Using prices of hospital admissions and visits to five types of physicians, we analyzed how provider and insurer market concentration—as measured by the Herfindahl-Hirschman Index (HHI)—interact and are correlated with prices. We found evidence that in the range of the Department of Justice’s and Federal Trade Commission’s definition of a moderately concentrated market (HHI of 1,500–2,500), insurers have the bargaining power to reduce provider prices in highly concentrated provider markets. In particular, hospital admission prices were 5 percent lower and cardiologist, radiologist, and hematologist/oncologist visit prices were 4 percent, 7 percent, and 19 percent lower, respectively, in markets with high provider concentration and insurer HHI above 2,000, compared to such markets with insurer HHI below 2,000. We did not find evidence that high insurer concentration reduced visit prices for primary care physicians or orthopedists, however. The policy dilemma that arises from our findings is that there are no insurer market mechanisms that will pass a portion of these price reductions on to consumers in the form of lower premiums. Large purchasers of health insurance such as state and federal governments, as well as the use of regulatory approaches, could provide a solution.
Health Insurance Expansions and Provider Behavior: Evidence from Substance Use Disorder Providers by Catherine Maclean, Ioana Popovici, Elisheva Stern :: SSRNFebruary 13, 2017
We examine how substance use disorder (SUD) treatment providers respond to private health insurance expansions induced by state equal coverage (‘parity’) laws for SUD treatment. We use data on the near universe of specialty SUD treatment providers in the United States between 1997 and 2010 in an event study analysis. During this period, 18 states implemented parity laws. Following the passage of a state parity law we find that providers are less likely to participate in public markets, are less likely to provide charity care, increase the quantity of healthcare provided, and become more selective of the type of patients they are willing to admit.
Maternity and family leave policies enable mothers to take time off work to prepare for and recover from childbirth and to care for their new children. While there is substantial variation in the details of these policies around the world, the existing research yields the following general conclusions. First, despite important barriers to the take-up of leave, both the implementation of new programs and extensions of existing ones increase leave-taking rates among new parents. Second, leave entitlements less than one year in length can improve job continuity for women and increase their employment rates several years after childbirth; longer leaves can negatively influence women’s earnings, employment, and career advancement. Third, extensions in existing paid leave policies have no impact on measures of child well-being, but the introduction of short paid and unpaid leave programs can improve children’s short- and long-term outcomes. Fourth, while more research is needed, the current evidence shows minimal impacts of existing U.S. state-level programs on employer-level outcomes such as employee productivity, morale, profitability, turnover rates, or the total wage bill.
A movement long identified with the notion that “love makes a family” today flirts dangerously with the dogma that “blood is thicker than water.” Biogeneticism, an ideology that favors biological modes of kinship and genetic conceptions of identity, informs many LGBT individuals’ choices about why and how to have children. In turn this ideology marks two troubling features of political efforts to facilitate LGBT parenthood: first, the markedly different understandings of equality — full versus formal, lived versus legal — that guide movement approaches to assisted procreation and adoption, respectively; and second, invocations of a fundamental “right to procreate” that valorize reproduction, idealize a biological model of parenthood, and threaten to entrench biogenetic bias in family law and constitutional doctrine.
There are inadequate consumer protections from harmful medical billing practices that result in unavoidable, unexpected, and often financially devastating medical bills. The problem stems from increasing cost shifting to patients underway in American health care and the inordinate complexity that makes health care transactions nearly impossible for consumers to navigate. A particularly outrageous exemplar is the phenomenon of surprise medical bills, which refers to unanticipated and involuntary out-of-network bills in emergencies or from out-of-network providers at in-network facilities. Other damaging medical billing practices also include the opaque and a la carte nature of medical bills, epitomized by added “facility fees,” as well as harsh medical debt collection and credit reporting practices. The impetus of this article was driven by the simple questions: are these harmful health care billing practices legal? And if so, what can be done to protect patients as consumers? The questions are simple but the answers are not. This article canvasses a growing body of financial protections under federal and state law for health care consumers and concludes that, notwithstanding these significant efforts, consumer financial protections are inadequate for most health care consumers in this country. The article sets forth a model set of policy reforms that build upon state reforms to protect health care consumers. The biggest gaps in protection, however, are structural ― most states have not adopted robust health care consumer financial protections, and even if many more states did, ERISA preempts many state efforts to protect health care consumers for the large and growing number of consumers insured by self-funded employer health plans. Despite salutary state innovation in the area of patient financial protection, a growing ERISA vacuum means a federal solution is necessary to protect all health care consumers from medical-billing abuses.
Estimating the Employment Effects of Recent Minimum Wage Changes: Early Evidence, an Interpretative Framework, and a Pre-Commitment to Future Analysis by Jeffrey P. Clemens, Michael R. Strain :: SSRNFebruary 2, 2017
This paper presents early evidence on the employment effects of state minimum wage increases enacted between January 2013 and January 2015, and offers an interpretative framework to understand why it is of interest to study recent changes in isolation. Given the ongoing transitions of many states’ minimum wage rates, we also set the stage for a pre-committed analysis of the minimum wage changes scheduled for coming years. Through 2015, we estimate that employment among young adults and young individuals with less than a completed high school education expanded modestly less quickly in states that enacted one-time or multi-phase statutory minimum wage increases than in states that enacted no minimum wage increases. Across the specifications we implement and the samples we analyze, many of our estimates are statistically indistinguishable from zero. Data on the longer-run effects of this period’s minimum wage changes will be essential for more fully assessing these changes’ effects and for drawing strong conclusions regarding how minimum wage increases affect employment in this decade’s institutional and economic environment. As data become available for the full 2016 through 2019 calendar years, we will execute and report the results of analyses that follow the road map this paper develops.
Source: Estimating the Employment Effects of Recent Minimum Wage Changes: Early Evidence, an Interpretative Framework, and a Pre-Commitment to Future Analysis by Jeffrey P. Clemens, Michael R. Strain :: SSRN