Workplace wellness programs have become increasingly common in the United States, although there is not yet consensus regarding the ability of such programs to improve employees’ health and reduce health care costs. In this paper, we study a program offered by a large U.S. employer that provides substantial financial incentives directly tied to employees’ health. The program has a high participation rate among eligible employees, around 80%, and we analyze the data on the first 4 years of the program, linked to health care claims. We document robust improvements in employee health and a correlation between certain health improvements and reductions in health care cost. Despite the latter association, we cannot find direct evidence causally linking program participation to reduced health care costs, although it seems plausible that such a relationship will arise over longer horizons.
The impact of financial incentives on health and health care: Evidence from a large wellness program – Einav – 2019 – Health Economics – Wiley Online LibraryJanuary 10, 2019
SeaTE: Subjective ex ante Treatment Effect of Health on Retirement by Pamela Giustinelli, Matthew D. Shapiro :: SSRNJanuary 2, 2019
This paper develops an innovative approach to measuring the effect of health on retirement. The approach elicits subjective probabilities of working at specified time horizons fixing health level. Using a treatment-effect framework, within-individual differences in elicited probabilities of working given health yield individual-level estimates of the causal effect of health (the treatment) on working (the outcome). We call this effect the Subjective ex ante Treatment Effect (SeaTE). The paper then develops a dynamic programming framework for the SeaTE. This framework allows measurement of individual-level value functions that map directly into the dynamic programming model commonly used in structural microeconometric analysis of retirement. The paper analyzes conditional probabilities elicited in the Vanguard Research Initiative (VRI)—a survey of older Americans with positive assets. Among workers 58 and older, a shift from high to low health would on average reduce the odds of working by 28.5 percentage points at a two-year horizon and 25.7 percentage points at a four-year horizon. There is substantial variability across individuals around these average SeaTEs, so there is substantial heterogeneity in taste for work or returns to work. This heterogeneity would be normally unobservable and hard to disentangle from other determinants of retirement in data on realized labor supply decisions and health states. The paper’s approach can overcome the problem that estimates of the effect of health on labor supply based on behavioral (realizations) data can easily overstate the effect of health on retirement whenever less healthy workers tend to retire earlier for reasons other than health.
Hunger Pains? SNAP Timing, and Emergency Room Visits by Chad D. Cotti, John Gordanier, Orgul D. Ozturk :: SSRNJanuary 2, 2019
The impact of poor nutrition has been established as an important determinant of health. It has also been demonstrated that the single monthly treatment of SNAP benefits leaves meaningful nutritional deficiencies in recipient households during the final weeks of the benefits cycle. Further, health related behaviors have been documented to be altered on the date of food stamp receipt. This project exploits highly detailed and linked administrative data on health care utilization of food stamp recipients and randomized food stamp receipt dates to allow us to measure the impact of food stamp treatment days and the low nutritional periods created by the SNAP benefits cycle on the likelihood of emergency department (ER) utilization among the Medicaid population. Our main finding is that among SNAP receiving individuals in the ER on a particular day, the share that received benefits on that day is 3.5% lower than would be expected. This effect is present across all age groups, although the magnitude is smallest for young children. Further, we find that for individuals 55 and over, the share of ER visits that comes from individuals that are past the third week of their SNAP benefit month, i.e. received benefits more than 21 days ago, is 1.5% larger than would be expected. This suggests that these older individuals are more likely to visit the ER late in the SNAP benefit cycle, which is consistent with increased food insecurity as a possible mechanism linking the food stamp benefits cycle to emergency care utilization. We find no such effect for younger individuals.
For this year’s Rosenkranz Debate, we have been asked to debate the question: Lochner v. New York: Still Crazy After All These Years? It is my job to defend the “negative” position. My burden is not to establish that Lochner was correctly decided, but merely that it was not “crazy.” I intend to meet that burden and exceed it. I intend to show how Lochner v. New York was not at all crazy; in fact, it was a reasonable and good decision.
Medical-Legal Partnerships and Mental Health: Qualitative Evidence that Integrating Legal Services and Health Care Improves Family Well-Being by Dayna Bowen Matthew :: SSRNJanuary 2, 2019
Medical-Legal partnerships are an innovative health care delivery model that integrates lawyers into primary care clinical settings. The objective is to preventively address patients’ legal needs that also have an adverse impact on their health outcomes. Since the first medical-legal partnership formally opened at the Boston Medical Center in 1993, nearly 300 of these entities have formed around the country. The empirical evidence that they improve health, however, is still emerging. This essay contributes results of interviews conducted among families who received medical legal partnership help as an intervention in Colorado. The evidence supports the conclusion that addressing patients’ legal stressors improves their mental health and family well-being.
No-Fault (Strict) Liability for Injuries From Innovative Treatments: Fairness or Also Efficiency by Tsachi Keren-Paz :: SSRNJanuary 2, 2019
Innovative treatments (ITs) have a distinct SIROT pattern: they often show, and are expected to show, significantly improved results over time. Of the four IT categories discussed, two stand out: SIROT treatments which are currently not in the patient’s best interest (BI) but will become superior treatment over time (category 3), and treatments which are already arguably BI but will clearly become the superior option as they improve with time (category 2).
There is a strong fairness argument to compensate patients injured from ITs because their injury led to improved knowledge benefitting future patients. By analogy to private necessity, IT patients should be considered ‘rescuers’ entitled to costs reimbursement, since future patients receive an incontrovertible benefit inextricably linked to their loss. Crucially, category 2 patients also deserve compensation, notwithstanding that their treatment was BI.
From an efficiency perspective, patients should avoid only irresponsible ITs (category 4) but they are not well-placed to identify such treatments. Patients’ incentives to submit to ITs are no worse, and perhaps slightly improve under strict liability (SL): SL might incentivise patients to undergo a treatment whose prospect as BI is in doubt but is likely to be SIROT. Finally, while under SL (but not negligence) category 2 cases yield liability, which may deter physicians from offering ITs, reputation loss under SL is lessened, so physicians’ incentives may improve (and they also have strong non-legal incentives to offer ITs).
Public Housing and Public Health: The Separate and Unequal Protection of Private and Public Housing Tenants’ Health in New York City by Justin R. La Mort :: SSRNJanuary 2, 2019
New York City Housing Authority (NYCHA) tenants’ health are put at risk by the policies and practices of the government. Public housing tenants receive unequal treatment when compared to tenants in private housing in obtaining repairs and preventing dangerous conditions. These conditions include lead, lack of heat and hot water, and mold which can have lasting consequences to those forced to suffer in the only home they can afford. This article argues lower rent does not mean lower expectations for tenant safety. After examining the history and regulatory structure that has led to this disparate treatment, the article stresses the importance of future NYCHA reform including greater funding, transparency, accountability, and equality to ensure decent, affordable housing for all.
Hospital Readmissions Reduction Program Does Not Provide the Right Incentives: Issues and Remedies by Kenan Arifoglu, Hang Ren, Tolga Tezcan :: SSRNJanuary 2, 2019
The Hospital Readmissions Reduction Program (HRRP) reduces Medicare payments to hospitals with higher-than-expected readmission rates where the expected readmission rate for each hospital is determined based on national average readmission levels. Although similar relative performance-based schemes are shown to lead to socially optimal outcomes in other settings, HRRP differs from these schemes in three respects: (i) deviation from the targets are adjusted using a multiplier; (ii) the total financial penalty for a hospital with higher-than-expected readmission rate is capped; and (iii) hospitals with lower-than-expected readmission rates do not receive bonus payments. We study three regulatory schemes derived from HRRP to determine the impact of each feature, and use a principle-agent model to show that: (i) HRRP over-penalizes hospitals with excess readmissions because of the multiplier and its effect can be substantial; (ii) having a penalty cap can curtail the effect of financial incentives and result in a no-equilibrium outcome when the cap is too low; and (iii) not allowing bonus payments leads to many alternative symmetric equilibria, including one where hospitals exert no effort to reduce readmissions. These results show that HRRP does not provide the right incentives for hospitals to reduce readmissions. Next we show that a bundled payment type reimbursement method, which reimburses hospitals once for each episode of care (including readmissions), leads to socially optimal cost and readmissions reduction efforts. Finally we show that, when delays to accessing care are inevitable, the reimbursement schemes need to provide additional incentives for hospitals to invest sufficiently in capacity.
Hemp in the United States: A Case Study of Regulatory Path Dependency by Trey Malone, Kevin D. Gomez :: SSRNJanuary 2, 2019
The Agricultural Act of 2014 allowed for federally funded research on hemp for the first time since 1937. Since 2014, pro-hemp legislation has received increasingly bipartisan support, culminating with the Hemp Farming Act of 2018, which would remove industrial hemp from its current Schedule 1 listing and allow hemp to be treated like any other agricultural commodity. In part because of this legalization, hemp production in the United States has the potential to increase substantially. This study describes what is known about the economic and regulatory considerations of US hemp agriculture through the lens of path dependency. Important questions remain regarding the legal and regulatory landscape of hemp and are further complicated by its current listing as a Schedule 1 drug.
Social Security Administration Payments to State Vocational Rehabilitation Agencies for Disability Program Beneficiaries Who Work: Evidence from Linked Administrative Data by Jody Schimmel, Paul O’Leary :: SSRNJanuary 2, 2019
This article’s authors use linked administrative data from the Social Security Administration (SSA) and the Department of Education’s Rehabilitation Services Administration to evaluate SSA’s investment in services provided by the federal-state Vocational Rehabilitation (VR) program. A unique data resource permits a comparison of the value of SSA payments to state VR agencies for services provided to disability program beneficiaries who find and maintain a substantial level of work with the value of the cash benefits those beneficiaries forgo because of work. The authors find that the value of cash benefits forgone by beneficiaries after applying for VR services is substantially greater than the value of SSA payments to state VR agencies for those services.
via Social Security Administration Payments to State Vocational Rehabilitation Agencies for Disability Program Beneficiaries Who Work: Evidence from Linked Administrative Data by Jody Schimmel, Paul O’Leary :: SSRN