Claims-shifting: The problem of parallel reimbursement regimes

Parallel reimbursement regimes, under which providers have some discretion over which payer gets billed for patient treatment, are a common feature of health care markets. In the U.S., the largest such system is under Workers’ Compensation (WC), where the treatment workers with injuries that are not definitively tied to a work accident may be billed either under group health insurance plans or under WC. We document that there is significant reclassification of injuries from group health plans into WC, or “claims shifting”, when the financial incentives to do so are strongest. In particular, we find that injuries to workers enrolled in capitated group health plans (such as HMOs) see a higher incidence of their claims for soft-tissue injuries (which are hard to classify specifically as work related) under WC than under group health, relative to those in non-capitated plans. Such a pattern is not evident for workers with traumatic injuries. Moreover, we find that such reclassification is more common in states with higher WC fees, once again for soft tissue but not traumatic injuries. Our results imply that a significant shift towards capitated reimbursement, or reimbursement reductions, under GH could lead to a large rise in the cost of WC plans

The Effect of Schooling, Wages, Marriage, and Socio-Economic Circumstances on Fertility Behavior in Russia

The total fertility rate in Russia has been falling over the past several decades from above the replacement fertility level in the early 1960's (2.42 children) to significantly below the `safety zone' in 2000 (1.20 children). The low fertility rate is accompanied by the highest death rate among all countries with at least moderate development, suggesting a projected 30% decline in the Russian population by 2053. This research applies the rich longitudinal data found in the Russia Longitudinal Monitoring Survey (1994-2006) to study life-cycle fertility decisions leading to the most recent substantial fertility decline in Russia. Specifically, I estimate a comprehensive model of female life-cycle behavior, which accounts explicitly for the interdependence of annual reproductive choices, educational, employment, and marriage decisions as well as earnings outcomes and controls for individual- and community-level heterogeneity. Modeling these fertility-related outcomes jointly allows for a correction for the potential endogeneity arising from the existence of unobserved individual or community characteristics shaping all modeled choices. In addition to demonstrating the importance of the endogeneity correction, the findings indicate that fertility policies should be directed away from supplementation of non-labor income, as it is observed now, and toward macro-stabilization efforts and the reconciliation of the incompatibility of the career demands of the new market system with the requirements of motherhood.Doctor of Philosoph