Losers and Losers: Some Demographics of Medical Malpractice Tort Reforms

Our research examines individual differences in the effects of medical malpractice tort reforms on pre-trial settlement speed and settlement amounts by age and most likely settlement size. Findings of note include that, unlike previously assumed, both absolute and percentage losses from tort reform are small for infants in an asset value sense and that the prime-aged working population is the group most negatively affected by tort reform. Maximum entropy quantile regressions highlight the robustness of our conclusions and reveal that the settlement losses most informative for policy evaluation differ greatly from mean regression estimates.medical malpractice, tort reform, Texas closed claims, damage caps, quantile regression, maximum entropy

The Essays on Unintended Consequences of Public Policy

This dissertation studies three examples of public policies having consequences other than those intended when the policy was passed. They demonstrate that due to the interconnectedness of the economy, the intended effect of a policy is rarely the sole effect. The first essay examines the Texas Top 10% Plan. This policy guarantees automatic admission to their state university of choice for all high school seniors who graduate in the top 10% of their high school class. The essay shows evidence that households reacted strategically to this policy by moving to neighborhoods with lower-performing schools, increasing property values by 4.9 percent in those areas relative to areas with slightly better performing schools. The effect is strongest among schools that were the lowest performing before the change in policy; and weakens as the previous performance of the school district increases. These strategic reactions were influenced by the number of local schooling options available: areas that had fewer school choices showed no reaction to the Top 10% Plan. The second essay examines individual differences in the effects of medical malpractice tort reforms on pre-trial settlement speed and settlement amounts by age and likely settlement size. I focus on changes in the value of settlements for those trying to receive quick compensation - an understudied but very important population. Findings of note include that, unlike previously assumed, losses from tort reform among infants are small in an asset value sense and that the prime-aged working population that are the most negatively affected by tort reform, losing over 50 percent of the value of their mean settlements post reform. Maximum entropy quantile results show that the median expected settlement losses are often the most informative for policy evaluation and differ greatly from mean policy effects. The third essay uses the implementation of medical malpractice damage caps in several states, and a panel of private insurance claims to identify the effect of damage caps on the amount physicians charge to insurance companies and the amount that insurance companies reimburse physicians for medical services. In most cases the amount that physicians charge insurers does not change, but the amount that insurers reimburse physicians (which is the price seen in the market) decreases. I estimate price reductions as large as 14.5 percent for specific procedures

Ranking Up by Moving Out: The Effect of the Texas Top 10% Plan on Property Values

Texas engaged in a large-scale policy experiment when it instituted the Top 10% Plan. This policy guarantees automatic admission to their state university of choice for all high school seniors who graduate in the top decile of their high school class. We find evidence that households reacted strategically to this policy by moving to neighborhoods with lower-performing schools, increasing both property values and the number of housing units in those areas. These effects are concentrated among schools that were very low-performing before the change in policy; property values and the number of housing units did not change discontinuously for previously high-performing school districts. We also find evidence that these strategic reactions were influenced by the number of local schooling options available: areas that had fewer school choices showed no reaction to the Top 10% Plan.property values, college choice, affirmative action, Top 10% Plan

An Apple a Day? Adult Food Stamp Eligibility and Health Care Utilization among Immigrants

In this study, we document the effect of food stamp access on adult health care utilization. While the Food Stamp Program provides one of the largest safety nets in the United States today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this, we use variation in documented immigrants’ eligibility for food stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to food stamps reduced physician visits. Additionally, we find that for single women, food stamps increased the affordability of specialty health care. These findings have important implications for cost-benefit analyses of the Food Stamp Program, as reductions in health care utilization because of food stamps may offset some of the program’s impact on the overall government budget owing to the existence of government-provided health insurance programs such as Medicaid

Losers and Losers: Some Demographics of Medical Malpractice Tort Reforms

Our research examines individual differences in the effects of medical malpractice tort reforms on pre-trial settlement speed and settlement amounts by age and most likely settlement size. Findings of note include that, unlike previously assumed, both absolute and percentage losses from tort reform are small for infants in an asset value sense and that the prime-aged working population is the group most negatively affected by tort reform. Maximum entropy quantile regressions highlight the robustness of our conclusions and reveal that the settlement losses most informative for policy evaluation differ greatly from mean regression estimates

Association of Ambulance Use in New York City with the Implementation of the Patient Protection and Affordable Care Act

Importance: Expanding insurance coverage may be associated with overuse of medical care because newly insured patients are insulated from having to pay the full cost. Objective: To examine the use of ambulance transport before and after the rollout of the Patient Protection and Affordable Care Act (ACA) in New York City (NYC), New York. Design, Setting, and Participants: In this case-control study, the volume of ambulance dispatches in NYC for minor injuries before and after the rollout of the ACA was examined. Data were drawn from a census of all ambulance dispatches in NYC between January 1, 2013, and July 31, 2016. Ambulance dispatches for more severe injuries, which are more difficult to characterize as unnecessary, were used as the control group. Analyses were conducted from August 17, 2017, to May, 10, 2019. Main Outcome and Measures: The main outcome was the number of ambulance dispatches for minor injuries, defined per month per dispatch zone. The implementation of the ACA was measured using an indicator variable of 1 for dispatches starting January 1, 2014, and 0 for dispatches before January 1, 2014. The number of ambulance dispatches for injuries and major injuries was used to account for secular trends. Injury severity was classified by the dispatchers based on information from the 911 callers with a severity score on a scale of 1 to 8, where 1 is the most severe; minor injuries had a score of 7; injuries, 5; and major injuries, 3. Results: There were 4787180 ambulance dispatches in NYC during the study. After the 2014 expansion of insurance coverage under the ACA, there was an increase in ambulance dispatches for minor injuries compared with dispatches for more severe injuries. Compared with the preimplementation mean (SD) of 20.75 (14.24) minor injury dispatches per dispatch zone per month, there were 7.71 (95% CI, 1.23-14.19) additional minor injury dispatches per dispatch zone per month compared with dispatches for other types of injuries, an increase of 37.2%. Given that NYC has 31 dispatch zones, this increase is equivalent to approximately 239 additional dispatches per month or 2868 additional dispatches per year for minor injuries. Conclusions and Relevance: There was a significant increase in use of ambulance transport for minor injuries in NYC after the ACA insurance expansion, suggesting that the change in health insurance structure was associated with increased use of emergency medical services in nonemergent situations. Future reforms to the US health insurance system should take into account the potential for increased use of emergency medical services in nonemergent situations, which the literature suggests may lead to congestion and slower response times

Does the Healthcare Educational Market Respond to Short-Run Local Demand?

The Patient Protection and Affordable Care Act (ACA) increased demand for healthcare across the U.S., but it is unclear if or how the supply side has responded to meet this demand. In this paper, we take advantage of plausibly exogenous geographical heterogeneity in the ACA in order to examine the response of the healthcare education sector to increased demand for healthcare services. We look across educational fields, types of degrees, and types of institutions; we pay particular attention to settings where our conceptual model predicts heightened responses. We find no statistically significant evidence of increases in graduates and can rule out fairly modest effects. This implies that healthcare production may have adjusted to increased demand from insurance expansion in other ways rather than primarily through new graduates from local healthcare educational markets

The Impact of Agglomeration Economies on Hospital Input Prices

Singapore MOE Academic Research Tier 1Initial Review Stage Journal of Regional Science</p