Hospital reimbursement and capacity constraints: Evidence from orthopedic surgeries

Health care providers’ response to payment incentives may have consequences for both fiscal spending and patient health. This paper studies the effects of a change in the payment scheme for hospitals in Norway. In 2010, payments for patients discharged on the day of admission were substantially decreased, while payments for stays lasting longer than one day were increased. This gave hospitals incentives to shift patients from one-day stays to two-day stays, or to decrease the admission of one-day stays. I study hospital responses using two separate difference-in-differences estimation strategies, exploiting, first, the difference in price changes across diagnoses, and secondly, the difference in bed capacity across hospitals. Focusing on orthopedic patients, I find no evidence that hospitals respond to price changes, and capacity constraints do not appear to explain this finding. Results imply that the current payment policy yields little scope for policymakers to affect the health care spending and treatment choices.publishedVersio

Reconciling estimates of the long-term earnings effect of fertility

This paper presents novel methodological and empirical contributions to the child penalty literature. We propose a new estimator that combines elements from standard event study and instrumental variable estimators and demonstrate their relatedness. Our analysis shows that all three approaches yield substantial estimates of the long-term impact of children on the earnings gap between mothers and their partners, commonly known as the child penalty, ranging from 11 to 18 percent. However, the models not only estimate different magnitudes of the child penalty, they also lead to very different conclusions as to whether it is mothers or partners who drive this penalty – the key policy concern. While the event study attributes the entire impact to mothers, our results suggest that maternal responses account for only around one fourth of the penalty. Our paper also has broader implications for event-study designs. In particular, we assess the validity of the event-study assumptions using external information and characterize biases arising from selection in treatment timing. We find that women time fertility as their earnings profile flattens. The implication of this is that the event-study overestimates women’s earnings penalty as it relies on estimates of counterfactual wage profiles that are too high. These new insights in the nature of selection into fertility show that common intuitions regarding parallel trend assumptions may be misleading, and that pre-trends may be uninformative about the sign of the selection bias in the treatment period

Rike miljøsvin? En spillteoretisk analyse av klimagassutslipp.

Klimautfordringen er et globalt miljøproblem. Det spiller ingen rolle hvor utslippet av karbondioksid eller andre klimagasser kommer fra; virkningen på klimaet kjenner ingen landegrenser. Selv om global oppvarming vil ramme hele kloden, vil konsekvensene variere mellom land og områder. I denne oppgaven vil utslippsstrategier for to land som begge bidrar til et globalt fellesonde bli drøftet. Målet er å kaste lys over hvordan landsspesifikke ulikheter slik som initial realkapitalbeholdning, diskontering av fremtiden og sårbarhet for en eventuell klimakatastrofe kan påvirke landenes miljøpolitikk, som representert ved utslippsbaner for klimagasser. Er det slik at forsvarsløse lavinntektsland sitter igjen med svarteper fra rike lands miljøsvineri? Oppgaven ser på et simultant spill mellom to aktører, der egen strategi velges uten å vite noe om den andres valg av strategi. Spillet foregår over én periode, men neddiskontert velferd fra periode to og videre frem i tid fanges opp i en skrapverdifunksjon og vil dermed påvirke valgene som gjøres innledningsvis. Hvert land ønsker å finne den utslippsstrategien som maksimerer egen neddiskontert velferd, men må også ta hensyn til det andre landets valg av utslipp. Spillet løses ved å spesifisere Nashlikevekten, for så å se hvordan denne påvirkes ettersom landene endrer egenskaper. Jeg kan nok ikke friste med noen entydig moralsk fordømming av rike lands klimapolitikk. Interessante resultater kan likevel noteres. Modellen viser at dersom et land legger lavere vekt på fremtidig velferd, som hypotesen er for et fattig land, vil landet øke eget utslipp av klimagasser. Utslipp fra det andre landet vil reduseres under forutsetningen om strategiske substitutter. Under noen antakelser, kan vi trekke samme konklusjon for et land som får en større initialbeholdning av realkapital, som gjerne er tilfellet for et rikt land. Vi viser også at når et land blir mer sårbart for en klimaendring, noe som er rimelig for et relativt fattig land, vil de redusere eget utslipp. Det relativt rike landet vil svare med å øke sitt utslipp. Med velvilje gir de to sistnevnte slutningene en indikasjon på at rike land er miljøsvin. Oppgaven forsøker å gi en forklaring på hvorfor vi ser disse resultatene

Regional variation in healthcare utilization and mortality

Geographic variation in healthcare utilization has raised concerns of possible inefficiencies in healthcare supply, as differences are often not reflected in health outcomes. Using comprehensive Norwegian microdata, we exploit cross-region migration to analyze regional variation in healthcare utilization. Our results indicate that hospital region factors account for half of the total variation, while the rest reflect variation in patient demand. We find no statistically significant association between the estimated hospital region effects and overall mortality rates. However, we document a negative association with relative utilization-intensive causes of death such as cancer, suggesting high-supply regions may achieve modestly improved health outcomes

Impacts of Hospital Wait Time on Health and Labor Supply

We estimate the effects of wait time for orthopedic surgery on health and labor market outcomes of Norwegian workers. Our identification strategy exploits variation in wait times for surgery generated by the idiosyncratic variation in system congestion at the time of referral. While we find no significant evidence of lasting health effects, longer wait times have persistent negative effects on subsequent labor supply. For every 10 days spent waiting for surgery, we estimate health-related workplace absences increase 8.7 days over the five years following referral, and the likelihood of permanent disability insurance increases by 0.4 percentage point. Cost benefit calculations point to sizable fiscal savings from shorter wait time

Spending the night. Provider incentives, capacity constraints and patient outcomes

Healthcare providers’ response to payment incentives may have consequences for both fiscal spending and patient health. This paper studies the effects of a change in the payment scheme for hospitals in Norway. In 2010, payments for patients discharged on the day of admission were substantially decreased, while payments for stays lasting longer than one day were increased. This gave hospitals incentives to shift patients from one-day stays to two-day stays, or to decrease the admission of one-day stays. I study hospital responses by exploiting the variable size of price changes across diagnoses in a difference-in-differences framework. I find no evidence that hospitals respond to price changes, and capacity constraints do not appear to explain this finding. Results imply that the current payment policy yields little scope for policymakers to affect the healthcare spending and treatment choices

Spending the night. Provider incentives, capacity constraints and patient outcomes

Healthcare providers’ response to payment incentives may have consequences for both fiscal spending and patient health. This paper studies the effects of a change in the payment scheme for hospitals in Norway. In 2010, payments for patients discharged on the day of admission were substantially decreased, while payments for stays lasting longer than one day were increased. This gave hospitals incentives to shift patients from one-day stays to two-day stays, or to decrease the admission of one-day stays. I study hospital responses by exploiting the variable size of price changes across diagnoses in a difference-in-differences framework. I find no evidence that hospitals respond to price changes, and capacity constraints do not appear to explain this finding. Results imply that the current payment policy yields little scope for policymakers to affect the healthcare spending and treatment choices.Denne artikkelen studerer effektene av en endring i finansieringssystemet for norske sykehus. I 2010 ble sykehusenes kompensasjon for dagbehandling drastisk redusert, mens kompensasjonen for døgnbehandling ble økt. Dette ga sykehusene insentiver til å flytte pasienter fra dagbehandling til døgnbehandling, eller til å redusere antall dagbehandlinger. Slike tilpasninger til økonomiske insentiver kan ha konsekvenser både for offentlige finanser og for pasienters helse. Artikkelen utnytter variasjon mellom diagnosegrupper i størrelsen på marginalgevinsten av å legge inn pasienten for å undersøke om sykehus responderer på insentivendringene. Resultatene viser at sykehus ikke responderer på endringene i insentiver, og det ser ikke ut til at mangel på ledige sengeplasser forklarer hvorfor pasienter ikke flyttes fra dagbehandling til døgnbehandling. Disse funnene indikerer at dagens finansieringsmodell gir lite rom for at økonomiske insentiver kan påvirke behandlingsvalg og ressursbruk i helsetjenestenpublishedVersio

Regional variation in healthcare utilization and mortality

Geographic variation in healthcare utilization has raised concerns of possible inefficiencies in healthcare supply, as differences are often not reflected in health outcomes. Using comprehensive Norwegian microdata, we exploit cross-region migration to analyze regional variation in healthcare utilization. Our results indicate that hospital region factors account for half of the total variation, while the rest reflect variation in patient demand. We find no statistically significant association between the estimated hospital region effects and overall mortality rates. However, we document a negative association with relative utilization-intensive causes of death such as cancer, suggesting high-supply regions may achieve modestly improved health outcomes

Hospital reimbursement and capacity constraints: Evidence from orthopedic surgeries

Health care providers’ response to payment incentives may have consequences for both fiscal spending and patient health. This paper studies the effects of a change in the payment scheme for hospitals in Norway. In 2010, payments for patients discharged on the day of admission were substantially decreased, while payments for stays lasting longer than one day were increased. This gave hospitals incentives to shift patients from one-day stays to two-day stays, or to decrease the admission of one-day stays. I study hospital responses using two separate difference-in-differences estimation strategies, exploiting, first, the difference in price changes across diagnoses, and secondly, the difference in bed capacity across hospitals. Focusing on orthopedic patients, I find no evidence that hospitals respond to price changes, and capacity constraints do not appear to explain this finding. Results imply that the current payment policy yields little scope for policymakers to affect the health care spending and treatment choices