Death spin
Erin Taylor et al.
Health Affairs, January 2015, Pages 104-110
Abstract:
Federal subsidies available to enrollees in health insurance Marketplaces are pegged to the premium of the second-lowest-cost silver plan available in each rating area (as defined by each state). People who qualify for the subsidy contribute a percentage of their income to purchase coverage, and the federal government covers the remaining cost up to the price of that premium. Because the number of plans offered and plan premiums vary substantially across rating areas, the effective value of the subsidy may vary geographically. We found that the availability of more plans in a rating area was associated with lower premiums but higher deductibles for enrollees in the second-lowest-cost silver plan. In rating areas with more than twenty plans, the average deductible in the second-lowest-cost silver plan was nearly $1,000 higher than it was in rating areas with fewer than thirteen plans. Because premium costs for second-lowest-cost silver plans are capped, deductibles may be a more salient measure of plan value for enrollees than premiums are. Greater standardization of plans or an alternative approach to calculating the subsidy could provide a more consistent benefit to enrollees across various rating areas.
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Medicaid as an Investment in Children: What is the Long-Term Impact on Tax Receipts?
David Brown, Amanda Kowalski & Ithai Lurie
NBER Working Paper, January 2015
Abstract:
We examine the long-term impact of expansions to Medicaid and the State Children's Health Insurance Program that occurred in the 1980's and 1990's. With administrative data from the IRS, we calculate longitudinal health insurance eligibility from birth to age 18 for children in cohorts affected by these expansions, and we observe their longitudinal outcomes as adults. Using a simulated instrument that relies on variation in eligibility by cohort and state, we find that children whose eligibility increased paid more in cumulative taxes by age 28. These children collected less in EITC payments, and the women had higher cumulative wages by age 28. Incorporating additional data from the Medicaid Statistical Information System (MSIS), we find that the government spent $872 in 2011 dollars for each additional year of Medicaid eligibility induced by the expansions. Putting this together with the estimated increase in tax payments discounted at a 3% rate, assuming that tax impacts are persistent in percentage terms, the government will recoup 56 cents of each dollar spent on childhood Medicaid by the time these children reach age 60. This return on investment does not take into account other benefits that accrue directly to the children, including estimated decreases in mortality and increases in college attendance. Moreover, using the MSIS data, we find that each additional year of Medicaid eligibility from birth to age 18 results in approximately 0.58 additional years of Medicaid receipt. Therefore, if we scale our results by the ratio of beneficiaries to eligibles, then all of our results are almost twice as large.
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Regulator Leniency and Mispricing in Beneficent Nonprofits
Jonas Heese, Ranjani Krishnan & Frank Moers
Harvard Working Paper, January 2015
Abstract:
We posit that nonprofits that provide a greater supply of unprofitable services (beneficent nonprofits) face lenient regulatory enforcement for mispricing in price-regulated markets. Consequently, beneficent nonprofits exploit such regulatory leniency and exhibit higher mispricing. Drawing on organizational legitimacy theory, we argue that both regulators and beneficent nonprofits seek to protect their legitimacy with stakeholders, including those who demand access to unprofitable services. Using data from hospitals, we examine mispricing via “upcoding”, which involves misclassifying ailment severity. Archival analysis indicates less stringent regulatory enforcement of upcoding for beneficent nonprofit hospitals, defined as hospitals that provide higher charity care and medical education. After observing regulator leniency, beneficent hospitals demonstrate higher upcoding. Our results suggest that lenient enforcement assists beneficent nonprofits to obtain higher revenues in price-regulated markets.
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Frank Lichtenberg
Journal of Human Capital, Winter 2014, Pages 432-480
Abstract:
I investigate whether diseases subject to more rapid pharmaceutical innovation experienced greater declines in Americans’ disability days and use of medical services during the period 1997–2010, controlling for several other factors, using data from the Medical Expenditure Panel Survey. The mean number of work loss days, school loss days, and hospital admissions declined more rapidly among medical conditions with larger increases in the mean number of new (post-1990) prescription drugs consumed. The value of reductions in work loss days and hospital admissions attributable to pharmaceutical innovation is estimated to be three times as large as the cost of new drugs consumed.
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Pricing in the Market for Anticancer Drugs
David Howard et al.
NBER Working Paper, January 2015
Abstract:
Drugs like bevacizumab ($50,000 per treatment episode) and ipilimumab ($120,000 per episode) have fueled the perception that the launch prices of anticancer drugs are increasing over time. Using an original dataset of 58 anticancer drugs approved between 1995 and 2013, we find that launch prices, adjusted for inflation and drugs’ survival benefits, increased by 10%, or about $8,500, per year. Although physicians are not penalized for prescribing costly drugs, they may be reluctant to prescribe drugs with prices that exceed subjective standards of fairness. Manufacturers may set higher launch prices over time as standards evolve. Pricing trends may also reflect manufacturers’ response to expansions in the 340B Drug Pricing Program, which requires manufacturers to provide steep discounts to eligible providers.
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An Early Look At Changes In Employer-Sponsored Insurance Under The Affordable Care Act
Fredric Blavin et al.
Health Affairs, January 2015, Pages 170-177
Abstract:
Critics frequently characterize the Affordable Care Act (ACA) as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers’ incentives to offer health insurance and workers’ incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. We found no evidence that any of these rates have declined under the ACA. They have, in fact, remained constant: around 82 percent, 86 percent, and 71 percent, respectively, for all workers and around 63 percent, 71 percent, and 45 percent, respectively, for low-income workers. To date, the ACA has had no effect on employer coverage. Economic incentives for workers to obtain coverage from employers remain strong.
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Daifeng He, Melissa McInerney & Jennifer Mellor
Journal of Health Economics, March 2015, Pages 97–108
Abstract:
Prior studies suggest that hospital care is countercyclical among Medicare beneficiaries, and if anything, procyclical among the non-elderly. In this paper, we provide the first physician-level analysis of changes in healthcare provision to Medicare and privately-insured patients across the business cycle. Using Florida discharge data aggregated to the physician level, we find that as county unemployment rates increase, physicians treat fewer privately-insured patients in both inpatient and outpatient settings. In contrast, physicians who are more exposed to income losses during recessions provide more care to Medicare patients as the unemployment rate rises. Further analysis suggests that easing capacity constraints may contribute to this rise in Medicare volume; however, even in areas that are not capacity constrained, care provided to Medicare patients remains countercyclical among physicians with a large share of privately-insured patients. This pattern is consistent with demand inducement in response to a negative income shock.
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Sources of Geographic Variation in Health Care: Evidence from Patient Migration
Amy Finkelstein, Matthew Gentzkow & Heidi Williams
NBER Working Paper, December 2014
Abstract:
We study the drivers of geographic variation in US health care utilization, using an empirical strategy that exploits migration of Medicare patients to separate the role of demand and supply factors. Our approach allows us to account for demand differences driven by both observable and unobservable patient characteristics. We find that 40-50 percent of geographic variation in utilization is attributable to patient demand, with the remainder due to place-specific supply factors. Demand variation does not appear to result from differences in past experiences, and is explained to a significant degree by differences in patient health.
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Christopher Robertson et al.
University of Arizona Working Paper, January 2015
Abstract:
Traditional cost sharing for health care is stymied by limited patient wealth. The “split benefit” is a new way to reduce consumption of high-cost, low-value treatments for which the risk/benefit ratio is uncertain. When a physician prescribes a costly unproven procedure, the insurer could pay a portion of the benefit directly to the patient, creating a decision opportunity for the patient. The insurer saves the remainder, unless the patient consumes. In this paper, a vignette-based randomized controlled experiment with 1,800 respondents sought to test the potential efficacy of the split benefit. The intervention reduced the odds of consumption by about half. It did so regardless of scenario (cancer or cardiac stent), type of split (rebate, prepay, or health savings account), or amount of split (US$5,000 or US$15,000). Respondents viewed the insurer that paid a split as behaving fairly, as it preserved access and choice. Three-quarters of respondents supported such use in Medicare, which did not depend on political party affiliation. The reform is promising for further testing since it has the potential to decrease spending on low-value interventions, and thereby increase the value of the health care dollar.
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Maria Polyakova
Stanford Working Paper, October 2014
Abstract:
Conventional wisdom suggests that if private health insurance plans compete alongside a public option, they may endanger the latter's financial stability by cream-skimming good risks. Documenting cream-skimming in dual insurance systems empirically is challenging, since selection into private insurance is non-random and being privately insured may change individual's healthcare consumption. In this paper, I use a regression discontinuity design based on exogenous variation in the propensity of choosing private health insurance to address this challenge. The empirical setting is the health insurance system in Germany, where there exists an unsubsidized non-group for-profit private health insurance market in parallel to a statutory alternative. Federal regulation mandates individuals with income below an annually set threshold to enroll into the statutory system, which is a policy that I exploit for my empirical strategy. Surprisingly, the data does not corroborate the conventional wisdom about selection on the extensive margin, as I do not find compelling support for cream-skimming by private insurers. Using a discrete choice model of demand for private insurance, I explore heterogeneous tastes for convenience in healthcare consumption and long-term contract design of private insurers as potential explanations for this result.
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The Effect of Closure on Quality: The Case of Rural Nursing Homes
John Bowblis & Andrew Vassallo
Journal of Competition Law & Economics, December 2014, Pages 909-931
Abstract:
Understanding the role of competition in determining prices and quality is important in evaluating various public policies, including any antitrust investigation of a proposed merger. This is especially true in health-care markets where consumers are less informed than providers and standard mechanisms such as warranties cannot protect consumers against inferior products. This article examines how market structure affects the quality of care provided in a health-care market by examining the nursing home industry. We empirically test if quality is affected by a change in market structure that arises when a competitor exits the market. Using a sample of rural nursing homes that have a competitor exit and also experience no entry from new competitors, the effect of market structure is identified using a difference-in-differences approach that compares facilities that are within the same geographic market as the exiting facility to a group of facilities outside that geographic market. We find that total staffing levels are lower after the closure after adjusting for transitory effects. All non-staffing quality measures show improvement after the closure, although not all are found to be statistically significant. This suggests supracompetitive markets with excess capacity may actually have lower levels of quality than more concentrated markets.
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Jennifer DeVoe et al.
JAMA Pediatrics, January 2015, e143145
Objective: To estimate the effect on a child’s health insurance coverage status when (1) a parent randomly gains access to health insurance and (2) a parent obtains coverage.
Design, Setting, and Participants: Oregon Experiment randomized natural experiment assessing the results of Oregon’s 2008 Medicaid expansion. We used generalized estimating equation models to examine the longitudinal effect of a parent randomly selected to apply for Medicaid on their child’s Medicaid or Children’s Health Insurance Program (CHIP) coverage (intent-to-treat analyses). We used per-protocol analyses to understand the impact on children’s coverage when a parent was randomly selected to apply for and obtained Medicaid. Participants included 14 409 children aged 2 to 18 years whose parents participated in the Oregon Experiment.
Results: In the immediate period after selection, children whose parents were selected to apply significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a nonsignificant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent’s selection compared with children whose parents were not selected (adjusted odds ratio [AOR] = 1.18; 95% CI, 1.10-1.27). The effect remained significant during months 7 to 12 (AOR = 1.11; 95% CI, 1.03-1.19); months 13 to 18 showed a positive but not significant effect (AOR = 1.07; 95% CI, 0.99-1.14). Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage (AOR = 2.37; 95% CI, 2.14-2.64).
Conclusions and Relevance: Children’s odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid. Children whose parents were selected and subsequently obtained coverage benefited most. This study demonstrates a causal link between parents’ access to Medicaid coverage and their children’s coverage.
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Avi Dor, William Encinosa & Kathleen Carey
Health Affairs, January 2015, Pages 71-77
Abstract:
Previous research has found that Hospital Compare, Medicare’s public reporting initiative, has had little impact on patient outcomes. However, little is known about the initiative’s impact on hospital prices, which may be significant because private insurers are generally well positioned to respond to quality information when negotiating prices with hospitals. We estimated difference-in-differences models of the effects of Hospital Compare quality reporting on transaction prices for two major cardiac procedures, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). States that had mandated their own public reporting systems before the implementation of Hospital Compare formed the control group. We found that prices for these procedures continued to increase overall after the initiation of Hospital Compare quality scores, but the rate of increase was significantly lower in states with no quality reporting metrics of their own before Hospital Compare, when compared to the control states (annual rates of increase of 4.4 percent versus 8.7 percent for PCI, and 3.9 percent versus 10.6 percent for CABG, adjusted for overall inflation). This finding implies that Hospital Compare provided leverage to purchasers in moderating price increases, while adding competitive pressures on hospitals. Providing accurate quality information on both hospitals and health plans could benefit consumers.
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Can Health Insurance Competition Work? Evidence from Medicare Advantage
Vilsa Curto et al.
NBER Working Paper, December 2014
Abstract:
We estimate the economic surplus created by Medicare Advantage under its reformed competitive bidding rules. We use data on the universe of Medicare beneficiaries, and develop a model of plan bidding that accounts for both market power and risk selection. We find that private plans have costs around 12% below fee-for-service costs, and generate around $50 dollars in surplus on average per enrollee-month, after accounting for the disutility due to enrollees having more limited choice of providers. Taxpayers provide a large additional subsidy, and insurers capture most of the private gains. We use the model to evaluate possible program changes.
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Medicare and Private Spending Trends From 2008 to 2012 Diverge in Texas
Luisa Franzini et al.
Medical Care Research and Review, February 2015, Pages 96-112
Abstract:
The recent relatively slow growth in health care spending masks significant differences among payers, clinical settings, and geographic areas. To better understand the spending slowdown, we focus on 2008-2012 trends in Texas among Medicare fee-for-service beneficiaries and enrollees in Blue Cross Blue Shield of Texas (BCBSTX). Spending per person for Medicare grew only 1.5% per year on average, compared with 5.2% for BCBSTX. In Medicare, utilization rates were relatively flat, while prices grew more slowly than input prices. In BCBSTX, spending growth was driven by increases in negotiated prices, in particular hospital prices. We find that geographic variation declined sharply in Medicare, due to drops in spending on post–acute care in two notoriously high-spending regions but rose slightly in BCBSTX. The aggregate spending trends mask two divergent stories: spending growth in Medicare is very slow, but price increases continue to drive unsustainable spending growth among the privately insured.
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The Impact of Non-Economic Damages Caps on Obstetrics: Incentives versus Practice Style
Anca Cotet-Grecu
Economics & Human Biology, forthcoming
Abstract:
This paper uses 1989-2010 county-level data to reexamine the effect of non-economic damages caps on the field of obstetrics. Previous literature found that caps on damages lead to both changes in the number of physicians and changes in treatment patterns. This paper investigates whether the changes in procedures are attributable to changes in incentives or to selection when new entrants could have a different practice style than incumbents. First, I find that the relationship between non-economic damages caps and the number of physicians and procedures identified in previous literature is not robust to the inclusion of the newer policy changes. Second, over the period when such changes were observed, the impact on procedures is concentrated in areas with the greatest changes in the number of obstetricians/gynecologists per capita, suggesting that most of the effect on procedures is driven by differences in practice style between entrants and incumbents.
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Insurance Crisis or Liability Crisis? Medical Malpractice Claiming in Illinois, 1980-2010
David Hyman
University of Illinois Working Paper, November 2014
Abstract:
Four times in the last four decades, Illinois has enacted tort reform limiting medical malpractice (“med mal”) suits – each time in response to complaints about a crisis in med mal premiums. Using a previously unavailable database maintained by the Illinois Department of Insurance, we analyze statewide trends in med mal claiming from 1980-2010, covering three of the four crises. The total direct cost of Illinois’ med mal system has never exceeded 1% of health care spending, and that figure has declined steadily since 1992. Paid claim rates rose sharply from 1980-1985, roughly leveled off from 1986-1993, and then experienced a sustained decline. By 2010, paid claims rates were 75% lower than in the peak year (1991). Mean and median payout per claim has steadily increased since 1980, but these increases are largely attributable to the disappearance of smaller claims involving less severe injuries. We find no evidence that Cook, Madison and St. Clair counties are “judicial hellholes.” To summarize, of the three med mal insurance crises during our sample period, only the first coincided with a major change in med mal liability risk.
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Public Health Insurance and Disparate Eligibility of Spouses: The Medicare Eligibility Gap
Allison Witman
Journal of Health Economics, March 2015, Pages 10–25
Abstract:
I exploit the age-based eligibility structure of Medicare and the age gap between spouses to examine the impact of Medicare eligibility of an older spouse on the insurance coverage of younger, Medicare-ineligible spouses. Using a regression discontinuity framework, I find that Medicare eligibility of an older spouse can crowd-out the health insurance coverage of a younger spouse. Medicare eligibility of older wives increases the likelihood that younger husbands are uninsured. Younger wives are less likely to be covered through an employer-based plan and more likely to have non-group coverage after an older husband turns 65.
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Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010
Emily Gadbois et al.
Medical Care Research and Review, forthcoming
Abstract:
Nurse practitioners and physician assistants can alleviate some of the primary care shortage facing the United States, but their scope-of-practice is limited by state regulation. This study reports both cross-sectional and longitudinal trends in state scope-of-practice regulations for nurse practitioners and physician assistants over a 10-year period. Regulations from 2001 to 2010 were compiled and described with respect to entry-to-practice standards, physician involvement in treatment/diagnosis, prescriptive authority, and controlled substances. Findings indicate that most states loosened regulations, granting greater autonomy to nurse practitioners and physician assistants, particularly with respect to prescriptive authority and physician involvement in treatment and diagnosis. Many states also increased barriers to entry, requiring high levels of education before entering practice. Knowledge of state trends in nurse practitioner and physician assistant regulation should inform current efforts to standardize scope-of-practice nationally.
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California’s Hospital Fair Pricing Act Reduced The Prices Actually Paid By Uninsured Patients
Ge Bai
Health Affairs, January 2015, Pages 64-70
Abstract:
California’s Hospital Fair Pricing Act, passed in 2006, aims to protect uninsured patients from paying hospital gross charges: the full, undiscounted prices based on each hospital’s chargemaster. In this study I examined how the law affects the net price actually paid by uninsured patients — a question critical for evaluating the law’s impact. I found that from 2004 to 2012 the net price actually paid by uninsured patients shrank from 6 percent higher than Medicare prices to 68 percent lower than Medicare prices; the adjusted collection ratio, essentially the amount the hospital actually collected for every dollar in gross price charged, for uninsured patients dropped from 32 percent to 11 percent; and although hospitals have been increasingly less able to generate revenues from uninsured patients, they have raised the proportion of services provided to them in relation to total services provided to all patients. The substantial protection provided to uninsured patients by the California Hospital Fair Pricing Act has important implications for federal and state policy makers seeking to achieve a similar goal. States or Congress could legislate criteria determining the eligibility for discounted charges, mandate a lower price ceiling, and regulate for-profit hospitals in regard to uninsured patients.
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Spillovers from health insurance to the US underground economy
Rajeev Goel & James Saunoris
Applied Economics Letters, Spring 2015, Pages 474-482
Abstract:
Employing recent data on the prevalence of the underground economy across states in the United States, this article uniquely studies the nexus between health insurance coverage and the underground economy. We find a positive effect of health insurance coverage on the spread of the underground sector. Upon disaggregation, while private health coverage promotes the underground sector, government health insurance has the opposite effect.
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Health Insurance, Health Savings Accounts and Healthcare Utilization
Richard Peter, Sebastian Soika & Petra Steinorth
Health Economics, forthcoming
Abstract:
Assuming symmetric information, we show that a high-deductible health plan (HDHP) combined with a tax-favored health savings account (HSA) induces more savings and less treatment compared with a full coverage plan under reasonable risk preferences. Furthermore, a higher tax subsidy increases savings in any case but decreases medical utilization if and only if treatment expenses are above the deductible. A larger deductible increases savings but does not necessarily decrease healthcare utilization. Whether an HDHP/HSA combination is preferred over a full coverage contract depends on absolute risk aversion. A higher tax advantage increases the attractiveness of an HDHP/HSA combination, whereas the effects of changes in the deductible are ambiguous. The paper shows that a potential regulator needs to carefully set the size of the deductible as only in a certain corridor of the probability of sickness, its effect on aggregate healthcare costs are unambiguously favorable.
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Sukyung Chung et al.
Health Affairs, January 2015, Pages 11-20
Abstract:
Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007–13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65–75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10–20 percentage points lower than was the case for people with private coverage (43–44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors’ use of preventive services.
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Kathryn Wagner
Journal of Health Economics, March 2015, Pages 69–82
Abstract:
Disabled individuals under 65 years old account for 15% of Medicaid recipients but half of all Medicaid spending. Despite their large cost, few studies have investigated the effects of Medicaid expansions for disabled individuals on insurance coverage and crowd-out of private insurance. Using an eligibility expansion that allowed states to provide Medicaid to disabled individuals with incomes less than 100% of the federal poverty level, I address these issues. Crowd-out estimates range from 49% using an ordinary least squares procedure to 100% using two-stage least-squares analysis. This potentially large degree of crowd-out could have fiscal implications for the Affordable Care Act which has greatly expanded Medicaid eligibility in 2014.
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The relationship between altruistic attitudes and dentists’ Medicaid participation
Susan McKernan et al.
Journal of the American Dental Association, January 2015, Pages 34–41
Background: The authors investigated the role of private practitioners in the dental safety net, including the provision of care for Medicaid enrollees and attitudinal factors that affect participation.
Methods: In 2013, the authors sent a mixed-mode survey to all general dentists in Iowa assessing their current Medicaid participation and factors affecting participation, including attitudinal statements about altruism, the Medicaid program, and the government’s role in providing access to dental care.
Results: Fifty-six percent of responding dentists accepted new Medicaid-enrolled patients; dentists living in nonmetropolitan areas were significantly more likely to accept Medicaid than were those in metropolitan areas. Results from a logistic regression model demonstrated that participating dentists scored significantly higher in altruistic attitudes and perceived problems with Medicaid as less important.
Conclusions: Dentists who accepted Medicaid-enrolled patients had significantly more positive attitudes about Medicaid administration and altruistic attitudes in general. Investigators in future studies should examine how these attitudes are shaped by educational and professional experiences.
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Suzanne Bentler et al.
PLoS ONE, December 2014
Background: Continuity of medical care is widely believed to lead to better health outcomes and service utilization patterns for patients. Most continuity studies, however, have only used administrative claims to assess longitudinal continuity with a provider. As a result, little is known about how interpersonal continuity (the patient's experience at the visit) relates to improved health outcomes and service use.
Methods: We linked claims-based longitudinal continuity and survey-based self-reported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a five-year period.
Results: Patient-reported continuity was associated with reduced emergency department use, preventable hospitalization, and mortality. Most of the claims-based measures, including those most frequently used to assess continuity, were not associated with reduced utilization or mortality.
Conclusion: Our results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, suggesting that reform efforts must include the patient-provider experience when evaluating health care quality.
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Colorectal Cancer Screening and State Health Insurance Mandates
Mary Hamman & Kandice Kapinos
Health Economics, forthcoming
Abstract:
Colorectal cancer (CRC) is the third most deadly cancer in the USA. CRC screening is the most effective way to prevent CRC death, but compliance with recommended screenings is very low. In this study, we investigate whether CRC screening behavior changed under state mandated private insurance coverage of CRC screening in a sample of insured adults from the 1997 to 2008 Behavioral Risk Factor Surveillance Survey (BRFSS). We present difference-in-difference-in-differences (DDD) estimates that compare insured individuals age 51 to 64 to Medicare age-eligible individuals (ages 66 to 75) in mandate and non-mandate states over time. Our DDD estimates suggest endoscopic screening among men increased by 2 to 3 percentage points under mandated coverage among 51 to 64 year olds relative to their Medicare age-eligible counterparts. We find no clear evidence of changes in screening behavior among women. DD estimates suggest no evidence of a mandate effect on either type of CRC screening for men or women.