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Zonder onderwerpscode: economie

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Zonder onderwerpscode: economie

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We analyze the effects of states' expansions of CHIP eligibility to children in higher income families during 2002-2009 on take-up of public coverage, crowd-out of private coverage, and rates of uninsurance. Our results indicate these expansions were associated with limited uptake of public coverage and only a two percentage point reduction in the uninsurance rate among these children. Because not all of the take-up of public insurance among eligible children is accounted for by children who transfer from being uninsured to having public insurance, our results suggest that there may be some crowd-out of private insurance coverage; the upper bound crowd-out rate we calculate is 46 percent.

Zonder onderwerpscode: economie

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We use the implementation of a new prospective payment system (PPS) for inpatient rehabilitation facilities (IRFs) to investigate the effect of changes in marginal and average reimbursement on costs. The results show that the IRF PPS led to a significant decline in costs and length of stay. Changes in marginal reimbursement associated with the move from a cost based system to a PPS led to a 7 to 11% reduction in costs. The elasticity of costs with respect average reimbursement ranged from 0.26 to 0.34. Finally, the IRF PPS had little or no impact on costs in other sites of care, mortality, or the rate of return to community residence.

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This research explores social networks and their relationship to access to health care among adult Mexican-Americans. We use data from the Medical Expenditure Panel Survey (MEPS) linked to data from the 2000 U.S. Census and other data sources. We analyze multiple measures of access to health care. Measures of social networks are constructed at the ZCTA level and include percent of the population that is Hispanic, percent of the population that speaks Spanish, and percent of the population that is foreign-born and Spanish-speaking. Regressions are stratified by insurance status and social network measures are interacted with individual-level measures of acculturation. For insured Mexican-American immigrants, living in an area populated by relatively more Hispanics, more immigrants, or more Spanish-speakers increases access to care. The social network effects are generally stronger for more recent immigrants compared to those who are better established. We find no effects of these characteristics of the local population on access to care for U.S. born Mexican-Americans, suggesting that similarities in race and language may contribute more to the formation of social ties among individuals who are less acculturated to the U.S. Among the uninsured, we find evidence suggesting that social networks defined by ethnicity improve access to care among recent immigrants. A finding particular to the uninsured is the negative influence of percent of the population that is Hispanic and the percent that is Spanish-speaking on access to care among U.S. born Mexican-Americans. The results provide evidence that social networks play an important role in access to health care among Mexican-Americans. The results also suggest the need for further study using additional measures of social networks, analyzing other racial and ethnic groups, and exploring social networks defined by characteristics other than race, language and ethnicity.