Health insurance and the demand for medical care: evidence from a randomized experiment.

We estimate how cost sharing, the portion of the bill the patient pays, affects the demand for medical services. The data come from a randomized experiment. A catastrophic insurance plan reduces expenditures 31 percent relative to zero out-of-pocket price. The price elasticity is approximately -0.2. We reject the hypothesis that less favorable coverage of outpatient services increases total expenditure (for example, by deterring preventive care or inducing hospitalization).     

More health care utilization with more insurance coverage? Evidence from a latent class model with German data

We analyse the impact of optional deductibles, private supplementary health insurance and income on the demand for health care utilization, measured as the number of physician visits with data from the German Socio-Economic Panel (SOEP). With a set of newly available variables for the years 2002, 2004 and 2006 that measure individual health more accurately and including risk-attitudes towards health we find that possible endogeneity of the insurance choice is not a problem. A latent class approach that takes into account the panel structure of the data reveals that especially individuals who have few doctor visits, the low users, respond strongest to insurance status and income. In this group we find that more insurance increases the demand for physician visits and there is a pro-rich inequity in health care utilization. No such effects are found for the high users.     

Reference Pricing with Elastic Demand for Pharmaceuticals

In this paper, we re‐examine the properties of two commonly adopted government reimbursement schemes for pharmaceuticals: reference pricing and fixed percentage reimbursement. We depart from the previous literature by assuming that the individual demand is price‐sensitive and depends on the copayment rate (i.e., the part paid by each consumer). We obtain two novel results under reference pricing: first, as the copayment rate increases, so do pharmaceutical prices; second, this increase in pharmaceutical prices reduces social welfare. Whilst reference pricing does emerge as a preferable reimbursement scheme, demand elasticities and the copayment rate interact in complex ways. This leads (unexpectedly) to the possibility that a higher copayment rate (lower reimbursement rate) results in higher government expenditure.     

Structural oil price shocks and policy uncertainty

Increases in the real price of oil not explained by changes in global oil production or by global real demand for commodities are associated with significant increases in economic policy uncertainty and its four components (the volume of newspaper coverage of policy uncertainty, CPI forecast interquartile range, tax legislation expiration, and federal expenditures forecast interquartile range). Oil-market specific demand shocks account for 31% of conditional variation in economic policy uncertainty and 22.9% of conditional variation in CPI forecast interquartile range after 24 months. Positive oil shocks due to global real aggregate demand for commodities significantly reduce economic policy uncertainty. Structural oil price shocks appear to have long-term consequences for economic policy uncertainty, and to the extent that the latter has impact on real activity the policy connection provides an additional channel by which oil price shocks have influence on the economy. As a robustness check, structural oil price shocks are significantly associated with economic policy uncertainty in Europe and energy-exporting Canada.     

Incentive effects of paying demand response in wholesale electricity markets

Recently issued U.S. Federal Energy Regulatory Commission regulations require comparable treatment of demand reduction and generation in the wholesale electric market so that they are compensated at the same market clearing price. The new regulations measure demand reduction as a reduction from a “customer baseline,” a historically based estimate of the expected consumption. In this paper, we study the incentive effects on the efficiency of the demand response regulation using a static equilibrium model and a dynamic extension of the model. Our analysis provides three main results. Firstly, our analysis shows that the demand reduction payment will induce consumers to (1) inflate the customer baseline by increasing consumption above the already excessive level during normal peak periods and (2) exaggerate demand reduction by decreasing consumption beyond the efficient level during a demand response event. This result persists when applied to alternative baseline designs in a dynamic model. Secondly, we study alternative policy remedies to restore the efficiency of demand response regulation and introduce a new approach to define the customer baseline as a fixed proportion of an aggregate baseline. In particular, the aggregate baseline approach can significantly weaken or eliminate the incentive to inflate the baseline. Finally, we illustrate that if the baseline inflation problem is solved and demand and supply functions are linear, the current policy can produce a net social welfare gain. However, the welfare improvement requires that demand reduction be paid only when the wholesale price is at least twice the fixed retail rate. This argues that the policy should include a sufficiently high threshold price below which demand response is not dispatched.     

Anti-inflation taxation policy: An alternative to wage and price controls

One reason the postwar economy has become increasingly inflation prone is that oligopolistic firms tend to act as if demand is completely inelastic for price increases no greater than the expected rate of inflation. Hence, in the absence of mandatory price controls, there is no effective disincentive at the individual firm level to price increases of this magnitude. The policy proposed below provides such a disincentive by linking each firm's tax rate to the increase in its revenues attributable to price changes.     

新医改背景下我国药品流通产业集中度提升的路径探讨

当前新医改已进入关键攻坚时期,整顿药品流通秩序、规范经营主体行为、降低药品价格是新医改的重要内容。但我国药品流通产业集中度偏低的局面依然严重影响着市场流通秩序、行业利润和药品价格。依据"推-拉理论",我国政府应该在宏观层面和中观层面实施积极的经济政策,形成一种推力促进行业的快速整合;大型流通企业应该通过技术、规模、资金、品牌等优势形成一种拉力来加快兼并收购或结成战略联盟,进而来提升药品流通产业的集中度。提升药品流通产业集中度对促进医改有促进作用。     

城镇职工医疗保险政策研究:个人账户与医疗支出

自医疗保险的个人账户政策推行以来,国内外学者对它的功能和作用一直存在争议.本文利用南京市医疗保险数据,采用非平衡面板固定效应回归模型及Robust和Cluster校正的方法,对2002-2006年门诊患者个人账户与医疗支出进行了实证分析.结果显示:个人账户在一定程度上有朝着约束医疗费用的方向发展,特别是对于退休人群而言,医疗个人账户资金在医疗需求更大的人群中得到了释放,而在医疗需求较小的人群中得以储存.该研究的基本结论是,个人账户对城镇医疗保险制度的影响与预期的政策目标基本一致.     

Determinants of healthcare spending: a state level analysis

Within the high and rising level of healthcare spending for the US as a whole is substantial variation in spending across states. Yet relatively little attention has been given to the empirical analysis of interstate differences in aggregate healthcare expenditures, and therefore little empirical evidence exists at the state level to guide policymakers. Using data for all 50 states for the year 1998, we estimate an empirical model that includes structural and reduced-form healthcare spending equations and a health production function to assess the significance, size and relative importance of factors that prior research indicates, may play an important role in explaining interstate variation in medical care expenditures, and the main pathways through which they operate. Our results indicate higher levels of healthcare spending for state populations with higher income, less education, fewer uninsured residents, less healthy lifestyles, larger proportion of elderly residents, greater availability of medical care providers and less urbanization. Our findings suggest that the most effective cost containment measures may be those that increase education and promote healthy lifestyles. Not only do these actions lead to reductions in healthcare spending, they also improve the health status of the population, and may help to achieve other important social policy goals.     

Information transmission and incentives not to price discriminate

This paper analyzes how the pricing policy of an incumbent may signal information not only on the demand level but also on the demand composition. A signalling game with two periods and two players (an established firm and a potential entrant) is considered. The potential entrant has incomplete information on market demand. There exist many sequential equilibria in which the uniform price policy acts as an entry deterrence device by hiding actual market profitability. We can interpret the uniform pricing policy as a rejection of the use of superior information on market demand composition in order to reduce the entrant's expected profits.     

Hospital Care inflation in the United States: prices adjustments in a disequilibrium econometric framework

Uncontrollable medical care expenditure inflation in excess of general price inflation in the United States has prompted the writing of this paper. It is argued that such a frustrating phenomenon is due to the existence of disequilibrium in the hospital market. This phenomenon can be verified only by modelling the market by disequilibrium methods. In this paper, a model of price adjustment in non-clearing market is presented and tested by using autoregressive techniques. It is found that excess demand for hospital care has been the source of disequilibrium for a large part of the period of the study, 1965–1984. It is observed then the key factor causing excess demand is low out-of-pocket expenditure for hospital care by patients due to third-party payments. Had the co-insurance rate been adjusted upward or co-payment patient rate not fallen, excess demand would have been eliminated. This study also finds that the response of providers and regulators to cost inflation through price control policy seems to be ineffective in bringing the market to a state of equilibrium.     

Evolution of infant and child mortality in Chile: a model

The author contends that birth rate and infant and child mortality rates are jointly determined by demographic, economic, health care, and other influences. Working under this structural assumption, a multiequation model is developed, estimated, and simulated, in which real earnings, unemployment, midwife visits, access to cheap energy, public health expenditures, and degree of urbanization are determinant factors of declining infant and child mortality in Chile. Most notably, mortality declined during a period of increasing unemployment and falling living standards for at least part of the population. The study found all 3 rates to be jointly determined, but by different variables. Specifically, unemployment affected birth rate and child mortality rate, while declining infant mortality was based upon midwife visits, health expenditure, and access to cheap energy. At the policy level, trade-offs often result between infant and child mortality, especially where high birth rates prevail. Where movement along the Phillips curve is possible, higher earnings should be preferred over lower unemployment for the benefit of infant and child mortality. Preferred policy would week to provide a carefully balanced combination of better earnings and more midwife visits.     

A Micro-Econometric Analysis of Determinants of Unsustainable Consumption in The Netherlands

Recently, much attention has been given to the notion of `sustainable consumption'. Whereas environmental economics traditionally has focused environmental policy analysis on producers, this new notion broadens the perspective to include environmental policies aimed at directly influencing consumer decisions regarding buying, using, and recycling products. This could suggest policies that link not only to price incentives, but also and especially to persuasive instruments, such as education and information provision. These policies might take into account certain characteristics of households, such as lifestyle and family size. This article presents a first econometric analysis of consumption in the context of environmental sustainability. Relationships between different types of household expenditures and a range of household characteristics are assessed, based on a large micro data set of households for the Netherlands. Use is made of various demand models and econometric techniques to adequately address theoretical and technical issues involved. The article ends with a discussion of the implications of the results for environmental policy directed at stimulating sustainable consumption.     

THE EFFECTS OF ENDOGENOUS MARKET ENTRY OF PHYSICIAN‐OWNED HOSPITALS ON MEDICARE EXPENDITURES: AN INSTRUMENTAL VARIABLES APPROACH

This study examines the effect of physician‐owned hospitals (POHs) on Medicare per enrollee expenditures at the metropolitan area (MSA) level nationwide, spanning the 8‐year time period from 1998 to 2005. The study uses fixed effects panel data estimation with instrumental variables to account for the bias introduced by endogenous POH market entry (i.e., POHs may be more likely to open in high‐growth/high‐demand markets with high levels of Medicare per enrollee expenditures). After controlling for other variables that are likely to affect expenditures (especially the age and sex distribution of the MSA), we find no association between POH presence and Medicare expenditures per enrollee at the MSA level. The results are robust to changes in model specification, estimation technique, and definition of geographic market. These findings suggest that the “demand inducement” aspects of physician ownership of acute care hospitals (if any) have no meaningful impact on market‐level Medicare expenditures per enrollee. Current policies based on an assumption that POHs are associated with significant increases in total expenditures may need to be reassessed. (JEL I11, L10, C33)     

An estimation of the demand and supply for physician services using a panel data

Using the single-equation and simultaneous equations methods, demand and supply for physician services at medical practices are estimated with panel data, which is primarily based on American Medical Association divisional surveys. Fixed effects and no-effects models are employed for estimation of the parameters of the simultaneous equations and their elasticities. The results suggest that the demand is highly income inelastic. However, private insurance and Medicaid raise the rate of utilization. The adverse effect of uninsured is also evident, though it is not as high as private insurance. Evidence also supports the demand inducement hypothesis and points to the rising demand for health care as the U.S. population is aging. The supply function parameters generally demonstrate their expected pattern. It is notable that the malpractice liability premiums exhibit a negligible effect on the supply of office visits.     

Price level determinacy and the choice of policy targets under rational expectations

We show that in a conventional macro model with rational expectations, the government can use monetary policy to peg real interest rates, and still attain a determinate price level provided it also pegs some nominal policy variable, e.g., nominal expenditures.     

Telephone nursing: evidence of client and organizational benefits

Telephone nursing (TN) or telephone triage (TT) has been identified as part of a successful cost-reduction demand management strategy. The author examines TN utilization and related client satisfaction, client education, reduction in drop-in clinic visits, and unnecessary ER and urgent care visits associated with an outpatient pediatric clinic population. This study examined 25% of the total of an average of TN 120 phone calls processed by this Southwestern clinic in an average summer month and achieved an 87.3% response rate to followup study questions. "Telephone nursing was performed by specially trained and experienced RNs using approved, written, clinic-specific protocols." The primary goals of the TN program was the "efficient use of health care resources" and provision of the "appropriate level of care at the appropriate time." Over 80% of the callers surveyed reported that if they hadn't been able to speak to the nurse they would have sought medical care elsewhere.     

Economic Growth and Medicare Funding Systems

This article compares the long-run effects of changes in health conditions, population growth, price of medical care, and Medicare indemnity rate on capital formation and medical expenditures under fully funded and pay-as-you-go Medicare. Surprisingly, it is found that population growth, rising medical prices, and increasingly adverse health conditions may or may not raise medical expenditures in the long run. Moreover, the directions of some of these effects under the pay-as-you-go Medicare system are reversed under the fully funded system. Finally, it is shown that fully funded Medicare results in higher steady-state capital than pay-as-you-go Medicare; however, the welfare effect of the former may or may not be higher than that of the latter in general. (JEL H550 , E620 )