Three essays in health economics

textAs medical care becomes an increasingly large share of Gross Domestic Product, understanding the mechanisms for how and why medical care spending is rising becomes increasingly important. Such an evaluation should consider the productivity relationship between medical care and health. An evaluation of medical productivity involves the measurement of medical care input prices, disease treatment output prices, and the productive relationship between medical care inputs and disease treatment health outcomes. Medical care price measurement is complicated by the heterogeneity of services, the role of insurance in negotiating prices, rapid technological advancements in medical care and limited availability of transaction price data. Health outcome prices are difficult to construct because of the difficulty in measuring health outcomes, the heterogeneity of health outcomes, and the messy relationship between consumption goods and health. Finally, in addition to accurate input and output price measurement, a productivity assessment requires a measurable causal relationship between medical care services and health outcomes. To date, all of these requirements have been insurmountable hurdles to assessing the productivity of medical care for the entire United States economy. This dissertation uses the Medical care Expenditure Panel Survey to address the necessary requirements for evaluating the productivity of medical care. The second chapter constructs regional medical care price indices using transaction prices that control for service type heterogeneity. The data employed in the analysis associates the observed medical care spending with the diseases the spending is used to treat. This association is exploited in the third chapter, which constructs medical care treatment prices for twelve of the major health conditions in the United States. The fourth chapter compares the productivity of medical care services used to produce disease treatment health outcomes across insurance types.Economic

The Effects of Prices and Policies on the Demand for Marijuana: Evidence from the National Household Surveys on Drug Abuse

Recent studies have shown that efforts to curb alcohol use by increasing the price of alcohol and limiting youth's access have succeeded, but they may have had the unintended consequencce of increasing marijuana use. This possibility is troubling in light of a recent government report that shows that marijuana use among teens more than doubled between 1990 and 1997. What impact will the proposed large increase in cigarette prices have on the demand for other substances such as marijuana? To better understand how the demand for marijuana responds to changes in the policies and prices that affect its use, we explore the National Household Survy on Drug Abuse (NHSDA). Overall, we find that marijuana, alcohol, and tobacco are complements, sot that increasing the price of any one will decrease the demand for marijuana. The results of this paper will help guide the creation of comprehensive policies that curb the use of marijuana in two ways: first, they quantify the effects of policies aimed at curbing the use of each substance, allowing policymakers to evaluate alternative policy options; and second, they clarify the dynamics and interactions between alcohol, tobacco, and marijuana use in response to government policies.

Replication data for: Entry Threats and Pricing in the Generic Drug Industry

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The role of education in the production of health: An empirical analysis of smoking behavior

We estimate the effect of education on smoking. Our estimation strategy "differences out" the impact of unobserved characteristics correlated with education by exploiting education differences between similarly selected groups 1 year apart in their life cycle. Individuals with a given age, education, and student status in the current and previous year are compared to their counterparts born 1 year later with the same age, education, and student status in the following and current year. We find that an additional year of education does not have a causal effect on smoking. Unobserved factors correlated with education entirely explain their cross-sectional relationship.Education Health Smoking

WORK IN PROGRESS: NOT FOR CITATION How Vertical Integration Affects Health Outcomes and Total Costs for Medicare Recipients *

Abstract Recent years have seen a sharp increase in the number of healthcare providers employed by health systems. The implications of this trend are poorly understood and controversial. To shed light on the phenomenon, we exploit rich data from the Centers for Medicare and Medicaid Services in conjunction with a set of mergers that financially integrated one or more hospitals with formerly independent physician practices. We specifically examine whether these transactions are associated with changes in the location of service provision, overall costs, and health outcomes. Our results suggest that these mergers have had heterogeneous effects. Some mergers led to statistically significant reductions in hospital utilization and costs, while others produced the opposite. An analysis of the determinants of mergers' effects suggests that transaction-level details matter a great deal

Economics at the FTC: Hospital Mergers, Authorized Generic Drugs, and Consumer Credit Markets

Antitrust, Consumer credit, Consumer protection, FTC, Hospital mergers, Pharmaceuticals,