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1.
J Health Econ ; 90: 102776, 2023 07.
Article in English | MEDLINE | ID: mdl-37329669

ABSTRACT

Resource allocation generally involves a tension between efficiency and equity, particularly in health care. The growth in exclusive physician arrangements using non-linear prices is leading to consumer segmentation with theoretically ambiguous welfare implications. We study concierge medicine, in which physicians only provide care to patients paying a retainer fee. We find limited evidence of selection based on health and stronger evidence of selection based on income. Using a matching strategy that leverages the staggered adoption of concierge medicine, we find large spending increases and no average mortality effects for patients impacted by the switch to concierge medicine.


Subject(s)
Concierge Medicine , Physicians , Humans , Delivery of Health Care , Resource Allocation , Income
2.
J Health Econ ; 79: 102494, 2021 09.
Article in English | MEDLINE | ID: mdl-34280727

ABSTRACT

We examine whether the least educated population groups experienced the worst mortality trends at the beginning of the 21st century by measuring changes in mortality across education quartiles. We document sharply differing gender patterns. Among women, mortality trends improved fairly monotonically with education. Conversely, male trends for the lowest three education quartiles were often similar. For both sexes, the gap in mortality between the top 25 percent and the bottom 75 percent is growing. However, there are many groups for whom these patterns are reversed - with better experiences for the less educated - or where the differences are statistically indistinguishable.


Subject(s)
Gender Identity , Mortality , Educational Status , Female , Humans , Male
3.
J Health Econ ; 61: 193-204, 2018 09.
Article in English | MEDLINE | ID: mdl-30165267

ABSTRACT

This paper compares mortality between Gold and Silver medalists in Olympic Track and Field to study how achievement influences health. Contrary to conventional wisdom, winners die over one year earlier than losers. I find strong evidence of differences in earnings and occupational choices as a mechanism. Losers pursued higher-paying occupations than winners according to individual Census records. I find no evidence consistent with selection or risk-taking. How people respond to success or failure in pivotal life events may produce long-lasting consequences for health.


Subject(s)
Athletes/statistics & numerical data , Longevity , Track and Field/statistics & numerical data , Achievement , Adolescent , Adult , Aged , Aged, 80 and over , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Young Adult
4.
J Health Econ ; 32(6): 1325-44, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24308882

ABSTRACT

We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets, focusing on the ability of consumers to evaluate and optimize their choices of plans. Our analysis of administrative data on medical claims in Medicare Part D suggests that fewer than 25% of individuals enroll in plans that are ex ante as good as the least cost plan specified by the Plan Finder tool made available to seniors by the Medicare administration, and that consumers on average have expected excess spending of about $300 per year, or about 15% of expected total out-of-pocket cost for drugs and Part D insurance. These numbers are hard to reconcile with decision costs alone; it appears that unless a sizeable fraction of consumers place large values on plan features other than cost, they are not optimizing effectively.


Subject(s)
Choice Behavior , Insurance Coverage/economics , Medicare Part D , Databases, Factual , Humans , Insurance Claim Review , Models, Theoretical , United States
6.
Bull World Health Organ ; 86(11): 849-856, 2008 Nov.
Article in English | MEDLINE | ID: mdl-19030690

ABSTRACT

OBJECTIVE: To explore factors associated with household coping behaviours in the face of health expenditures in 15 African countries and provide evidence for policy-makers in designing financial health protection mechanisms. METHODS: A series of logit regressions were performed to explore factors correlating with a greater likelihood of selling assets, borrowing or both to finance health care. The average partial effects for different levels of spending on inpatient care were derived by computing the partial effects for each observation and taking the average across the sample. Data used in the analysis were from the 2002-2003 World Health Survey, which asked how households had financed out-of-pocket payments over the previous year. Households selling assets or borrowing money were compared to those that financed health care from income or savings. Those that used insurance were excluded. For the analysis, a value of 1 was assigned to selling assets or borrowing money and a value of 0 to other coping mechanisms. FINDINGS: Coping through borrowing and selling assets ranged from 23% of households in Zambia to 68% in Burkina Faso. In general, the highest income groups were less likely to borrow and sell assets, but coping mechanisms did not differ strongly among lower income quintiles. Households with higher inpatient expenses were significantly more likely to borrow and deplete assets compared to those financing outpatient care or routine medical expenses, except in Burkina Faso, Namibia and Swaziland. In eight countries, the coefficient on the highest quintile of inpatient spending had a P-value below 0.01. CONCLUSION: In most African countries, the health financing system is too weak to protect households from health shocks. Borrowing and selling assets to finance health care are common. Formal prepayment schemes could benefit many households, and an overall social protection network could help to mitigate the long-term effects of ill health on household well-being and support poverty reduction.


Subject(s)
Adaptation, Psychological , Developing Countries/economics , Financing, Personal/methods , Health Care Surveys , Health Expenditures/statistics & numerical data , Africa , Ambulatory Care/economics , Cross-Cultural Comparison , Cross-Sectional Studies , Family Characteristics , Financing, Personal/statistics & numerical data , Health Services Accessibility/economics , Hospitalization/economics , Humans , Logistic Models , Poverty
7.
8.
Health Aff (Millwood) ; 26(4): 921-34, 2007.
Article in English | MEDLINE | ID: mdl-17630434

ABSTRACT

Poor countries account for 56 percent of the global disease burden but less than 2 percent of global health spending. With the global commitment to the Millennium Development Goals in 2000, poverty and the deplorable health conditions of the world's poor have finally reached center stage in the international policy arena, and aid for health has greatly increased. This paper evaluates health financing in developing countries from global- and country-level perspectives and briefly describes the types of reforms needed in the global aid architecture to make effective use of this historic opportunity to improve the plight of the world's poor.


Subject(s)
Developing Countries/economics , Financing, Organized/statistics & numerical data , Global Health , Health Care Reform/economics , Health Expenditures/statistics & numerical data , Developing Countries/statistics & numerical data , Disease Outbreaks/economics , Disease Outbreaks/prevention & control , Female , Humans , Infant , Infant Mortality , Infant, Newborn , International Cooperation , Poverty , Pregnancy , Pregnancy Complications/economics , Pregnancy Complications/mortality
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