Essays on the provision and regulation of healthcare services

Corredor Waldron, Adriana

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Description

Title

Essays on the provision and regulation of healthcare services

Author(s)

Corredor Waldron, Adriana

Issue Date

2019-04-12

Director of Research (if dissertation) or Advisor (if thesis)

Powers, Elizabeth

Doctoral Committee Chair(s)

Powers, Elizabeth

Committee Member(s)

• Miller, Nolan
• Borgschulte, Mark
• Marshall, Guillermo

Department of Study

Economics

Discipline

Economics

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• Spillover effects
• healthcare services
• Medicaid
• Medicare

Abstract

Changes in healthcare regulation can have unintended consequences on the provision of healthcare services and health outcomes of individuals. This dissertation quantifies the indirect effects of changes in healthcare regulation in three different settings. In the first chapter, I examine the effects of an increase in Medicare fees on nursing homes' willingness to treat Medicaid beneficiaries. Both Medicare and Medicaid offer health insurance, but they cover different services and pay healthcare providers at varying levels of fees. The divergence between the payment structures of the programs can create conflicting incentives for nursing homes, as Medicaid fees are less generous than Medicare fees. In the case of nursing homes, Medicare pays for skilled nursing care and up to 100 days of residency, while Medicaid pays for custodial care and until the resident dies or her condition improves. Thus, admitting a Medicaid resident has dynamic implications for future capacity constraints on nursing homes, as assigning a bed to a Medicaid resident will prevent the facility from using the bed for future highly profitable, Medicare residents. I find that capacity-constrained nursing homes respond to an overly generous Medicare fee by substituting away from Medicaid patients, who are low-profit patients. I exploit variation in the number of certificate-of-need and moratorium laws across states to approximate for the severity of capacity constraints. The chapter provides empirical evidence pertaining to indirect effects of Medicare policy on the healthcare utilization of non-Medicare beneficiaries and enriches the ongoing debate over the conflicting incentives between the Medicare and Medicaid programs and how this disconnection affects beneficiaries. In the second chapter I study the impact of Prescription Drug Monitoring Programs (PDMPs) on suicides. PDMPs aim to discourage prescription drug abuse and diversion by requiring pharmacies to report the names of both patients and prescribers to a central database when dispensing controlled-substance drugs such as OxyContin. The recent empirical evidence supports the critical role PDMPs play in reducing opioid prescriptions, especially those with the highest potential for abuse. In this study, we hypothesize that a negative supply shock to the market for diverted drugs, like the implementation of a PDMP, has differential effects on the total number of suicides. We first develop a dynamic model of addicts' choice between continued drug use, exerting effort to quit drugs, or committing suicide. In the absence of drug treatment services, a negative shock to the supply of prescription drugs makes a drug habit unsustainable, and thus the addict commits suicide. On the other hand, in places with strong addiction-help networks, the productivity of a unit of effort towards recovery is higher. In this case a negative supply shock boosts the incentive to seek treatment. We test the predictions of our model using information regarding the number of suicides and treatment facilities at the county level and find that PDMPs reduce suicides in counties with strong addiction-help networks. A major policy implication of this study is that access to drug treatment centers is an important factor in the fight against the opioid epidemic. Finally, in the third chapter I explore the responses of pediatricians to the implementation of the Children's Health Insurance Program (CHIP) in 1997. The findings reinforce prior evidence that pediatricians decrease their work hours in response to increases in the number of Medicaid- enrolled children. This is consistent with CHIP crowding out private insurance for children. I provide evidence that the response is due in part to changes in the extensive margin, as physicians in high-expansion states are more likely to move from solo practices to large practices such as group practices and hospitals. The latter results suggest that expansions in public health insurance can change the labor supply of physicians as well as the market structure of healthcare markets.

Graduation Semester

2019-05

Type of Resource

text

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Copyright and License Information

Copyright 2019 Adriana Corredor Waldron

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