Three essays in health economics

The present PhD Thesis titled “Three Assays on Health Economics” consists of three separates pieces of research on three different topics. The first paper is entitled “Do mergers affect hospital outputs and outcomes? Evidence from the English secondary care sector”. We analyze the impact of hospital mergers on several measures of hospital outputs and outcomes over the period 2000-2008 in order to understand whether English hospital Trusts that have merged are able to reconfigure their service offer more significantly than non-merged Trusts and consequently to achieve an advantage relative to non-merged Trusts. In order to answer this question, for the analysis on hospital outputs, we adopt an innovative flexible conditional difference-in-difference approach, developed by Dettman et al. (2020) able to capture mergers with varying start dates and varying treatment durations. Regarding the analysis on hospital outcomes, we adopt a fixed effect ordered logit model as developed by Dickerson et al. (2014). Our empirical analysis shows a negative impact of hospital mergers on both hospital outputs and outcomes. The second paper is entitled “Financial crisis, fiscal austerity, and health in Italy”. This paper aims to assess whether the economic crisis (2007-2008) and the Italian sovereign debt crisis (2010-2011) have both had any impact on the health of the Italian population, proxied by a wide set of indicators. Following previous papers by Kentikelenis (2015), Kentikelenis et al. (2014) and Karanikolos et al. (2013) we analyze the effect of regional bail-out plans adoption on a broad set of health status measures during the period 1999-2015 considering the bail-out effect on physical and psychological measures of health status, focus on social distress. We adopt a Variable Instrumental approach to address potential endogeneity issues associated with the choice of adopting bail-out plans. Our empirical results show a general increase in mortality rate, and also of the incidence of some infectious diseases. The adoption of bail-out plans affects mainly vulnerable people with psychological diseases. The third paper is entitled “Does co-payment exemption increase diagnostic care utilization? A causal approach for the Italian care system”. The purpose of this paper is to analyze the effect of co-payment exemption on the diagnostic care utilization. Increased utilization of healthcare can be driven either by health needs or by opportunistic behavior. In this preliminary analysis we overcome the potential endogeneity associated to co-payment exemption by adopting an Instrumental Variable approach. We consider the Global Competitiveness Index at regional level as the proxy of bureaucracy and administrative slowness. Our findings reveal a weakness of instrument due to weak joint statistical independence. In order to estimate the possible effect of co-payment on diagnostic cares utilization, we adopt an alternative empirical method based on the estimation of intersection bound. Preliminary findings confirm that co-payment exemption increase the average number of diagnostic care and also, reveal potential opportunist behavior. Even if our preliminary results cannot allow to estimate the exact effect of co-payment exemption, the inference on intersection bounds permits to identify the possible dimension of the issue

Do hospital mergers reduce waiting times? Theory and evidence from the english NHS

We analyse - theoretically and empirically- the effect of hospital mergers on waiting times in healthcare markets where prices are fixed. Using a spatial modelling framework where patients choose provider based on travelling distance and waiting times, we show that the effect is theoretically ambiguous. In the presence of cost synergies, the scope for lower waiting times as a result of the merger is larger if the hospitals are more profit- oriented. This result is arguably confirmed by our empirical analysis, which is based on a conditional flexible difference-in-differences methodology applied to a long panel of data on hospital merger in the English NHS, where we find that the effects of a merger on waiting times crucially rely on a legal status that can reasonably be linked to the degree of profit-orientation. Whereas hospital mergers involving Foundation Trusts tend to reduce waiting times, the corresponding effect of mergers involving hospitals without this legal status tends to go in the opposite direction

Focus on Banking & Finance piece on the financing of company expansions or rel

Focus on Banking & Finance piece on the financing of company expansions or relocations. The close relationship among the U.S. Small Business Administration (SBA), traditional lenders, and gap financing institutions is a model in Maine. Co-owners Travis Holland and Dave Hoidal of Toegoz, a flip-flop company, used a combination of bank and SBA loans to move from a leased space in Sanford to a building they bought in Portland. Rynel Inc., which received state and local tax breaks, moved from leased space in Boothbay to the former Maine Yankee site in Wiscasset, where owner National RE/Sources is financing and building a facility for the foam manufacturing company. John Bader and other managers of bankrupt Wahlco Engineered Products Inc. in Lewiston used bank loans and community-based gap financing instititions to buy their sister company in the U.K. and turn what is now Wahlco-Metroflex into a growing air pollution control system manufacturer. With a list of some business financing resources in Maine

Focus on Building & Real Estate piece on Stoneham-based Crowell Construction,

Focus on Building & Real Estate piece on Stoneham-based Crowell Construction, owned by Gary Crowell, 49. Author Stephen King tapped Crowell to be project manager for a $1 million renovation of the Charles P. Brown house next to the Kings\u27 Bangor home. Because he was committed to projects in the Kezar Lake area, Crowell could not do the actual work on the house. As the Lovell/Stoneham area has become a destination spot for vacationers, Crowell\u27s custom projects have increased in size and value from the camps he once built. Crowell has a skilled team, and compared with other area builders, he subcontracts far less. He tries to persuade his customers to build at a distance from the lake\u27s shore to preserve the views for others

Focus on Technology piece on Governor John Baldacci\u27s Connect Maine initiative

Focus on Technology piece on Governor John Baldacci\u27s Connect Maine initiative, which aims to provide 90 percent of Maine communities with broadband high-speed Internet access by 2010. Connect Maine\u27s other goal is that 100 percent of Maine communities have quality wireless cell phone service by 2008. Expanding broadband to rural areas is not cost effective for the major Maine providers, Adelphia, Verizon and Time Warner. Fletcher Kittredge, founder and CEO of Great Works Internet (GWI) in Biddeford, sees opportunity in the rural markets. Half of GWI\u27s business is in rural areas. With comments by Chris Burke, director of the Maine Internet Service Provider Association, and Tim McAfee, general manager and network engineer of Houlton-based Pioneer Wireless

Focus on Northern Maine piece on training programs for new logging workers. I

Focus on Northern Maine piece on training programs for new logging workers. In response to a shortage of logging workers, timber companies have collaborated with Maine community colleges to offer training programs that combine classroom learning with hands-on experience in the woods. Pat Sutherland of Northern Maine Community College said he received more than 50 applications for 12 openings in the last logger training program

Focus on Midcoast Region piece on Bath resident Marty O\u27Brien, who hopes to op

Focus on Midcoast Region piece on Bath resident Marty O\u27Brien, who hopes to open a for-profit opiate treatment program called Turning Tide in Rockland, with business partner Angel Fuller-McMahon of Owl\u27s Head, a recovering heroin addict. Inspired by the Zen-based Greystone Bakery-and-social-services project that turned around a Yonkers, N.Y., neighborhood, they plan to develop social services for patients. Before they were able to meet with townspeople, word of the plan leaked out and zoning changes were instituted that blocked them from finding the needed property. Turning Tide filed a lawsuit, as yet unresolved. All five of Maine\u27s methadone clinics are operating at capacity and have waiting lists. In Maine, addiction to opiates other than heroin--such as OxyContin--increased 1,821 percent in the past ten years. With details on the advantages of running a for-profit versus a nonprofit facility

Focus on Technology piece on the town of Windham, which until 2003, had no bro

Focus on Technology piece on the town of Windham, which until 2003, had no broadband capabilities. Keith Luke, the town\u27s economic development director, said the lack of service left residents and businesses disgruntled. In recent months, the community has added not just high-speed cable service from Adelphia, but broadband solutions from Pine Tree Networks, Fairpoint New England, Lightship Telecom and Verizon. Luke said that the difference in business attraction and retention is noticeable

Focus: Environment piece on Gorham-based Guerin Companies, a provider of envir

Focus: Environment piece on Gorham-based Guerin Companies, a provider of environmental cleanup and site remediation for properties contaminated by oil, chemicals and other pollutants. Marianne Sensale-Guerin, founder and CEO, said most of the 100 jobs her company handles annually are old facilities with lingering problems from when there was little or no environmental regulation. Tom Lawless, an environmental engineer for GZA GeoEnvironmental, says that Sensale-Guerin\u27s straightforward approach to remediation has earned her a reputation of excellence in the industry

Focus on Northern Maine piece on the lack of skilled forestry workers, which l

Focus on Northern Maine piece on the lack of skilled forestry workers, which last year drove up pulpwood costs to an all-time high of $40-$50 a ton. Many sawmills came close to closing, and Patrick Hackley of the Forest Resources Association predicts a continued lack of workers. Last summer, due to a crackdown on the number of H-2B visas issued for temporary international workers, contractors were unable to hire the Canadians who traditionally make up a large portion of the logging workforce. In addition to the visa shortage, many younger workers no longer see logging as a desirable job. With comments by Peter Triandafillou of Huber Resources in Old Town, Reggie Beaulieu of Gerard Pelletier Inc., and Rep. Troy Jackson (D-Fort Kent)