nep-ias New Economics Papers
on Insurance Economics
Issue of 2020‒10‒19
24 papers chosen by
Soumitra K. Mallick
Indian Institute of Social Welfare and Business Management

  1. Policies to Achieve Near-Universal Health Insurance Coverage By Congressional Budget Office
  2. Federal Subsidies for Health Insurance Coverage for People Under 65: 2020 to 2030 By Congressional Budget Office
  3. Revisiting the Effects of Unemployment Insurance Extensions on Unemployment: A Measurement-Error-Corrected Regression Discontinuity Approach By Dieterle, Steven; Bartalotti, Otávio; Brummet, Quentin
  4. Transfer Payment Systems and Financial Distress: Insights from Health Insurance Premium Subsidies By Schmid, Christian P. R.; Schreiner, Nicolas; Stutzer, Alois
  5. Insurance and Inequality in Sub-Saharan Africa: Policy Thresholds By Asongu, Simplice; Odhiambo, Nicholas
  6. Who Went Without Health Insurance in 2019, and Why? By Congressional Budget Office
  7. Who benefits from health insurance? Uncovering heterogeneous policy impacts using causal machine learning By Noemi Kreif; Andrew Mirelman; Rodrigo Moreno-Serra; Taufik Hidayat,; Karla DiazOrdaz; Marc Suhrcke
  8. Health Insurance Menu Design for Large Employers By Kate Ho; Robin S. Lee
  9. A Method for Measuring the Effect of Certified Electronic Health Record Technology on Childhood Immunization Status Scores Among Medicaid Managed Care Network Providers By Paul Messino; Hadi Kharrazi; Julia M. Kim; Harold Lehmann
  10. Finanzrisiken für den Bund durch die demographische Entwicklung in der Sozialversicherung By Werding, Martin; Läpple, Benjamin
  11. Does Obamacare Care? A Fuzzy Difference-in-Discontinuities Approach By Galindo-Silva, Hector; Somé, Nibene Habib; Tchuente, Guy
  12. Redistribution and Insurance in Welfare States Around the World By , Stone Center; Bartels, Charlotte; Neumann, Dirk
  13. Comparative Profitability of Product Disclosure Statements By Burkovskaya, Anastasia; Li, Jian
  14. Changes in Healthcare Utilization, Spending, and Perceived Health during COVID–19: A Longitudinal Study from Singapore By Ahn, SangNam; Kim, Seonghoon; Koh, Kanghyock
  15. Rules vs. Discretion: Treatment of Mental Illness in U.S. Adolescents By Emily Cuddy; Janet Currie
  16. COVID-19 Changed Tastes for Safety-Net Programs By Alex Rees-Jones; John D'Attoma; Amedeo Piolatto; Luca Salvadori
  17. Health of Elderly Parents, Their Children's Labor Supply, and the Role of Migrant Care Workers By Wolfgang Frimmel; Martin Halla; Jörg Paetzold; Julia Schmieder
  18. Opportunities for Improving Chronic Care Management to Address Demands for Accessible Accountable Care During and After the Pandemic By Ann O'Malley; Eugene Rich
  19. Can informal redistribution withstand formal safety nets? Insights from urban-rural transfers in Burkina Faso By Grimm, Michael; Hartwig, Renate; Reitmann, Ann-Kristin; Bocoum, Fadima Yaya
  20. Drivers of Profit Inefficiency in Iowa Crop Production By Sawadgo, Wendiam P. M.; Plastina, Alejandro
  21. Direct Certification with Medicaid for Free and Reduced-Price Meals (DCM-F/RP) Demonstration, Year 2 By Lara Hulsey; Andrew Gothro; Joshua Leftin; Liana Washburn; Brian Estes; Kathy Wroblewska; Hilary Wagner; Amanda Lee; Claire Smither Wulsin; Kelsey Chesnut
  22. Could State and Local DI Programs Shed Light on Trends in SSDI? By Anek Belbase; Laura D. Quinby; James Giles
  23. Are frail elderly people in Europe high-need subjects? First evidence from the SPRINTT data By Jonathan Sicsic; Bastian Ravesteijn; Thomas Rapp
  24. Deterrence Effects of Antifraud and Abuse Enforcement in Health Care By David H. Howard; Ian McCarthy

  1. By: Congressional Budget Office
    Abstract: CBO examines policy approaches that could achieve near-universal health insurance coverage. As defined by CBO, a proposal would achieve near-universal coverage if close to 99 percent of citizens and noncitizens who are lawfully present in this country were insured either by enrolling in comprehensive major medical coverage or by receiving automatic coverage through a default plan.
    JEL: H30 I13 I18
    Date: 2020–10–01
  2. By: Congressional Budget Office
    Abstract: The federal government subsidizes health insurance for most Americans under age 65 through various programs and tax provisions. This report describes updated baseline projections by CBO and the staff of the Joint Committee on Taxation of the federal costs associated with each kind of subsidy and the number of people with different types of health insurance. Those projections incorporate an assumption that current laws governing health insurance coverage and federal subsidies for that coverage remain in place.
    JEL: H30 I13 I18
    Date: 2020–09–29
  3. By: Dieterle, Steven; Bartalotti, Otávio; Brummet, Quentin
    Abstract: This study documents two potential biases in recent analyses of UI benefit extensions using boundary-based identification: bias from using county-level aggregates and bias from across-border policy spillovers. To examine the first bias, the analysis uses a regression discontinuity approach that accounts for measurement error in county-level aggregates. These results suggest much smaller effects than previous studies, casting doubt on the applicability of border-based designs. The analysis then shows substantial spillover effects of UI benefit duration on across-border work patterns, consistent with increased tightness in high-benefit states and providing evidence against a dominant vacancy reduction response to UI extensions.
    Date: 2020–05–01
  4. By: Schmid, Christian P. R. (CSS Institute for Empirical Health Economics); Schreiner, Nicolas (University of Basel); Stutzer, Alois (University of Basel)
    Abstract: How should payment systems of means-tested benefits be designed to improve the financial situation of needy recipients most effectively? We study this question in the context of mandatory health insurance in Switzerland, where recipients initially received either a cash transfer or subsidized insurance premiums (a form of in-kind transfer). A federal reform in 2014 forced cantons (i.e. states) to universally switch to in-kind provision. We exploit this setting based on a difference-in-differences design, analyzing rich individual-level accounting data and applying a machine learning approach to identify cash recipients prior to the reform. We find that switching from cash to in-kind transfers reduces the likelihood of late premiums payments by about 20% and of government debt collection for long-term missed payments by approximately 16%. There is no evidence for a negative spillover effect on the timely payment of the non-subsidized coinsurance bills for health services after the regime change.
    Keywords: health insurance, transfers, cash subsidies, in-kind transfers, financial distress, debt collection
    JEL: D14 H24 I13
    Date: 2020–10
  5. By: Asongu, Simplice; Odhiambo, Nicholas
    Abstract: In this study, we examine how insurance affects income inequality in sub-Saharan Africa, using data from 42 countries during the period 2004-2014. Three inequality variables are used, namely: the Gini coefficient, the Atkinson index and the Palma ratio. Two insurance premiums are employed, namely: life insurance and non-life insurance. The empirical evidence is based on the Generalized Method of Moments (GMM). Life insurance increases the Gini coefficient and increasing life insurance has a net positive effect on the Gini coefficient and the Atkinson index. Non-life insurance reduces the Gini coefficient and increasing non-life insurance has a net positive effect on the Palma ratio. The analysis is extended to establish policy thresholds at which increasing insurance premiums completely dampen the net positive effects. From the extended analysis, 7.500 of life insurance premiums (% of GDP) is the critical mass required for life insurance to negatively affect inequality, while 0.855 of non-life insurance premiums (% of GDP) is the threshold required for non-life insurance to negatively affect inequality. Policy thresholds are provided at which insurance penetration decreases income inequality in sub-Saharan Africa.
    Keywords: Insurance; Inclusive development; Africa; Sustainable Development
    JEL: I28 I30 I32 O40 O55
    Date: 2020–01
  6. By: Congressional Budget Office
    Abstract: CBO estimates that at any given point in 2019, about 12 percent of the population under age 65, or 30 million people, were uninsured— that is, they were not enrolled in a private health insur¬ance plan or a government health program that provides comprehensive major medical coverage. Examining that uninsured population in 2019 reveals groups that were often not reached by current federal programs, subsi¬dies, and other sources of coverage even during a strong economy with historically low unemployment.
    JEL: H30 I13 I18
    Date: 2020–09–30
  7. By: Noemi Kreif (Centre for Health Economics, University of York, York, UK); Andrew Mirelman (World Health Organization, Geneva, Switzerland); Rodrigo Moreno-Serra (Centre for Health Economics, University of York, York, UK); Taufik Hidayat, (Center for Health Economics and Policy Studies (CHEPS), Faculty of Public Health, Universitas Indonesia, Depok, Indonesia); Karla DiazOrdaz (Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK); Marc Suhrcke (Centre for Health Economics, University of York, UK and Luxembourg Institute of Socio-economic Research, Luxembourg)
    Abstract: To be able to target health policies more efficiently, policymakers require knowledge about which individuals benefit most from a particular programme. While traditional approaches for subgroup analyses are constrained only to consider a small number of arbitrarily set, pre-defined subgroups, recently proposed causal machine learning (CML) approaches help explore treatment-effect heterogeneity in a more flexible yet principled way. This paper illustrates one such approach – ‘causal forests’ – in evaluating the effect of mothers’ health insurance enrolment in Indonesia. Contrasting two health insurance schemes (subsidised and contributory) to no insurance, we find beneficial average impacts of enrolment in contributory health insurance on maternal health care utilisation and infant mortality. For subsidised health insurance, however, both effects were smaller and not statistically significant. The causal forest algorithm identified significant heterogeneity in the impacts of the contributory insurance scheme: disadvantaged mothers (i.e. with lower wealth quintiles, lower educated, or in rural areas) benefit the most in terms of increased health care utilisation. No significant heterogeneity was found for the subsidised scheme, even though this programme targeted vulnerable populations. Our study demonstrates the power of CML approaches to uncover the heterogeneity in programme impacts, hence providing policymakers with valuable information for programme design.
    Keywords: policy evaluation;machine learning;heterogeneous treatment effects;health insurance
    Date: 2020–10
  8. By: Kate Ho; Robin S. Lee
    Abstract: We explore the challenges faced by a large employer designing a health insurance plan menu for its employees. Using detailed administrative data from Harvard University, we estimate a model of plan choice and utilization, and evaluate the benefits of cost sharing and plan variety. For a single plan with a generous out-of-pocket maximum, we find that a modest coinsurance rate of approximately 30% with a zero deductible maximizes average employee surplus. Gains from offering choice are limited if based solely on financial dimensions, but can be economically significant if paired with other features that appeal to sicker households.
    JEL: I11 I13 L2
    Date: 2020–09
  9. By: Paul Messino; Hadi Kharrazi; Julia M. Kim; Harold Lehmann
    Abstract: This study integrates multiple health care administrative data sources from 2010 through 2014, analyzed through an interrupted time series design and a hierarchical Bayesian model.
    Keywords: Electronic health record, Immunization, Quality, Bayes, Attribution, Propensity score
  10. By: Werding, Martin; Läpple, Benjamin
    Abstract: Die demographische Alterung tritt in Deutschland derzeit in akute Phase ein, die insbesondere in den gesetzlichen Sozialversicherungen zu finanziellen Anspannungen führt und mittelbar auch Risiken für die Entwicklung des Bundeshaushalts erzeugt. Dies wird im vorliegenden Bericht mit Hilfe von Langfrist-Simulationen für Ausgaben und Einnahmen der Renten-, Kranken-, Pflege- und Arbeitslosenversicherung, einschließlich der Effekte für die jeweils geleisteten Zuschüsse aus dem Bundeshaushalt, genauer untersucht. Einbezogen werden auch Ausgaben für die soziale Sicherung Beamter. Neben einem Basisszenario und einigen Alternativvarianten werden auch erste, vorläufige Abschätzungen der Auswirkungen der Covid-19-Pandemie und ihrer Bekämpfung auf die in der Studie untersuchten Entwicklungen erstellt. Zentrale Ergebnisse der Simulationen sind Szenarien zur Entwicklung des gesamtstaatlichen Haushalts bis 2060 und Kennziffern für dessen langfristige Tragfähigkeit. Die wichtigsten Schlussfolgerungen aus den Berechnungen lauten: I. Der absehbare Druck auf die Finanzen der Sozialversicherungen und den gesamtstaatlichen Haushalt nimmt in den nächsten zwanzig Jahren schnell und deutlich zu und geht in der Folgezeit nicht wieder zurück. II. Diese ungünstigen Perspektiven ändern sich auch bei realistisch erscheinenden Variationen der zugrundeliegenden Annahmen nur wenig. III. Die Auswirkungen der Covid-19-Pandemie und der dadurch ausgelösten Wirtschaftskrise könnten die langfristige finanzielle Entwicklung der Sozialversicherungen aus heutiger Sicht weitgehend unbeeinflusst lassen. IV. Trotzdem erhöht sich durch die finanzpolitischen Maßnahmen zur Krisenbekämpfung der Konsolidierungsbedarf, den die demographische Alterung für den gesamtstaatlichen Haushalt insgesamt erzeugt.
    Keywords: demographische Alterung,öffentliche Finanzen,Alterssicherung,Gesundheit,Pflege,Arbeitslosigkeit,Tragfähigkeit,Konsolidierung,Demographic Ageing,Public Finances,Old-age Provision,Health Care,Long-term Care,Unemployment,Sustainability,Budget Consolidation
    JEL: E27 H50 H60 J11
    Date: 2020
  11. By: Galindo-Silva, Hector; Somé, Nibene Habib; Tchuente, Guy
    Abstract: This paper explores the use of a fuzzy regression discontinuity design where multiple treatments are applied at the threshold. The identification results show that, under the very strong assumption that the change in the probability of treatment at the cutoff is equal across treatments, a differencein- discontinuities estimator identifies the treatment effect of interest. The point estimates of the treatment effect using a simple fuzzy difference-in-discontinuities design are biased if the change in the probability of a treatment applying at the cutoff differs across treatments. Modifications of the fuzzy difference-in-discontinuities approach that rely on milder assumptions are also proposed. Our results suggest caution is needed when applying before-and-after methods in the presence of fuzzy discontinuities. Using data from the National Health Interview Survey, we apply this new identification strategy to evaluate the causal effect of the Affordable Care Act (ACA) on older Americans' health care access and utilization. Our results suggest that the ACA has (1) led to a 5% increase in the hospitalization rate of elderly Americans, (2) increased the probability of delaying care for cost reasons by 3.6%, and (3) exacerbated cost-related barriers to follow-up care and continuity of care: 7.0% more elderly individuals could not afford prescriptions, 7.2% more could not see a specialist, and 5.5% more could not afford a follow-up visit. Our results can be explained by an increase in the demand for health services without a corresponding adjustment in supply following the implementation of the ACA.
    Keywords: Fuzzy Difference-in-Discontinuities,Identification,Regression Discontinuity Design,Affordable Care Act
    JEL: C13 I12 I13 I18
    Date: 2020
  12. By: , Stone Center (The Graduate Center/CUNY); Bartels, Charlotte; Neumann, Dirk
    Abstract: Redistribution across individuals in a one-year-period framework is an empirically intensely studied question. However, a substantial share of annual redistribution might turn out to serve individual insurance in a longer perspective, reducing the level of actual redistribution across individuals. This paper investigates to what extent long-run redistribution diverges from annual redistribution in welfare states of different types. Exploiting panel data from the Cross-National Equivalent File (CNEF) for Australia, Germany, South Korea, Switzerland, the United Kingdom, and the United States, we find that welfare states like Germany that are assumed to engage in a high level of redistribution actually achieve relatively less redistribution between individuals in the long run than the United Kingdom or the United States. Regression results show that a higher share of elderly in a country is associated with more annual redistribution, but with less long-run redistribution between individuals. The results suggest that, in welfare states with aging populations, we might expect growing annual redistribution that, to a substantial extent, is in fact income smoothing for the elderly. (Stone Center on Socio-Economic Inequality Working Paper Series)
    Date: 2020–09–17
  13. By: Burkovskaya, Anastasia; Li, Jian
    Abstract: In insurance industry, product disclosure statements (PDSs) consist of descriptions of uncertain contingencies by the insurance plans (e.g., “hospital coverage†, “dental coverage†, etc.) and are often very different. In this paper, we model PDSs as information partitions of the state space, which can influence how a consumer perceives the structure of her choice problem and hence her deductible choices. We study a model of an insurance company that aims to promote profit by designing the framing of its PDS. We compare the company’s profits under two PDSs, one of which is coarser than the other. Our main results show that under simple conditions, the PDS consisting of finer partitions of the more expensive states is more profitable.
    Date: 2020–02–04
  14. By: Ahn, SangNam (University of Memphis); Kim, Seonghoon (Singapore Management University); Koh, Kanghyock (Korea University)
    Abstract: The COVID–19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. Using monthly panel data of nationally representative middle-aged and older Singaporeans, we examined the associations of the pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health. At its peak, doctor visits decreased by 30% and out-of-pocket medical spending decreased by 23%, mostly driven by reductions in inpatient and outpatient care. Although there were little changes in self-reported health and sleep quality, COVID–19 increased depressive symptoms by 4%. We argue that it is imperative to monitor COVID–19's long-term health effects among non-COVID–19 patients since our findings indicated delayed healthcare and worsened mental health during the outbreak.
    Keywords: COVID–19, pandemic, healthcare utilization, healthcare spending, self-reported health status, mental health
    JEL: I12 I18
    Date: 2020–09
  15. By: Emily Cuddy; Janet Currie
    Abstract: Mental health disorders are a leading cause of disability worldwide. Many mental health disorders start in adolescence and appropriate treatment at the outset may improve trajectories. We use a large national data base of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next two years. We find that receiving follow up mental health treatment in the first three months after an initial mental health claim increases the total cost of care over the next 24 months. These higher costs are entirely accounted for by children who receive treatment that is not consistent with practice guidelines. Our estimates imply that, within 24 months, children who initially received a red-flag drug have 205% higher costs than those of the average treated child and are 131% more likely to have used an emergency room or experienced a hospitalization. These results show that large numbers of U.S. children are receiving mental health care that falls outside of accepted guidelines and poses risks to their health. In doing so, they provide support for the guidelines themselves, and demonstrate that analyses of large-scale claims data can provide a useful complement to clinical research studies in identifying best practices.
    JEL: I1 I11
    Date: 2020–10
  16. By: Alex Rees-Jones; John D'Attoma; Amedeo Piolatto; Luca Salvadori
    Abstract: In June 2020, we surveyed 2,516 Americans regarding their preferences for both short- and long-term expansions to government-provided healthcare and unemployment insurance programs. We find that support for such programs is positively associated with (a) COVID-19 deaths and infections in the respondent’s county, (b) the pandemic-induced change in the unemployment rate in the respondent’s county, and (c) survey elicitations of the respondent’s perceptions of COVID-19’s consequences. These associations persist when controlling for pre-COVID-19 political ideology and demographics. These results suggest that real or perceived exposure to COVID-19’s consequences has influenced support for expansions to the U.S. safety-net system.
    JEL: H2 H5
    Date: 2020–09
  17. By: Wolfgang Frimmel; Martin Halla; Jörg Paetzold; Julia Schmieder
    Abstract: We estimate the impact of parental health on adult children’s labor market outcomes. We focus on health shocks which increase care dependency abruptly. Our estimation strategy exploits the variation in the timing of shocks across treated families. Empirical results based on Austrian administrative data show a significant negative impact on labor market activities of children. This effect is more pronounced for daughters and for children who live close to their parents. Further analyses suggest informal caregiving as the most likely mechanism. The effect is muted after a liberalization of the formal care market, which sharply increased the supply of foreign care workers.
    Keywords: Informal care, formal care, aging, health, labor supply, labor migration
    JEL: J14 J22 I11 I18 R23
    Date: 2020
  18. By: Ann O'Malley; Eugene Rich
    Abstract: The COVID-19 pandemic presents further opportunities for improving Chronic Care Management services.
    Keywords: Chronic care management, COVID-19, pandemic, accountable care
  19. By: Grimm, Michael; Hartwig, Renate; Reitmann, Ann-Kristin; Bocoum, Fadima Yaya
    Abstract: Households in rural areas still depend on informal transfers to meet subsistence needs and cope with shocks. Yet, to provide additional monetary support, formal safety nets are increasingly introduced in developing countries. However, it remains unclear whether such social protection policies will have the desired welfare effects. This article addresses this question by analyzing the private transfer response to changes in the income of rural recipients using novel data from Burkina Faso. We assume that the transfer-income relationship is a non-linear one where transfer motives, and therefore also transfer responses, vary with the recipient's position in the income distribution. Our findings support this view. We find a pronounced, negative private transfer response among the poorest of the poor. This observation has important policy implications, because those households that depend most on private transfers, would be most affected by crowding-out effects. In terms of transfer motives, the negative relationship for the lowest income class is consistent with transfers being altruistically motivated. With increasing income levels, transfers cease being altruistic at the margin and switch toward exchange motives. However, the observed transfer pattern is also indicative of an (informal) insurance role of private transfers. Rural households receive higher private transfers in response to negative shocks. These results can serve as a basis for the design of formal social protection mechanisms in a context where informal redistribution still plays an important role.
    Keywords: private transfers,crowding-out,sharing norms,informal insurance,Burkina Faso
    JEL: D64 H31 I30 O12
    Date: 2020
  20. By: Sawadgo, Wendiam P. M.; Plastina, Alejandro
    Abstract: In this paper, we use data envelopment analysis and a panel of Iowa farms to evaluate profit inefficiency in corn and soybean production. We find that farms have, on average, profit inefficiency scores of 89.4% in combined corn and soybean production, suggesting that profit could be increased by 89.4% if farms eliminated technical and allocative inefficiencies. Overall, profit efficiency improved from 2011 to 2018, a period generally characterized by decreasing farm net worth. Moreover, while factors such as farm size and operator age affect technical inefficiency, these variables do not have a significant effect on profit inefficiency, while farms’ net worth per acre and crop insurance indemnity payments positively affect profit inefficiency. Land tenure does not have a significant effect on technical or profit inefficiency.
    Date: 2020–01–01
  21. By: Lara Hulsey; Andrew Gothro; Joshua Leftin; Liana Washburn; Brian Estes; Kathy Wroblewska; Hilary Wagner; Amanda Lee; Claire Smither Wulsin; Kelsey Chesnut
    Abstract: This report examines the impact of using Medicaid data to directly certify students for free and reduced-price school meals in the National School Lunch and School Breakfast Programs in fifteen states in School Year 2017-18.
    Keywords: NSLP, SBP, direct certification, Medicaid, school meals
  22. By: Anek Belbase; Laura D. Quinby; James Giles
    Abstract: According to the U.S. Social Security Administration, one out of every four young workers today will develop a work-limiting disability over the course of their career. For those unable to continue in the labor force, programs like Social Security Disability Insurance (SSDI) serve as a much-needed economic safety net. Despite broad agreement on this need, policymakers continue to vigorously debate the best way to design a DI program to protect individuals and families from loss of income while incentivizing work among those who are still able. This brief investigates whether researchers could turn to a unique population of workers Ð state and local government employees Ð to assess how DI program structure affects claiming and other outcomes. The discussion proceeds as follows. The first section introduces a unique database of state and local DI programs that was developed for this analysis and will be made publicly available on the CenterÕs website in the fall of 2020. The second section explores the state and local DI landscape, with an eye toward variation in program structure that could be used to study how design choices affect outcomes. The third section offers suggestive evidence that eligibility rules, benefit levels, and employee occupation could all affect the DI claiming rate. The final section concludes that state and local DI programs offer a fruitful avenue for research.
    Date: 2020–09
  23. By: Jonathan Sicsic (LIRAES - EA 4470 - Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé - UP - Université de Paris); Bastian Ravesteijn (Erasmus School of Economics - Erasmus University Rotterdam); Thomas Rapp (LIRAES - EA 4470 - Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé - UP - Université de Paris)
    Abstract: Physical frailty and sarcopenia (PF&S) has received growing attention in empirical models of health care use. However, few articles focused on objective measures of PF&S to assess the extent of care consumption among the frail population at risk of dependency. Using baseline data from the SPRINTT study, a sample of 1518 elderly people aged 70+ recruited in eleven European countries, we analyse the association between various PF&S measures and health care / long term care (LTC) use. Multiple health care and LTC outcomes are modelled using linear probability models adjusted for a range of individual characteristics and country fixed effects. We find that PF&S is associated with a significant increase in emergency admissions and hospitalizations, especially among low-income elders. All PF&S measures are significantly associated with increased use of formal and informal LTC. There is a moderating effect of income on LTC use: poor frail elders are more likely to use any of the formal LTC services than rich frail elders. Our results are robust to various statistical specifications. They suggest that the inclusion of PF&S in the eligibility criteria of public LTC allowances could contribute to decrease the economic gradient in care use among the elderly community-dwelling European population.
    Keywords: Frailty,Sarcopenia,Long-term care,Health care use,SPRINTT trial
    Date: 2020
  24. By: David H. Howard; Ian McCarthy
    Abstract: Estimates of the benefits of antifraud enforcement in health care typically focus on direct monetary damages. Deterrence effects are acknowledged but unquantified. We evaluate the impact of a Department of Justice investigation of hospitals accused of billing Medicare for unnecessary implantable cardiac defibrillator (ICD) procedures on their use. Using 100% inpatient and outpatient procedure data from Florida, we estimate that the investigation caused a 22% decline in unnecessary ICD implantations. The present value of savings nationally over a 10 year period is $2.7 billion, nearly 10 times larger than the $280 million in settlements the Department of Justice recovered from hospitals. The investigation had a large and long-lasting effect on physician behavior, indicating the utility of antifraud enforcement as a tool for reducing wasteful medical care.
    JEL: I18 K42
    Date: 2020–10

This nep-ias issue is ©2020 by Soumitra K. Mallick. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.