Personalizing Health Care: Using Economics to Target Treatments
Friday, Jan. 4, 2019 8:00 AM - 10:00 AM
- Chair: Gautam Gowrisankaran, University of Arizona
Extrapolation using Selection and Moral Hazard Heterogeneity from within the Oregon Health Insurance Experiment
AbstractI aim to shed light on why emergency room (ER) utilization increased following the Oregon
Health Insurance Experiment but decreased following a Massachusetts policy. To do so, I unite
the literatures on insurance and treatment effects. Under an MTE model that assumes no more
than the LATE assumptions, comparisons across always takers, compliers, and never takers
can inform the impact of polices that expand and contract coverage. Starting from the Oregon
experiment as the “gold standard," I make comparisons within Oregon and extrapolate my findings to Massachusetts. Within Oregon, I find adverse selection and heterogeneous moral hazard. Although previous enrollees increased their ER utilization, evidence suggests that subsequent enrollees will be healthier, and they will decrease their ER utilization. Accordingly, I can reconcile the Oregon and Massachusetts results because the Massachusetts policy expanded coverage from a higher baseline, and new enrollees reported better health.
The Impacts of Hospital Delivery Practices on Infant Health
AbstractRisk-adjusted rates of cesarean delivery vary widely across hospitals. We use discharge records for low-risk first births in California, merged to vital statistics and inpatient and outpatient data for the year after birth, to study the impacts of these differences on infant health. We classify hospitals within local health care markets as having high or low c-section rates, and use relative distance from a mother’s home to the nearest high versus low c-section hospital as an instrumental variable for the type of hospital at delivery. Proximity to a high c-section hospital leads to more cesarean deliveries, fewer vaginal births after prolonged labor, and higher average Apgar scores. Infants of complying mothers are more likely to visit the emergency department in the year after birth but less likely to be readmitted to hospital. They also have lower infant mortality, driven by a reduction in the joint probability of prolonged labor and subsequent death. A simple cost-benefit calculation suggests that re-allocating births to high-c-section hospitals could lead to net social benefits.
- I1 - Health
- L1 - Market Structure, Firm Strategy, and Market Performance