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By exploiting a unique health insurance benefit design, we provide novel evidence on the causal association between outpatient and inpatient care. Our results indicate that greater outpatient spending was associated with more hospital admissions: a $100 increase in outpatient spending was associated with a 2.7% increase in the probability of having an inpatient event and a 4.6% increase in inpatient spending among enrollees in our sample. Moreover, we present evidence that the increase in hospital admissions associated with greater outpatient spending was for conditions in which it is plausible to argue that the physician and patient could exercise discretion.
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We evaluate reclassification risk and adverse selection in the small group insurance market from a period before ACA community rating regulations. Using detailed individual-level data from a large insurer, we find a pass through of 5-43% from expected health risk to premiums. This limited reclassification risk cannot be explained by market power or search frictions but may be due to implicit long-term contracts. We find no evidence of adverse selection generated by reclassification risk. The observed pricing policy adds $2,346 annually in consumer welfare over 10 years relative to experience rating. Community rating would not increase consumer welfare substantially.
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We use unique data from an insurer that exclusively offers high-deductible, "consumer-directed" health plans to identify the effect of plan features, notably the spending account, on health care spending. Our results show that the marginal dollar in the spending account is entirely spent on outpatient and pharmacy services. In contrast, inpatient and out-of-pocket spending were not responsive to the amount in the spending account. Our results represent the first plausibly causal estimates of the components of consumer-driven health plans on health spending. The magnitudes of the effects suggest important moral hazard consequences to higher spending account levels.
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A growing literature argues that early environments affecting childhood health may influence significantly later-life health and financial wellbeing. We present new evidence on the relationship between child health and later-life outcomes using variation in infant mortality in England and Wales at the onset of World War II. Using data from the British Household Panel Survey, we exploit the variation in infant mortality across birth cohorts and region to estimate the associations between infant mortality and adult outcomes such as disability and employment. Our findings suggest that higher infant mortality is significantly associated with higher likelihood of disability, a lower probability of employment, and less earned income.
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Policies to reduce health care payments can lead to health care access issues if providers reduce their supply in response to reimbursement rate reductions. We examine the impact of a policy that reduced reimbursement rates by 30% in a workers' compensation insurance system that provided generous reimbursement rates relative to other payers even after the rate reduction. The results suggest that providers' supply is inelastic at the part of the reimbursement distribution that we study. Our estimates indicate that the policy reduced annual workers' compensation medical costs by over $400 million without affecting injured workers' health care utilization or health.
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