews of the first edition: "This compilation brings a variety of perspectives, national settings, and disciplinary backgrounds to the topic and provides a unique survey of theoretical and applied thinking about the connections between health care and social justice... Physicians and others interested in this field will find this book an engaging introduction to the theoretical and practical challenges pertaining to social justice and health care." New England Journal of Medicine "Although much work in bioethics has focused on clinical encounters, there has been a current of discussion about questions of social justice for decades-at least since the allocation of access to dialysis was widely understood in the 1960s to be a matter of justice, not of medical judgment. This volume will facilitate heightened awareness and deeper discussion of such issues." JAMA "Impressively, the editors have chosen an array of essays that explore the philosophical and bioethical foundations of distributive justice; review the current practice of rationing and patients' access to care in a number of different countries; highlight the issues raised by various special needs groups; and then wrestle with some dilemmas in assessing priorities in distributing healthcare... This book is an excellent resource. " Doody's

Essays on the Economic and Clinical Impact of Health Information Technology

Essays on the Economic and Clinical Impact of Health Information Technology
Author: Chenzhang Bao
Publisher:
Total Pages:
Release: 2019
Genre: Medical care
ISBN:

The U.S. healthcare system is characterized as inefficient, with excessive expenditure but low care quality. Recent healthcare reform aims to address these concerns and advocates health information technology (IT) as a key component to assist in this goal. In this dissertation, we study the role of health IT innovations under the value-based care structure in reducing cost, boosting quality of care, and improving healthcare efficiency. In the first essay, we focus on the Medicare Accountable Care Organization (ACO) program, which is a major healthcare payment reform initiative. We find that electronic health record (EHR) as an enabler of health information exchange enhances the association between ACO efficiency and quality of care. Our results indicate that meaningful use of EHR contributes to the capability to pursue both performance dimensions with respect to delivery of high-quality care in an efficient manner. In the second essay, we further verify that health information sharing is beneficial in terms of shorter emergency department wait time, reduced inpatient expense, and lower length of stay. However, it is not easy to exchange patient health records across providers. We empirically show that hospitals that adopt electronic medical records (EMR) from commercial vendors are more likely to exchange clinical data when compared to hospitals that use self-developed EMR systems. We also find that both participating in a health information exchange (HIE) and using the same EMR as other regional peer hospitals contribute to the capability of communicating patient data. In the third essay, we focus on patient-centric health IT, termed “patient portals”. We examine the impact of effective usage of patient portal technologies on health outcomes of congestive heart failure patients. We observe that frequent usage of clinical-oriented features, including viewing lab results, requesting medication refills and advice, and interactive messaging with providers, is associated with improvements in several health outcome measures with respect to the frequency of inpatient and emergency visits, readmission risk, and length of hospital stay. Collectively, this dissertation reveals the impact and the mechanism through which health IT systems are improving healthcare delivery, thereby providing a foundation to better understand the role of health IT in the era of healthcare reform. We posit that our findings provide implications associated with the adoption and usage of health IT for healthcare practitioners and policy makers, in an endeavor to revive the U.S. healthcare system.