Essays in health care economics
- This dissertation presents new empirical evidence on how three related aspects of health insurance regulation affect productivity of health care delivery in the US. First, it addresses the potential role of managed care in decreasing costs in Medicaid by examining evidence on use of C-sections for Medicaid beneficiaries in Florida. I find HMO enrollees are nearly 40% less likely to receive a C-section compared to those on traditional Medicaid, all else equal. This effect is heterogeneous and declines in magnitude as patient complications become more severe - with no difference in case of patients with severe delivery complications. I interpret these results as evidence that managed care influences physicians to choose lower cost treatments, without sacrificing patient health. Second, I address the role of recent payment reforms in enhancing quality of care. I exploit the introduction of a large federal program that penalizes hospital readmissions and policy-driven variation in penalty across hospitals to identify causal effects on quality of care as well as selective admission of patients. I begin by documenting a modest decline in readmission rates due to the penalty. Next I show that both channels are quantitatively important and that improvements in quality account for 50-60% of the decrease in readmission rates. I also find substantial heterogeneity in effectiveness of the penalty incentive across different types of conditions. Third, in a paper co-authored with Mark Duggan and Emilie Jackson I consider the recent Medicaid expansion mandated by the Affordable Care Act and identify causal effects on a) crowd-out of existing informal insurance, and b) consumer moral hazard and health effects. We deploy administrative data from hospitals and emergency rooms in California over 2008-15. We find evidence of substantial crowd-out of county insurance programs -- implying a large transfer from federal taxpayers to local governments. We estimate a large increase in the rate of hospital and ER use due to insurance coverage among the near-elderly. However we find only suggestive improvements in patient health. Financial benefits for hospitals are more readily apparent. Hospitals previously serving a high share of uninsured patients benefit disproportionately with a 10\% increase in total revenue relative to remaining hospitals.
|Type of resource
|electronic; electronic resource; remote
|1 online resource.
|Gupta, Atul, (Of Wharton School)
|Stanford University, Department of Economics.
|Bloom, Nick, 1973-
|Bloom, Nick, 1973-
|Statement of responsibility
|Submitted to the Department of Economics.
|Thesis (Ph.D.)--Stanford University, 2017.
- © 2017 by Atul Gupta
- This work is licensed under a Creative Commons Attribution Non Commercial 3.0 Unported license (CC BY-NC).
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