Health Insurance, Hospitals, or Both? Evidence from the United Mine Workers’ Health Care Programs in Appalachia by Theodore F. Figinski, Erin Troland :: SSRN

September 18, 2018

Should the government subsidize health insurance, health care facilities, or both? The United States has subsidized both for many decades, targeting under-served populations and geographic areas. We study these questions in the first rigorous quantitative analysis of two major natural experiments in Appalachian coal country. In the early 1950s, the United Mine Workers of America (UMWA) coal mining union began to provide free health insurance to coal miners and their families. A few years later, the UWMA opened ten new state-of-the-art hospitals in Appalachia. These interventions give us the unique opportunity to separately identify (i) the effect of health insurance from (ii) the combined effect of the insurance plus new hospitals for the same place, time, and population. To do so, we use difference-in-differences at the county-year level. We find that the health insurance had large effects on pregnant women and infants. A woman’s probability of delivering her baby in a hospital increased from 60 percent to over 90 percent. The probability of her infant dying before the age of one decreased from 36 to 9 per 1,000. For the new hospitals, crowd-out was low. Adding UMWA hospitals increased hospital beds by more than 50 percent. Health care workers more than doubled.

via Health Insurance, Hospitals, or Both? Evidence from the United Mine Workers’ Health Care Programs in Appalachia by Theodore F. Figinski, Erin Troland :: SSRN


Health Data and Privacy in the Digital Era by Lawrence O. Gostin, Sam Halabi, Kumanan Wilson :: SSRN

September 18, 2018

In 2010, the social networking site Facebook launched a platform allowing private companies to request users’ permission to access personal data. Few users were aware of the platform, which was integrated into Facebook’s terms of service. In 2014, Cambridge Analytica, a UK-based political consulting firm, developed a data-harvesting app. That app prompted Facebook users to provide psychological profiles, including responses such as “I get upset easily” and “I have frequent mood-swings” as part of a “research project.”
The Facebook platform allowed users to share their friends’ data as well, enabling Cambridge Analytica to access tens of millions of personal profiles, identifying voters’ political preferences. The controversy revealed risks to identifiable health data posed by social media and web services companies’ practices. After the Cambridge Analytica controversy, Facebook suspended a project that aimed to link data about users’ medical conditions with information about their social networks.
Individuals often reveal detailed, sensitive health information online. Through wearable devices, social media posts, traceable web searches, and online patient communities, users generate large volumes of health data. Although some individuals participate in online patient forums and wellness information sharing apps under their own names, others participate via pseudonyms, assuming their privacy is preserved. Many users believe their data will be shared only with those they designate.

via Health Data and Privacy in the Digital Era by Lawrence O. Gostin, Sam Halabi, Kumanan Wilson :: SSRN


Analyzing the Economic Effects of State-Level Regulation by Mark Febrizio :: SSRN

September 16, 2018

Existing research on the economic impacts of regulation largely focuses on federal or cross-country regulatory restrictions, but the problem of regulatory accumulation is expected to also occur at the state level. Public choice economics and market process theory offer insight into why regulations alter economic outcomes. Since regulations change the rules of the game and the payoffs that participants receive, looking beyond stated intentions to the way regulations motivate behaviors is critical. Markets are an entrepreneurially driven process characterized by changing conditions, but regulations can inhibit creative destruction and distort incentives. I use the novel State RegData dataset from the QuantGov platform, which analyzes state regulatory texts to provide measures of restriction counts and industry relevance. I estimate the effect of industry-relevant restrictions on business establishments and employment using two econometric models: a multivariate linear regression model with controls and a fixed-effects regression model. I find tentative results that a greater amount of regulation in states is associated with negative percent changes in establishments and employment. My study is a starting point for future investigations of the relationship between regulation and state-level economic outcomes.

via Analyzing the Economic Effects of State-Level Regulation by Mark Febrizio :: SSRN


Medicare Secondary Payer and Settlement Delay

June 7, 2018

The Medicare Secondary Payer Act of 1980 and its subsequent amendments require that insurers and self‐insured companies report settlements, awards, and judgments that involve a Medicare beneficiary to the Centers for Medicare and Medicaid Services. The parties then may be required to compensate CMS for its conditional payments. In a simple settlement model, this makes settlement less likely. Also, the reporting delays and uncertainty regarding the size of these conditional payments are likely to further frustrate the settlement process. We provide results, using data from a large insurer, showing that, on average, implementation of the MSP reporting amendments led to a delay in the resolution of disputes involving auto accidents of about six months.

via Medicare Secondary Payer and Settlement Delay by Eric Helland, Jonathan Klick :: SSRN


Declining Teen Employment: Minimum Wages, Other Explanations, and Implications for Human Capital Investment

May 29, 2018

We explore the decline in teen employment in the United States since 2000, which was sharpest for those age 16–17. We consider three explanatory factors: a rising minimum wage that could reduce employment opportunities for teens and potentially increase the value of investing in schooling; rising returns to schooling; and increasing competition from immigrants that, like the minimum wage, could reduce employment opportunities and raise the returns to human capital investment. We find that higher minimum wages are the predominant factor explaining changes in the schooling and workforce behavior of those age 16–17 since 2000. We also consider implications for human capital. Higher minimum wages have led both to fewer teens in school and employed at the same time, and to more teens in school but not employed, which is potentially consistent with a greater focus on schooling. We find no evidence that higher minimum wages have led to greater human capital investment. If anything, the evidence points to adverse effects on longer-run earnings for those exposed to these higher minimum wages as teenagers.

via Declining Teen Employment: Minimum Wages, Other Explanations, and Implications for Human Capital Investment by David Neumark, Cortnie Shupe :: SSRN


Household Bundling to Reduce Adverse Selection: Application to Social Health Insurance

May 17, 2018

This paper explores the use of bundling to reduce adverse selection in insurance mar-kets and its application to social health insurance programs. When the choice to buy health insurance is made at the household level, bundling the insurance policies of household mem-bers eliminates the effect of adverse selection within a household since the household can no longer select only sick members to enroll. However, this can exacerbate adverse selection across households, as healthier households might choose to drop out of the insurance market. The net effect of this trade-off depends on the characteristics of the household demand for medical care and risk preferences. I explore this issue using individual survey data on insur-ance enrollment and medical spending in Vietnam that contain detailed information about the structure of the household. The reduced-form evidence suggests that income, own-price and cross-member substitution effects play important roles in the demand for medical care, which affects a household’s selection of members into insurance. I then develop and estimate a model of household insurance bundle choice and medical utilization that accounts for these features. The results suggest that much of the adverse selection is concentrated within the household. Counterfactual analysis reveals that under optimal pricing, household bundling yields significantly higher consumer surplus and insurance enrollment than individual pur-chase. Furthermore, the insurance market is less susceptible to complete unraveling under household bundling.

via Household Bundling to Reduce Adverse Selection: Application to Social Health Insurance by Anh Nguyen :: SSRN


Medicare Secondary Payer and Settlement Delay

May 13, 2018

The Medicare Secondary Payer Act of 1980 and its subsequent amendments require that insurers and self‐insured companies report settlements, awards, and judgments that involve a Medicare beneficiary to the Centers for Medicare and Medicaid Services. The parties then may be required to compensate CMS for its conditional payments. In a simple settlement model, this makes settlement less likely. Also, the reporting delays and uncertainty regarding the size of these conditional payments are likely to further frustrate the settlement process. We provide results, using data from a large insurer, showing that, on average, implementation of the MSP reporting amendments led to a delay in the resolution of disputes involving auto accidents of about six months.

via Medicare Secondary Payer and Settlement Delay by Eric Helland, Jonathan Klick :: SSRN