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

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

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

So Many Hospitals, So Little Information: How Hospital Value Based Purchasing is a Game of Chance

As part of the Patient Protection and Affordable Care Act, participating Medicare hospitals have part of their Medicare reimbursements withheld and then redistributed based on quality performance. The Hospital Value Based Purchasing reimbursement plan relies partly on ordinal rankings of hospitals to determine how money is distributed. We analyze the quality metric distributions used for payment and show that there is not enough information to reliably differentiate hospitals from one another near the payment cutoffs; and conclude that a large part of the payment formula is driven by sampling variability rather than true quality information. Alternative reimbursement plans are developed

Did the Dependent Coverage Mandate Reduce Crime?

The Affordable Care Act’s dependent coverage mandate (DCM) induced approximately 2 million young adults to join parental employer-sponsored health insurance plans. This study is the first to explore the impact of the DCM on crime, a potentially important externality. Using data from the National Incident-Based Reporting System, we find that the DCM induced a 2–5 percent reduction in property crime incidents involving young adult arrestees ages 22–25 relative to those ages 27–29. This finding is supported by supplemental analysis using data from the Uniform Crime Reports. An examination of the underlying mechanisms suggests that declines in large out-of-pocket expenditures for health care, increased educational attainment, and increases in cohabitation of parents and adult children may explain these declines in crime. Backof- the-envelope calculations suggest that the DCM generated approximately $371–$512 million in annual social benefits from crime reduction among young adults

Did the Dependent Coverage Mandate Reduce Crime?

The Affordable Care Act’s dependent coverage mandate (DCM) induced approximately 2 million young adults to join parental employer-sponsored health insurance plans. This study is the first to explore the impact of the DCM on crime, a potentially important externality. Using data from the National Incident-Based Reporting System, we find that the DCM induced a 2–5 percent reduction in property crime incidents involving young adult arrestees ages 22–25 relative to those ages 27–29. This finding is supported by supplemental analysis using data from the Uniform Crime Reports. An examination of the underlying mechanisms suggests that declines in large out-of-pocket expenditures for health care, increased educational attainment, and increases in cohabitation of parents and adult children may explain these declines in crime. Backof- the-envelope calculations suggest that the DCM generated approximately $371–$512 million in annual social benefits from crime reduction among young adults