‘Prime Health’ and the Regulation of Hybrid Healthcare by Nicolas Terry :: SSRN

October 18, 2018

This article examines the possible constructs behind the announcement by Amazon, Berkshire Hathaway, and JPMorgan Chase & Co., that they are jointly building a new healthcare entity for their employees. The article provides context by discussing and comparing the healthcare ambitions of the three largest information technology companies and argues that various forms of hybrid entities will increase their footprint in healthcare data and delivery. The core of the article is a thought experiment about the nature of what the article terms “Prime Health.” That analysis is based initially on observations about Amazon’s existing culture and business model of Amazon. Thereafter the article examines both what Prime Health could and should be, arguing that it will go beyond the pedestrian model of a very large self-funded group insurance plan, will disintermediate traditional healthcare insurers, and attempt to bring consumers and healthcare providers together into some type of online marketplace; an updated, privatized version of managed competition. The final parts of the article deal with the regulatory environment that hybrid healthcare generally and Prime Health in particular will face. The analysis includes federal device and data protection laws, some idiosyncratic state laws, and a brief discussion of the problems inherent in the limited regulation of hybrid healthcare entities.

via ‘Prime Health’ and the Regulation of Hybrid Healthcare by Nicolas Terry :: SSRN


The New Wave of Local Minimum Wage Policies: Evidence From Six Cities by Sylvia Allegretto, Anna Godøy, Carl Nadler, Michael Reich :: SSRN

October 17, 2018

In recent years, a new wave of state and local activity has transformed minimum wage policy in the U.S. As of August 2018, ten large cities and seven states have enacted minimum wage policies in the $12 to $15 range.1 Dozens of smaller cities and counties have also enacted wage standards in this range.2 These higher minimum wages, which are being phased in gradually, will cover well over 20 percent of the U.S. workforce. With a substantial number of additional cities and states poised to soon enact similar policies, a large portion of the U.S. labor market will be held to a higher wage standard than has been typical over the past 50 years.

These minimum wage levels substantially exceed the previous peak in the federal minimum wage, which reached just under $10 (in today’s dollars) in the late 1960s. As a result, the new policies will increase pay directly for 15 to 30 percent of the workforce in these cities and as much as 40 to 50 percent of the workforce in some industries and regions. By contrast, the federal and state minimum wage increases between 1984 and 2014 increased pay directly for less than eight percent of the applicable workforce.

This report examines the effects of these new policies. Although minimum wage effects on employment have been much studied and debated, this new wave of higher minimum wages attains levels beyond the evidential reach of most previous studies. Moreover, city-level policies might have effects that differ from those of state and federal policies. Yet, most of the empirical studies of minimum wages focus on the state and federal-level policies. The literature on the effects of city-level minimum wages is much smaller. Our report helps fill these gaps.

via The New Wave of Local Minimum Wage Policies: Evidence From Six Cities by Sylvia Allegretto, Anna Godøy, Carl Nadler, Michael Reich :: SSRN


Long-Term Changes in Married Couples’ Labor Supply and Taxes: Evidence from the US and Europe Since the 1980s by Alexander Bick, Bettina Brüggemann, Nicola Fuchs-Schundeln, Hannah Paule-Paludkiewicz :: SSRN

October 17, 2018

We document the time-series of employment rates and hours worked per employed by married couples in the US and seven European countries (Belgium, France, Germany, Italy, the Netherlands, Portugal, and the UK) from the early 1980s through 2016. Relying on a model of joint household labor supply decisions, we quantitatively analyze the role of non-linear labor income taxes for explaining the evolution of hours worked of married couples over time, using as inputs the full country- and year-specific statutory labor income tax codes. We further evaluate the role of consumption taxes, gender and educational wage premia, and the educational composition. The model is quite successful in replicating the time series behavior of hours worked per employed married woman, with labor income taxes being the key driving force. It does however capture only part of the secular increase in married women’s employment rates in the 1980s and early 1990s, suggesting an important role for factors not considered in this paper. We will make the non-linear tax codes used as an input into the analysis available as a user-friendly and easily integrable set of Matlab codes.

via Long-Term Changes in Married Couples’ Labor Supply and Taxes: Evidence from the US and Europe Since the 1980s by Alexander Bick, Bettina Brüggemann, Nicola Fuchs-Schundeln, Hannah Paule-Paludkiewicz :: SSRN


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