Essays on health care economics
- This dissertation explores the challenges inherent in the public and private provision of health care services and health insurance. The first chapter is a study of the impact of pricing regulations in an individual health insurance market. In the private market for Medicare supplemental insurance, also known as Medigap, policymakers have experimented with several regulatory solutions. In this paper, I study how bans on differential pricing and rejections affect premiums and coverage levels, compared to a regime that combines an initial open enrollment period with guaranteed renewal. I document two important effects. First, bans on differential pricing and rejections lead to substantial cross-subsidization from young to old. Under a ban on differential pricing, the youngest buyers see premiums that are $240 (16 percent) higher; when this is combined with a ban on rejections, the youngest buyers see premiums that are $640 (36 percent) higher. Second, a ban on rejections undoes consumers' incentives to buy early. A ban on differential pricing and rejections leads to a 12 percentage point (46 percent) reduction in early buying. I present evidence for the importance of this mechanism, which is often assumed in the theoretical literature but seldom documented empirically. This interpretation is corroborated by an event study of individuals who experience the onset of a chronic health condition. The second chapter is co-authored with Liran Einav, Jonathan Levin, and Jay Bhattacharya. We estimate the economic surplus created by Medicare Advantage under its reformed competitive bidding rules. We use data on the universe of Medicare beneficiaries, and develop a model of plan bidding that accounts for both market power and risk selection. We estimate that private plans have costs around 12% below fee-for-service costs, and generate around $50 in surplus on average per enrollee-month, after accounting for the disutility due to enrollees having more limited choice of providers. Taxpayers provide a large additional subsidy, and insurers capture most of the private gains. We use the model to evaluate possible program changes. The final chapter is co-authored with Monica Bhole. The Affordable Care Act (ACA) was signed into law in March 2010. One goal of the ACA was to expand Medicaid to anyone under the age of 65 whose family is below 133 percent of the federal poverty line (FPL) by January 2014. While the 2012 Supreme Court decisions make this expansion optional, as of April 2015 thirty states have chosen to participate in the Medicaid expansion. In this paper we study four locations that were early adopters of Medicaid expansion. We use the universe of Medicaid enrollment and claims data to construct state-month-level measures of enrollment, enrollee composition, physician access, and inpatient spending and utilization. We estimate the impacts of the expansion using a differences-in-differences estimation framework. We find that enrollment increases by 30 percent among adults between the ages of 23 and 65. Despite the large increases in enrollment, the number of physicians treating Medicaid patients does not decline. Finally, we provide some evidence that per-capita inpatient usage increases upon expansion.
|Type of resource
|electronic; electronic resource; remote
|1 online resource.
|Curto, Vilsa Eliana
|Stanford University, Department of Economics.
|Hoxby, Caroline Minter
|Hoxby, Caroline Minter
|Statement of responsibility
|Vilsa Eliana Curto.
|Submitted to the Department of Economics.
|Thesis (Ph.D.)--Stanford University, 2015.
- © 2015 by Vilsa Eliana Curto
- This work is licensed under a Creative Commons Attribution Non Commercial 3.0 Unported license (CC BY-NC).
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