Copyright (c) 2008 RAND Corporation All rights reserved. http://works.bepress.com/rand Recent documents in RAND Health -- Bing Center for Health Economics en-us Mon, 17 Nov 2008 03:26:06 PST 3600 http://works.bepress.com/christine_eibner/9 http://works.bepress.com/christine_eibner/9 Wed, 29 Oct 2008 12:57:15 PDT Data from the Employment Cost Index show that health insurance costs relative to payroll increased 34 percent between 1996 and 2005 and that the increase was largest for businesses paying low wages; simultaneously, data from the Employee Benefits Survey show that benefit packages became less generous, yet cost growth was not paralleled by a commensurate decrease in employer offers. Christine Eibner http://works.bepress.com/dana_goldman/61 http://works.bepress.com/dana_goldman/61 Wed, 24 Sep 2008 17:11:38 PDT Dana P. Goldman Health Economics http://works.bepress.com/pinar_karaca_mandic/23 http://works.bepress.com/pinar_karaca_mandic/23 Tue, 22 Jul 2008 05:26:57 PDT Geoffrey Joyce http://works.bepress.com/neeraj_sood/30 http://works.bepress.com/neeraj_sood/30 Tue, 15 Jul 2008 13:34:21 PDT We examine how employees reallocate compensation in response to increase in health insurance premiums. We find that a $1 increase in insurance premiums leads to a 52-cent increase in health insurance expenditures. Approximately 2/3 of this increase is financed through reduced wages and 1/3 through other benefits. Dana P. Goldman Health Economics http://works.bepress.com/neeraj_sood/29 http://works.bepress.com/neeraj_sood/29 Tue, 15 Jul 2008 13:34:16 PDT In an effort to balance their budgets many states are considering reducing eligibility for Medicaid. Using variation in state policies, this paper models the effect of more stringent eligibility criteria for Medicaid on the insurance status and the use of antiretroviral therapy (HAART) for people living with HIV, a group heavily dependent on Medicaid. Using nationally representative data from the mid-1990's, we find that stricter eligibility thresholds for Medicaid raise uninsurance rates and reduce the use of antiretroviral therapy among HIV+ patients, especially for those who are disabled. These stricter eligibility thresholds in turn adversely affect the survival prospects of HIV+ patients by lowering the rate of HAART use. Our estimates suggest approximately 13,000 lives could have been saved if all states had adopted the eligibility thresholds of California. We do not find any evidence of a "crowding out" effect of public insurance on private coverage among these patients. Arkadipta Ghosh Economics of the HIV Epidemic http://works.bepress.com/neeraj_sood/28 http://works.bepress.com/neeraj_sood/28 Tue, 15 Jul 2008 13:34:10 PDT We use the implementation of a new prospective payment system (PPS) for inpatient rehabilitation facilities (IRFs) to investigate the effect of changes in marginal and average reimbursement on costs. The results show that the IRF PPS led to a significant decline in costs and length of stay. Changes in marginal reimbursement associated with the move from a cost based system to a PPS led to a 7 to 11% reduction in costs. The elasticity of costs with respect average reimbursement ranged from 0.26 to 0.34. Finally, the IRF PPS had little or no impact on costs in other sites of care, mortality, or the rate of return to community residence. Neeraj Sood http://works.bepress.com/neeraj_sood/27 http://works.bepress.com/neeraj_sood/27 Tue, 15 Jul 2008 13:34:04 PDT Rewarding inventors with inefficient monopoly power has long been regarded as the price of encouraging innovation. Public prescription drug insurance escapes that trade-off and achieves an elusive goal: lowering static deadweight loss, while simultaneously encouraging dynamic investments in innovation. As a result of this feature, the public provision of drug insurance can be welfare-improving, even for risk-neutral and purely self-interested consumers. In spite of its relatively low benefit levels, the Medicare Part D benefit generate $3.5 billion of annual static deadweight loss reduction, and at least $2.8 billion of annual value from extra innovation. These two components alone cover 87% of the social cost of publicly financing the benefit. The analysis of static and dynamic efficiency also has implications for policies complementary to a drug benefit: in the context of public monopsony power, some degree of price-negotiation by the government is always strictly welfare-improving, but this should often be coupled with extensions in patent length. Darius Noshir Lakdawalla Innovation Health Insurance http://works.bepress.com/neeraj_sood/26 http://works.bepress.com/neeraj_sood/26 Tue, 15 Jul 2008 13:33:49 PDT The primary objective of this study is to conduct a set of analyses comparing costs and outcomes of lower extremity joint replacement patients discharged to three different post-acute settings: inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and patient homes. Multivariate techniques are employed in order to adjust these analyses for observable differences in severity of illness across sites of care. In doing so, multinomial models are used that predict which type of institutional post-acute care a beneficiary accesses, and these predictors are described. In addition, instrumental variables (IV) techniques are used that allow for the accounting of unobserved patient selection into IRFs and SNFs in order to learn how patient costs and outcomes are affected by the availability of IRF and SNF care. Melinda Beeuwkes Buntin http://works.bepress.com/neeraj_sood/25 http://works.bepress.com/neeraj_sood/25 Tue, 15 Jul 2008 13:33:34 PDT We used claims data from a large U.S. employer that introduced changes in its medical and drug coverage offerings in 2002 for non-Medicare eligible retirees. In addition to the existing plans, the employer introduced two new plans in 2002 that were less generous both in terms of medical and drug coverage. Further, one of the new plans had an annual benefit limit of $2,500 on prescription drugs, similar to the "doughnut hole" in the standard Medicare Part D benefit. We examined beneficiaries switching behavior in response to the new choice set and estimated the independent effects of medical and drug benefits on plan selection. We found that beneficiaries in better health were more likely to switch to the new, less generous plans. While the generosity of the medical benefit played a more important role in choosing a plan, choices did not vary significantly by health status. In contrast, sicker individuals were more likely to enroll in plans with generous drug benefits. This suggests that drug coverage may be more susceptible to adverse selection than medical insurance. Dana P. Goldman http://works.bepress.com/neeraj_sood/24 http://works.bepress.com/neeraj_sood/24 Tue, 15 Jul 2008 13:33:29 PDT As policymakers consider expanding insurance coverage for the human immunodeficiency virus (HIV+) population, it is useful to ask whether insurance has any effect on health outcomes, and, if so, whether public insurance is as efficacious as private insurance in preventing premature death. Using data from a nationally representative cohort of HIV-infected persons receiving regular medical care,we estimate the impact of different types of insurance on mortality in this population.Our main findings are that (1) ignoring observed and unobserved health status misleads one to conclude that insurance may not be protective for HIV patients, (2) after accounting for observed and unobserved heterogeneity, insurance does protect against premature death, and (3) private insurance is more effective than public insurance. The better performance of private insurance can be explained in part by more restrictive Medicaid prescription drug policies that limit access to highly efficacious treatment. Jayanta Bhattacharya Health Economics