Home care reimbursement,long-term care utilization,and health outcomes

Using a substantial change in Medicare reimbursement policy to study the market for home health care, I find that the introduction of tightly binding average per-patient reimbursement caps led to a large drop in the provision of home care, particularly to the least healthy beneficiaries. This decline in home health utilization was not offset by increases in institutional long-term care or other medical care and there were no associated adverse health consequences. However, approximately one-quarter of the decline in Medicare spending was offset by increases in out-of-pocket expenditures for home health care, with the offset concentrated in higher income populations.     

Income-related inequalities of health and health care utilization

By utilizing the China Health and Nutrition Survey (CHNS) data, this paper examines the extent of deviations in terms of horizontal equity in the field of China’s health and medical community, i.e., that those in equal demand ought to be treated equally, and computes the contribution of income in health inequality and utilization inequality of health care. The main conclusions are: There is pro-rich inequality in health and utilization of health care; income contribution to inequality of health care utilization accounts for 0.13–0.2; insurance also enlarges the inequality of health care utilization; health inequality in rural area is larger than that of in urban area; and both rural and urban health inequality are increasing. From 1991 to 2006, income changes in urban districts and rural area account for 7.08% and 13.38% respectively of raising inequality of rural and urban health.     

HMO plans,self-selection and utilization of health care services

This study examines the effect of health maintenance organizations (HMOs) on the use of health care services among the privately insured, nonelderly population. To consider jointly the possible self-selection bias and high frequency of zero observations in the applied utilization measures, we accommodate the endogeneity of health plan choice decisions in the censored regression model. Using data from the 2000 Medical Expenditure Panel Survey, we find strong evidence for favourable self-selection into HMO plans. Health maintenance organization enrollment is found to encourage greater use of office-based and hospital outpatient services. Overall satisfaction with the quality of care among HMO members is relatively low compared to that among nonHMO members. These findings suggest that more effort is needed to develop management strategies in HMOs in order to contain the moral hazard in utilization and assure the quality of service provided within the network of HMO providers.     

Prenatal care: Mechanisms and impacts on infant health and health care utilization

We estimate that prenatal care has positive impacts on health measured at birth, shifts the distribution of future health care utilization away from inpatient care, and find that some of these impacts likely come from an informational mechanism. We also find well child visits are used in a complementary fashion with emergency department care in the production of infant health, suggesting that factors beyond barriers to access may drive the demand for emergency care. Finally, we find differential impacts of prenatal care across racial groups with evidence that the information mechanism may be particularly important for black mothers.     

Gender and race as factors in health care utilization

The National Medical Care Utilization and Expenditure Survey of 1980 was employed to investigate gender and racial differences in the utilization of physicians and hospitals. Regression results indicate more physician contact for women in the post-childbearing years (45–65) than for comparable men. Caucasian, but not African-American, women were found to have lower probabilities of hospitalization than comparable men. Caucasian women over 65 years of age were also found to have significantly fewer nights in hospital than comparable men. A life-cycle hypothesis about gender differences in behavior was tested, using physician contact as a proxy variable for investment in health and number of nights in hospital as a proxy for morbidity. The use of hospitalization as a proxy variable for ill health was called into question by the findings that poverty and lack of health insurance were associated with fewer nights in hospital. College education, known to be correlated with better health, was positively associated with nights in hospital.     

Income velocity and non-GDP transactions in the UK

It is widely reported for many countries, including the UK, that income velocity has been highly variable around a declining trend in recent years. This paper advances the following hypothesis. The demand for credit and hence the broad money stock are influenced by total spending in the economy, rather than spending only on newly produced goods and services. Since total spending in the economy has generally increased relative to GDP (mainly because of asset transactions) credit and money have expanded more rapidly than GDP, with the resulting fall in income velocity. Using quarterly data from 1975 to 2008, we estimate a vector error correction with income velocity as the dependent variable and the ratio of total to GDP transactions as an explanatory variable. The results show substantial support for the hypothesis and raise (further) doubts about the information content of broad money aggregates for inflation targeting central banks.     

Supplementary private health insurance and health care utilization of people aged 50+

Does supplementary private health insurance (PHI) coverage influence health care utilization in countries where the coverage ratio with public health insurance is high? I estimate this effect using the Survey of Health, Ageing and Retirement in Europe. Handling the potential endogeneity of supplementary insurance coverage and the large fraction of zero observations in the utilization models influences the empirical results. I show that the effect of PHI coverage on inpatient and outpatient care utilization is not trivial even in countries with generous public health funding. The main finding is that supplementary PHI coverage increases dental care utilization, but decreases the visits to general practitioners. Private insurance is estimated to have little and insignificant influence on the utilization of inpatient care and outpatient specialist care. The magnitude of the effect of supplementary PHI on health care utilization varies with the characteristics of the health care systems.     

The effect of double coverage on health care utilization of children

Double coverage refers to a situation in which a person is covered by more than one health plan. In a family in which the husband and wife are both offered employer-provided insurances, it is possible for one or more family members to be double covered. This article is the first to examine double coverage of children and quantify the effects of double coverage on health care utilization for any population. Results show that double coverage does not affect the frequency at which children consume medical services, but rather double coverage leads children to consume more expensive forms of health care.     

Healthcare resource utilization among patients with relapsed multiple myeloma in the UK,France, and Italy

Aims: To assess the real-world healthcare resource utilization (HRU) and costs associated with different treatment regimens used in the management of patients with relapsed multiple myeloma in the UK, France, and Italy.

Methods: Retrospective medical chart review of characteristics, time to progression, level of response, HRU during treatment, and adverse events (AEs). Data collection started on June 1, 2015 and was completed on July 15, 2015. In the 3 months before record abstraction, eligible patients had either disease progression after receiving one of their country’s most commonly prescribed regimens or had received the best supportive care and died. Costs were calculated based on HRU and country-specific diagnosis-related group and/or unit reference costs, amongst other standard resources.

Results: Physicians provided data for 1,282 patients (387 in the UK, 502 in France, 393 in Italy) who met the inclusion criteria. Mean [median] total healthcare costs associated with a single line of treatment were €51,717 [35,951] in the UK, €37,009 [32,538] for France, and €34,496 [42,342] for Italy, driven largely by anti-myeloma medications costs (contributing 95.0%, 90.0%, and 94.2% of total cost, respectively). During active treatment, the highest costs were associated with lenalidomide- and pomalidomide-based regimens. Mean cost per month was lowest for patients achieving a very good partial response or better. Unscheduled events (i.e. not considered part of routine management, whether or not related to multiple myeloma, such as unscheduled hospitalization, AEs, fractures) accounted for 1–9% of total costs and were highest for bendamustine.

Limitations: The use of retrospective data means that clinical practice (e.g. use of medical procedures, evaluation of treatment response) is not standardized across participating countries/centers, and some data (e.g. low-grade AEs) may be incomplete or differently adjudicated/reported. The centers involved may not be fully representative of national practice.

Conclusions: Drug costs are the main contributor to total HRU costs associated with multiple myeloma. The duration of active treatment may influence the average total costs, as well as response, associated with a single line of therapy. Improved treatment outcomes, and reductions in unscheduled events and concomitant medication use may, therefore, reduce the overall HRU and related costs of care in multiple myeloma.     

Health care utilization and self-assessed health: specification of bivariate models using copulas

The discernment of relevant factors driving health care utilization constitutes one important research topic in health economics. This issue is frequently addressed through specification of regression models for health care use (y—often measured by number of doctor visits) including, among other covariates, a measure of self-assessed health (sah). However, the exogeneity of sah within those models has been questioned, due to the possible presence of unobservables influencing both y and sah, and because individuals’ health assessments may depend on the quantity of medical care received. This article addresses the possible simultaneity of (sah, y) by adopting a full information approach, through specification of the bivariate probability function (p.f.) of these discrete variables, conditional on a set of exogenous covariates (x). The approach is implemented with copula functions, which afford separate consideration of each variable margin and their dependence structure. The specification of the joint p.f. of (sah, y) enables estimation of several quantities of potential economic interest, namely features of the conditional p.f. of y given sah and x. The adopted models are estimated through maximum likelihood, with cross-sectional data from the Portuguese National Health Survey of 1998–1999. Estimates of the margins’ parameters do not vary much among different copula models, while, in accordance with theoretical expectations, the dependence parameter is estimated to be negative across the various joint models.     

Income, income inequality, and health: Evidence from China

This paper tests using survey data from China whether individual health is associated with income and community-level income inequality. Although poor health and high inequality are key features of many developing countries, most of the earlier literature has drawn on data from developed countries in studying the association between the two. We find that self-reported health status increases with per capita income, but at a decreasing rate. Controlling for per capita income, we find an inverted-U association between self-reported health status and income inequality, which suggests that high inequality in a community poses threats to health. We also find that high inequality increases the probability of health-compromising behavior such as smoking and alcohol consumption. Most of our findings are robust to different measures of health status and income inequality. Journal of Comparative Economics 34 (4) (2006) 668–693.     

Lost Exceptionalism? Comparative Income and Productivity in Australia and the UK, 1861–1948*

Australia had one of the highest per capita incomes in the world in the late nineteenth century, although this exceptional position subsequently eroded over time. This paper compares national income and sectoral labour productivity in Australia and the UK between 1861 and 1948 to uncover the underlying sources of Australia's high income and the reasons for its subsequent relative decline. We find that the country's higher per capita income was due primarily to higher labour productivity, because labour force participation, although higher in Australia than in the USA, was lower than in the UK. Australia had a substantial labour productivity lead in agriculture throughout the period, due to the importance of high value-added, non-arable farming, and a smaller lead in industry before World War I. The early productivity lead in industry was largely based on the importance of mining, and disappeared as manufacturing became more important. There was little productivity difference in services. These results reaffirm the importance of Australia's successful exploitation of its natural resource endowments in explaining the country's high initial income.     

A Different Perspective on the Evolution of UK Income Inequality

This paper scrutinizes the conventional wisdom about trends in UK income inequality and also places contemporary inequality in a much longer historical perspective. We combine household survey and income tax data to provide better coverage of all income ranges from the bottom to the very top (and make our estimates available to other researchers). We make a case for studying distributions of income between tax units (i.e. not assuming the full income sharing that goes with the use of the household as the unit of analysis) for reasons of principle as well as data harmonization. We present evidence that income inequality in the UK is as least as high today as it was just before the start of World War 2.     

收入、收入类别与环境库兹涅茨曲线

利用2000-2009年我国省际面板数据,对人均收入、收入类别与六种污染指标之间的关系进行了实证检验.结果表明:环境库兹涅茨倒U型关系取决于污染指标的选择,在样本期内,部分污染指标呈现出倒U型EKC关系;在倒U型曲线的转折点处,城镇人均可支配收入的临界水平高于农村人均纯收入的临界水平.     

Change, consolidation, and competition in health care markets.

The health care industry is being transformed. Large firms are merging and acquiring other firms. Alliances and contractual relations between players in this market are shifting rapidly. Within the next few years, many markets are predicted to be dominated by a few large firms. Antitrust enforcement authorities like the Department of Justice and the Federal Trade Commission, as well as courts and legislators at both the federal and state levels, are struggling with the implications of these changes for the nature and consequences of competition in health care markets. In this paper we summarize the nature of the changes in the structure of the health care industry. We focus on the markets for health insurance, hospital services, and physician services. We then discuss the potential implications of the restructuring of the health care industry for competition, efficiency, and public policy. As will become apparent, this area offers a number of intriguing questions for inquisitive researchers.