Alternative payment models and physician treatment decisions: Evidence from lower back pain

The capitated payment model has been used to address the high cost of health care. Under capitation, physicians are compensated with a fixed amount per patient, regardless of the services generated. We provide new evidence on how the capitation payment model changes physicians behaviors by studying the treatment of lower back pain, as this type of treatment provides substantial scope for physicians discretion. We use data from 2003 to 2006 from a large database of employer-sponsored health insurance claims and leverage capitation variation within the plan and physician to mitigate selection concerns. The results show that the treatment intensity—primarily derived from therapy and diagnostic testing —of patients under a capitation system is 7–12% lower than that of similar patients in a non-capitated plan. Furthermore, we find no evidence of increased relapse rates for patients in a capitated plan.     

Competition-driven physician-induced demand

This paper empirically investigates how competition affects physicians’ opportunistic behavior in the context of the utilization of MRI scanners. We examine micro-panel data on Japanese hospitals, where we observe how physicians change their usage of MRI scanners in response to MRI adoption by nearby hospitals. We identify competition-driven physician-induced demand: Hospitals lose patients because of MRI adoption by nearby hospitals, and, to compensate for this loss, physicians perform more MRI scans per patient. Although competition may benefit consumers through better access to MRI scanners, it also causes additional physician-induced demand.     

Crowd-Out and Emergency Department Utilization

When consumers gain Medicaid, their cost of healthcare changes. The direction of this change determines how utilization changes. The previously uninsured see a stark decrease in the price of primary care after gaining public insurance. Due to charity care, they may face an increase in the price of emergency department care. The previously insured see a reduction in emergency department prices and decreased access to primary care. We examine the impact of the prior insurance status of the newly publicly insured on substitution between healthcare. We base our identification on California’s LIHP and ACA Medicaid expansions. One challenge we face is estimating crowd-out. We use machine learning techniques to predict prior insurance status based on observable covariates in cross-sectional data. We find an increase in emergency department utilization caused entirely by those crowded-out whose access to primary care has decreased. We find the opposite utilization patterns for the previously uninsured.     

Access to orphan drugs – comparison across Balkan countries

The aim of this study was to compare orphan drug access in a sample of Balkan countries: five EU Member States (Bulgaria, Croatia, Greece, Romania, Slovenia) and two EU Candidates (Serbia, Montenegro). The comparative analysis was based on a cross-sectional study and included medicinal products with an active orphan designation and market authorisation on January 1, 2017.Access to orphan drugs is an ongoing challenge in these countries. Three clusters of countries were identified in terms of orphan drug access: Greece and Slovenia, making the top tier, Romania, Bulgaria, and Croatia, being in the middle, and EU Candidates, Serbia and Montenegro, forming the bottom tier, where a substantial number of EU market approved orphan drugs was not even registered. Available public health resources and market size are probably among the contributing factors for such inequalities. Sizeable part of EMA market authorised orphan medicinal products is not even priced in the Balkan countries. This is a serious issue, which is putting rare disease patients from this region in a particularly vulnerable situation.There is a need for further improvement in accessibility of orphan drugs in the Balkan countries. Cross-border collaboration in the field of pricing, health technology assessment, and reimbursement negotiation of orphan drugs may help to address these challenges.     

The impact of certificate of need laws on heart attack mortality: Evidence from county borders

Certificate of need (CON) regulations requires that health care providers obtain state approval before offering a new service or expanding existing facilities. The purported goal of CON regulations is to reduce health care costs by generating regional economies of scale and reducing redundant investments resulting from excessive competition. Critics of CON regulations note that the regulatory environment increases the costs of expansion and may incentivize health care providers to forgo capital investment, which can have a negative effect on health outcomes. To estimate the net effect of CON regulations, I use a border discontinuity design to measure within-regional heart attack mortality spanning 1968 to 1982. I estimate that CON regulations led to an increase in heart attack deaths, by 6%-10%, three years after the policy was enacted.     

Willingness to pay for reductions in health risks under anticipated regret

In this paper, we study the willingness to pay for reductions in health risks within a framework of anticipated regret. We show that ex post information provision can be a relevant factor for regret theory to account for why people are sometimes so inclined to protect themself against certain types of health risks but not others. In particular, we find that under full resolution of uncertainty disproportionate aversion to large regrets exaggerates willingness to pay estimates. The effect induced by this notion of regret aversion can be interpreted as if regret-averse people overweight risk reductions due to prevention. However, as feedback over forgone acts is missing, the regret aversion effect disappears. Finally, we show that information avoidance induced by regret aversion can significantly bias our evaluation to prefer those health programs that completely eliminate a risk, i.e., the certainty effect.     

初创社科类英文学术期刊国际影响力提升的探索与实践——以Financial Innovation为例

【目的】 探讨如何在稿源欠缺、显示度低、参与度差的情况下快速有效提升我国初创社科类英文学术期刊的国际影响力。【方法】 结合数据统计分析,结合《金融创新》(Financial Innovation)实际案例,归纳初创英文学术期刊提升国际影响力的途径及方法。【结果】 《金融创新》创刊5年中,跨越式实现从无到有,再到进入SSCI检索并进入学科Q1分区的进步。【结论】 前沿专刊筹措、邮件精准推广、期刊数据库挖掘是初创英文学术期刊在有限资源下取得突破、提升国际影响力的重要路径。