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  3. 2024
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  5. Public Health Programs
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Public Health Programs

Paper Session

Sunday, Jan. 7, 2024 10:15 AM - 12:15 PM (CST)

Convention Center, 301C
Hosted By: American Economic Association
  • Chair: Kara Smith, Belmont University

Could Health Insurance Enhance Confidence on Both the Supply and Demand Sides of Mortgage?

Fanyu Liu
,
Tulane University
Kerui Geng
,
Tulane University

Abstract

The Affordable Care Act (ACA) was designed to increase health insurance coverage and reduce financial barriers to accessing health insurance for people with low and moderate incomes. Even though the impact on health and family financial benefits is well documented, the effects of ACA reform on credit, particularly the role of ACA health insurance exchange subsidies, have not been fully explored. In this paper, we use near-administrative mortgage application data to estimate the impact of ACA exchange subsidies on mortgage applications and originations, thereby responding to the impact of the establishment of the exchange on the volume of mortgage demand among low-income people and the supply of mortgages by financial institutions. We use the difference-in-differences design to determine causal estimates using variations in health coverage rates across counties prior to the establishment of the exchange. We find that the reforms increased the dollar amount of residential mortgage applications and the dollar amount originated by financial institutions, and we also find that the ratio of applications to county population increased. We reached the same conclusion using data from the American Community Survey. One explanation is that ACA subsidies improve the financial situation of low-income households and reduce the uncertainty of their future risk. As an exploration of the mechanism, we found that the reforms increased health insurance coverage, consumer confidence in spending, and reduced substantial health care expenditures. Our results suggest that the ACA's health insurance subsidy policy had an impact on both the intensive and extensive margins of mortgage applications.

Improving Access to Psychological Therapies: Evaluating the Impact of a Nationwide Mental Health Service

Ekaterina Oparina
,
London School of Economics
Christian Krekel
,
London School of Economics
Sorawoot Srisuma
,
National University of Singapore

Abstract

Poor mental health is a serious concern worldwide. At the same time, national health services largely focus on treating physical rather than mental illness. This paper evaluates the effect of the English national psychological health programme that helps adults with depression and anxiety disorders. The Improving Access to Psychological Therapies (IAPT) programme is one of the largest and most ambitious public mental health programmes in the world. It is also a reference for similar initiatives in other countries. We provide a first causal evaluation of the effect of the IAPT programme on the mental health of participants. We use patient-level data on over 5 million patients who accessed the programme in the last 7 years. Our identification is based on the potential outcomes framework, where the quasi-control group is constructed using variation in waiting times between the initial assessment and the treatment. We further study the sources of inequalities in the effectiveness of the IAPT, using a combination of standard econometric techniques and machine learning. Our analysis includes local area measures of wealth, crime, education and deprivation, which help control for otherwise unobserved socio-economic effects. The results of this work will help to identify ways to improve the programme, informing evidence-based health policy in the UK and around the world.

Substitution Patterns and Welfare Implications of Local Taxation: Empirical Analysis of a Soda Tax

Jiawei Chen
,
University of California-Irvine
Colin Reinhardt
,
University of California-Irvine
Saad Andalib Syed Shah
,
University of California-Irvine

Abstract

We present a structural choice model that incorporates households' geographic and product substitution for studying the effects of localized taxation policies. Using detailed retail and household data pertaining to Philadelphia's soda tax, we estimate the choice model linking households' demographic characteristics and proximity to the city border to their tax avoidance behavior---switching from taxed to untaxed products or from Philadelphia to non-Philadelphia stores. We find that the inclusion of travel time is vital for modeling households' heterogeneous responses, with an extra minute of travel time to reach the untaxed region equivalent to adding 47¢ to the product price. Taking into account travel costs and the switch to less preferred products, Philadelphia households on average incur a loss in consumer surplus more than twice the amount of tax paid, with low-income households bearing the largest burden.

The Effect of Provider Networks on Health Care Utilization of Medicaid Beneficiaries: Evidence from Arkansas

Jee-Hun Choi
,
Lehigh University

Abstract

This paper investigates the impact of physician network breadth on the healthcare utilization of Medicaid beneficiaries, focusing on those in Arkansas who gained insurance coverage through the Affordable Care Act. Specifically, I analyze healthcare utilization among enrollees in two plans with different network breadths using healthcare claims data from the Arkansas All-Payer Claims Database (APCD). I argue that the plan choices for these beneficiaries are largely determined by the state's auto-assignment process, addressing the endogeneity issue related to plan choices. My findings show that beneficiaries in a narrower physician network plan are 8% less likely to see primary care physicians but 16% more inclined to visit emergency departments for primary care services compared to those in broader-network plans. I present empirical evidence supporting that this utilization discrepancy stems primarily from variations in network breadth. Furthermore, when examining two Medicaid eligibility groups with differing cost-sharing requirements, my analysis suggests that the primary factors driving Medicaid beneficiaries' primary care utilization in response to physician-network breadth are not their generous cost-sharing requirements. Rather, it appears to be their healthcare needs and preferences, shaped by socioeconomic status, that play a more pivotal role.

This study augments the existing literature by highlighting the role of physician networks in shaping discrepancies in healthcare utilization and access among Medicaid beneficiaries. The findings carry significant implications for network adequacy policies and the future design and management of Medicaid programs.

The Lasting Effects of Early Childhood Interventions: The National Vaccination Commando Program in Burkina Faso

Richard Daramola
,
University of Northern Iowa
Harounan Kazianga
,
Oklahoma State University
Md Shahadath Hossain
,
Binghamton University
Karim Nchare
,
Vanderbilt University

Abstract

After being in power in Burkina Faso for about a year, a military regime led by Thomas Sankara-, within weeks, vaccinated 77% of children under age six against measles, meningitis, and yellow fever. This program’s coverage and success set it apart from other contemporary vaccination programs, hence providing a policy experiment to test the effects of large immunization programs in low-income contexts. Using a difference-in-differences method, we estimate the impact of increased vaccination on child mortality, primary school completion, adulthood labor market outcomes, and farm productivity. We find that the vaccination campaign significantly reduced the child mortality rate. The result also shows an increase in primary school completion. In adulthood, the vaccinated cohorts are significantly more likely to be employed and earn higher agricultural yields.
JEL Classifications
  • I1 - Health