Browsing by Subject "Health Economics"

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    Essays in health economics
    (2018-06-22) Ghosh, Ausmita; Royalty, Anne Beeson; Simon, Kosali; Freedman, Seth; Morrison, Wendy; Antwi, Yaa Akosa
    My dissertation is a collection of three essays on the design of public health insurance in the United States. Each essay examines the responsiveness of health behavior and healthcare utilization to insurance-related incentives and draws implications for health policy in addressing the needs of disadvantaged populations. The first two essays evaluate the impact of Medicaid expansions under the Affordable Care Act (ACA) on health and healthcare utilization. The Medicaid expansions that included full coverage of preconception care, led to a decline in childbirths, particularly those that are unintended. In addition, these fertility reductions are attributable to higher utilization of Medicaidfinanced prescription contraceptives. The second essay documents patterns of aggregate prescription drug utilization in response to the Medicaid expansions. Within the first 15 months following the policy change, Medicaid prescriptions increased, with relatively larger increases for chronic drugs such as diabetes and cardio-vascular medications, suggesting improvements in access to medical care. There is no evidence of reductions in uninsured or privately-insured prescriptions, suggesting that Medicaid did not simply substitute for other forms of payment, and that net utilization increased. The effects on utilization are relatively higher in areas with larger minority and disadvantaged populations, suggesting reduction in disparities in access to care. Finally, the third essay considers the effect of Medicaid coverage loss on hospitalizations and uncompensated care use among non-elderly adults. The results show that coverage loss led to higher uninsured hospitalizations, suggesting higher uncompensated care use. Most of the increase in uninsured hospitalizations are driven by visits originating in the ED - a pattern consistent with losing access to regular place of care. These results indicate that policies that reduce Medicaid funding could be particularly harmful for patients with chronic conditions.
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    Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article.
    (Wolters Kluwer Health, 2016-01) French, Dustin D.; Dixon, Brian E.; Perkins, Susan M.; Myers, Laura J.; Weiner, Michael; Zillich, Allan J.; Haggstrom, David A.; Department of Epidemiology, Richard M. Fairbanks School of Public Health
    The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans’ electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers.The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs.A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation.Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office.VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment.There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees $1152 (95% CI: $807–1433) (P < 0.01) (in 2014 dollars) than VLER nonenrollees.Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons.