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Essays on Health Economics

Han, Shijie
http://rave.ohiolink.edu/etdc/view?acc_num=osu1492686365818753

Abstract Details

2017, Doctor of Philosophy, Ohio State University, Economics.
Given the fast-growing health care spending in public health programs and the mounting controversies on certain recent health policy mandates in US, it is critical to identify the elements in these programs and policies that promote efficiency and efficacy, and those that do not. My dissertation looks into the unintended consequences of privatizing Medicare Part D and the important benefits that the Affordable Care Act dependent coverage provision offers to the college graduates with student loan debt, adding insights and perspectives to the ongoing policy debates. The first chapter examines the effects of the 2010 Affordable Care Act (ACA) provision, which requires insurers to allow dependents to remain on parental health insurance policies until age 26, on a variety of outcomes among college graduates with student loan debt. Using data from the National Longitudinal Survey of Youth 1997, in which the majority of the sample were unable to benefit from the provision due to the age restriction, we find larger student loan debt is associated with a lower probability of having health insurance, and lower utilization of routine checkups as well as doctor visits in time of sickness. Using data from the Panel Survey of Income Dynamics, we find that among college graduates who were eligible for the provision, having more student loan debt increases the likelihood of joining a parental health insurance plan. We also estimate a difference-in-difference model and find that for the average college graduate in the sample, being eligible for the provision increased the likelihood of having health insurance by 9.8 percentage points more after 2010. Finally, we use college-level data from the College Scorecard to estimate the impact of the provision on college graduates’ financial outcomes in a fixed effects model identified by changes in the age distributions of students across cohorts which changes the average eligibility rates over time. We find that at the college level, a higher percentage of people satisfying the age criterion of the provision in the cohort led to a decrease in student loan default rate and an increase in student loan repayment rate after 2010. The second chapter studies the unintended consequences of privatizing Medicare prescription drug coverage (Part D). The use of risk-adjustment formulae in setting payments to Medicare Advantage (MA) plans reduces the potential for advantageous selection on factors included in the formulae, but can theoretically worsen overall selection if plans are able to target beneficiaries based on excluded factors. Since MA medical risk-adjustment excludes prescription drug utilization, demand for drugs can be exploited by plans to induce advantageous selection. We show evidence that the introduction of Medicare Part D provided a mechanism for MA plans to increase selection, and that consumers responded, increasing MA market shares among beneficiaries taking drugs associated with the strongest advantageous selection incentives. For the average Medicare beneficiary in our sample, we estimate that this change in advantageous selection following the introduction of Medicare Part D increased the probability of enrolling in an MA plan by about 7.1%.
Kurt Lavetti (Advisor)
Lucia Dunn (Committee Member)
Yi Xu (Committee Member)
135 p.
Economics
Health economics

Recommended Citations

Citations

  • Han, S. (2017). Essays on Health Economics [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1492686365818753

    APA Style (7th edition)

  • Han, Shijie. Essays on Health Economics. 2017. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1492686365818753.

    MLA Style (8th edition)

  • Han, Shijie. "Essays on Health Economics." Doctoral dissertation, Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1492686365818753

    Chicago Manual of Style (17th edition)

osu1492686365818753
84
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This open access ETD is published by The Ohio State University and OhioLINK.