Browsing by Subject "Health economics"
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Item Essays in health economics(2012-05) Mulligan, Karen Michelle; Abrevaya, Jason; Black, Sandra; Hamermesh, Daniel; Trejo, Stephen; Hayward, MarkThis dissertation consists of three chapters on health economics, two of which focus on contraception and the third on vaccination. Chapter one examines the impact of state-level contraception insurance coverage mandates on women's fertility outcomes. It utilizes variation in mandated insurance coverage for contraception across states and over time to determine the causal impact of insurance coverage of contraception on fertility outcomes, specifically abortion rates and birth rates. State-level results indicate that a mandate decreases abortion rates by 6% in the year of introduction and decreases birth rates by 3% two years following introduction, with the magnitude of both effects remaining steady over the long run. Chapter two utilizes longitudinal data on varicella (chicken pox) immunizations in order to estimate the causal effects of state-level school-entry and daycare-entry immunization mandates within the United States. We find significant causal effects of mandates upon vaccination rates among preschool children aged 19-35 months; these effects appear in the year of mandate adoption, peak two years after adoption, and show a minimal difference from the aggregate trend about six years after adoption. For a mandate enacted in 2000, the model and estimates imply that roughly 20% of the short-run increase in state-level immunization rates was caused by the mandate introduction. We find no evidence of differential effects for different socioeconomic groups. Combined with the previous cost-benefit analyses of the varicella vaccine, the estimates suggest that state-level mandates have been effective from an economic standpoint. Chapter three utilizes variations in access to emergency contraception (EC) across states to determine the impact of over the counter access on abortion rates, birth rates, and risky sexual behavior. Using state-level data, a flexible time specification finds that giving individuals over the counter access to EC reduces births and increases risky behavior, which is captured by STD rates. These effects are larger for adults compared with teenagers, however, there are not significant differential effects by race. Finally, the effects are increasing over time following the legislation.Item Essays on public finance(2012-05) Zebian, Firas Mahmoud; Dusansky, Richard; Sibley, David; Norman, Alfred; Oettinger, Gerald; Koc, CagatayIn the first chapter, I investigate the welfare effect of the government subsidizing medical insurance. To that extent, I construct and simulate a partial equilibrium computational model of medical care consumption and choice of insurance contracts. I use the overall utility of agents as a welfare measure and find that it is not welfare improving to subsidize uninsured agents by taxing insured ones. In addition I use the framework to verify the insurance contract choice effect and find a strong insurance contract choice effect. In Chapter 2, I investigate the effect of the price setting process under managed health care plans, such as HMOs and PPOs, on prices, profits of insurance companies and medical care providers, and household’s welfare compared to the indemnity plans prevalent before the advent of managed care. I construct a simple game played between a representative insurance company and a medical care provider to determine the price of medical care paid by insured and uninsured households. In addition, insurance companies set premiums not through solving the usual principal-agent problem which forces a zero profit condition, but rather and more realistically by optimizing profits. The outcome of this game is compared to the outcome of the indemnity plans where no price negotiations would occur. In Chapter 3, I investigate the effect of the suggested reform to the United States’ tax code in treatment of housing assets. In particular, I study the effect of the abolishment of the preferential tax treatment of housing assets (tax deductible mortgage interest payments and tax-free imputed rents) on the ownership and foreclosure rates in the housing market. I construct a model where heterogeneous agents decide on housing tenure in which default on housing mortgages occurs in equilibrium. I use this model to quantify the effect of this preferential tax treatment. I find that the elimination of the preferential tax treatment of housing assets results in a 33.4% reduction in foreclosures. Specifically, only eliminating the tax deductibility of interest on mortgage payments leads to a 12.4% reduction in foreclosure rates, while only taxing imputed rents generates a 32.5% reduction in foreclosure rates.Item Essays on the effects of government intervention in Texas' electricity market and the health insurance markets in Missouri and Oklahoma(2015-12) McKearin, Tobin Knowles; Geruso, Michael; Abrevaya, Jason; Oettinger, Gerald S; Zarnikau, Jay; Wozny, Nathan NThis public economics dissertation examines the effects resulting from government intervention in the electricity and health insurance markets. The first chapter analyzes the impact on residential electricity prices by studying a once regulated market in which government regulators withdrew from in hopes of allowing a free and competitive market to flourish. The second chapter analyzes the resulting effects on employment and other forms of health insurance that occur when the government tightens the income limits to qualify for Medicaid. The third and final chapter studies employment, health insurance, health, and emergency room usage effects when the government gives subsidies to employers providing health insurance to their employees.Item The state of health economics and pharmacoeconomics evaluation research in Zimbabwe(2007-12) Gavaza, Paul, 1972-; Rascati, Karen L.The study examined the state of health economics (including pharmacoeconomics) evaluation in Zimbabwe. A review of the literature was conducted to identify health economic evaluation articles that related to Zimbabwe. Fifty-nine articles were identified through database searches and 34 were excluded, leaving 25 articles for inclusion in the study. Two reviewers independently evaluated and scored each article using the data collection form designed for the study. A third researcher read and scored the article when there was disagreement among the reviewers. The data collection form had three main sections; general information (nine items), economic analysis information (18 items), and quality of the health economic information (16 items). The 25 articles were published in 13 different journals (based mostly outside of Zimbabwe). On average, each article was written by three authors, who had mostly medical/clinical training. The number of articles peaked between 1993 and 1997. Based on a 1 to 10 scale, with 10 indicating the highest quality, the mean quality score for all studies was 5.36 (SD = 1.57) and about one-third of the articles were of poor quality. The quality of articles was statistically significantly related (p < 0.10) to the country of the journal (non-Zimbabwe = higher), type of publication (non-medical = higher), number of authors (more authors = higher), year of publication (more recent = higher), and primary health intervention (services = higher than pharmaceutical and other interventions). The results of the study indicated that the use of health economics (including pharmacoeconomics) evaluation research in Zimbabwe is limited and about one-third of published articles were of poor quality. More and better quality health economics research in Zimbabwe are warranted.Item Three essays in health economics(2011-05) Komonpaisarn, Touchanun; Dusansky, Richard; Hamermesh, Daniel S.; Abrevaya, Jason; Warner, David C.; Trejo, Stephen J.; Chiburis, RichardThis dissertation consists of three studies in the field of health economics. The first chapter studies the market situation of the U.S. nursing home industry. It uses the most recent data available from the Annual Survey of Nursing Homes conducted in Wisconsin. In this study, we derive theoretical predictions from an optimization problem of a representative nursing home under various assumptions. We introduce a new measure, a home's bed-utilization rate, in our empirical strategy and find evidence of excess demand from Medicaid patients in Wisconsin. A positive relationship between Medicaid payment rates and private-pay prices is found in homes with high bed utilization. Additionally, we find strong adverse effects of higher reimbursement rates on quality measures. These findings prove there is an excess demand from Medicaid patients in Wisconsin. This conclusion has direct implications for the quality of care that a nursing home provides for its patients. The second study takes advantage of the "natural experiment" features of the major health care reform in Thailand in 2002 in order to estimate the price elasticity of health care demand among Thai citizens. We use the difference-in-difference technique to capture the pure effect of the reform on the health care utilization behavior of those who were directly affected by the reform. In order to capture any secular trend in health care utilization, we use data from a group of people who were not affected by the reform. We find that the reduction in health care price immediately induced those who lacked health insurance coverage to increase their visits to a public health care facility, although similar trends were not found a few years after the reform. The estimated change in visits is used to calculate the price elasticity of demand, which falls in the range of -1.36 to -0.58. The last study examines the relationship between risky behaviors among Americans aged 50-65 and their health insurance coverage. Despite the fact that moral hazard behaviors are predicted by economic theory, the study finds that health insurance has no significant effect on certain risky behaviors such as smoking. Surprisingly, we find a significantly positive relationship between health insurance coverage and healthy behaviors such as exercising regularly. This finding reflects the importance of health insurance companies in providing its customers with more health information that could encourage health-oriented attitudes.