Does Competition from HMOs Affect Fee-For-Service Physicians?

This paper develops county-level estimates of HMO market share for all counties in the United States and uses them to examine the relationship between HMO market share and the fee for a normal office visit with an established patient charged by 2,845 fee-for-service (FFS) physicians. Two-stage least squares estimates indicate that increases of 10 percentage points in HMO market share are associated with decreases of approximately 11 percent in the normal office visit fee. However, further examination indicates that the incomes of the physicians in the sample are not lower in areas with higher HMO market share. In addition, the quantity of services provided, measured by the number of hours worked and the number of patients seen per week, is not higher in these areas. While it is possible that physicians induce demand to change the volume or mix of services provided to patients in ways that do not affect the number of hours worked or patients seen, another hypothesis consistent with these findings is that FFS physicians respond to competition from HMOs by adopting multi-part pricing strategies in which the price for an office visit is reduced but prices for other services are raised.

Mandated Health Insurance Benefits and the Utilization and Outcomes of Infertility Treatments

During the last two decades, the treatment of infertility has improved dramatically. These treatments, however, are expensive and rarely covered by insurance, leading many states to adopt regulations mandating that health insurers cover them. In this paper, we explore the effects of benefit mandates on the utilization and outcomes of infertility treatments. We find that use of infertility treatments is significantly greater in states adopting comprehensive versions of these mandates. While greater utilization had little impact on the number of deliveries, mandated coverage was associated with a relatively large increase in the probability of a multiple birth. For relatively low fertility patients who responded to the expanded insurance coverage, treatment was often unsuccessful and did not result in a live birth. For relatively high fertility patients, in contrast, treatment often led to a multiple, rather than a singleton, birth. We also find evidence that the beneficial effects on the intensive treatment margin that have been proposed in other studies are relatively small. We conclude that, while benefit mandates potentially solve a problem of adverse selection in this market, these benefits must be weighed against the costs of the significant moral hazard in utilization they induce.

Intertemporal State Budgeting

This study presents intertemporal budgeting as of 1999 for all 50 U.S.states. Intertemporal state budgeting compares the present value of a state's projected receipts with the present value of its projected expenditures (exclusive of interest payments)plus the current value of its net debt (liabilities minus assets). Our projections start with the 1999 U.S.Census Bureau's State Government Finances survey of receipts,expenditures,and debt.We group these highly detailed data into a framework that is consistent with the National Income and Product Account accounts. The 1999 Census data are the latest available.To project total receipts and expenditures for years beyond 1999,we first form average 1999 receipts and expenditures by age and sex using relative age-and sex-specific receipts and expenditure profiles.We estimate these profiles the Current Population Survey and the Consumer Expenditure Survey. Next we grow these averages using an assumed growth rate in labor productivity. Finally,year-and state-specific age-sex population estimates are multiplied by projected average receipts and expenditures by age and sex in that year to form that year's total projected state-specific receipts and expenditures.We form our year-age-sex-and state-specific population projections using the 2001 Social Security Administration 's projection of the total U.S. population by age and sex in conjunction with the 1995 Census projections on state-specific age-sex population shares. Our base-case results use a 3 percent real discount rate and assume a 1.5 percent real productivity growth rate.They show a great range of state intertemporal imbalances. When measured as a share of (scaled by) the present value of projected expenditures, imbalances range from positive 48 percent in Alaska to negative 19 percent in Vermont. These and other findings proved to be very robust to changes in productivity and discount rates as well as changes in demographic assumptions. State official liabilities are not good proxies for their intertemporal imbalances.Indeed, the correlation between scaled state intertemporal imbalances and gross state debt scaled by state income is essentially zero.The corresponding correlation based on net state debt is negative. Given this, it's not surprising that we find very little correspondence between the ranking of the states based on their intertemporal budget imbalances and the credit ratings published by either Moody's or Standard and Poor's. Our user-friendly program for calculating intertemporal state budget imbalances (the difference between a)the present value of

Consumer Demand for Health Information on the Internet

The challenges consumers face in acquiring and using information are a defining feature of health care markets. In this paper, we examine demand for health information on the Internet. We find that individuals in poor health are more likely than those in better health to use the Internet to search for health information and to communicate with others about health and health care. We also find that individuals facing a higher price to obtain information from health care professionals are more likely to turn to the Internet for health information. Our findings indicate that demand for consumer health information depends on the expected benefits of information and the price of information substitutes.