Do Health Insurance Mandates Spillover to Education? Evidence from Michigan’s Autism Insurance Mandate

Social programs and mandates are usually studied in isolation, but unintended spillovers to other areas can impact individual behavior and social welfare. We examine the presence of spillovers from health care policy to the education sector by studying how health insurance coverage affects the education of students with Autism Spectrum Disorder (ASD). We leverage a state mandate that increased insurance coverage of ASD-related services, which often are provided by both the private sector and within public schools. The mandate primarily affected coverage for children with private health insurance, so we proxy for private insurance coverage with students’ economic disadvantage status and estimate effects via triple-differences. While we find little change in ASD identification, the mandate crowds-out special education supports for students with ASD. A lack of short-run impact on achievement supports our crowd-out interpretation and indicates that the mandate had little net effect on the academic achievement of ASD students.     

The transmission of health across 7 generations in China, 1789–1906

We study the intergenerational transmission of health using registered data from China between 1789 and 1906. We first document the intergenerational correlations in lifespans, and we find much higher correlations for mothers, compared to fathers. We then compare children born from brother and twin fathers, and the intergenerational transmission from fathers becomes weaker and is likely to be mostly driven by genetic factors. On the contrary, our results suggest a strong role of women in affecting their children’s health outcomes across generations in developing countries.     

The effect of hosting 3.4 million refugees on native population mortality

As of the end of 2017, 3.4 million Syrian refugees lived in Turkey. These refugees left a country where the health system was utterly broken. Several studies report that Syrian refugees faced numerous diseases during their exodus, brought certain infectious diseases to the hosting communities, and have a high incidence of health care utilization. Moreover, they have much higher fertility rates than natives. We examine the effect of Syrian refugees on the health care resources in Turkey and on natives’ mortality—with a focus on infant, child, and elderly mortality. Our OLS results yield suggestive evidence of an adverse effect of the refugee shock on infant and child mortality. However, we find that this is a result of endogenous settlement patterns of refugees. Once we account for the endogeneity using a plausibly exogenous instrument, we find no evidence of an effect on native mortality for any age group. We also analyze the refugees’ pressure on the health care services in Turkey and the government's response to understand our findings on mortality outcomes.     

The effect of Medicaid expansion on Medicaid participation,payer mix,and labor supply in primary care

Evidence of increased health care utilization associated with the Medicaid expansion suggests that clinicians increased capacity to meet demand. However, little is known about the mechanism underlying this response. Using a novel source of all-payer data, we quantified clinicians’ response to the Medicaid expansion – examining whether and how they changed their Medicaid participation decisions, payer mix, and overall labor supply. Primary care clinicians in expansion states provided an average of 49 additional appointments per year (a 21% relative increase) for patients insured by Medicaid, compared to clinicians in non-expansion states - with new-patient visits representing half (25 appointments) of this overall increase. Clinicians did not increase their labor supply to accommodate these additional appointments. They instead offset the 1.7 percentage point average increase in Medicaid payer mix with an equivalent reduction in commercial payer mix. However, this reduction in commercial patient share represented only a 2.8% relative decrease, with commercially insured patients still comprising the majority of the average clinician's patient panel. Subsample analyses revealed a larger increase in care for Medicaid patients among clinicians with high Medicaid participation preceding the eligibility expansion.     

R&D and market size: Who benefits from orphan drug legislation?

Since the early 80s, incentives have been introduced to stimulate R&D for rare diseases. We develop a theoretical model to study the impact of push and pull incentives on the intensive and extensive margin of optimal R&D investments. The model describes the mechanisms by which the type of incentives provided may favor R&D for orphan diseases with comparatively high prevalence. In our empirical analysis, we merge data on orphan drug designations by the Food and Drug Administration with Orphanet data on disease characteristics. In line with the theoretical results, we find evidence supporting the idea that the incentives adopted may have contributed substantially to widening the gap between more and less rare diseases classified as orphan. Our theoretical and empirical findings together suggest that, if providing some therapeutic option to patients with very rare diseases is a priority, a revision of the current system of incentives should be considered.     

农民生活满意度及其影响因素——对五台县某村的研究报告

[目的]了解农民生活满意度及其影响因素。[方法]运用农民生活满意度问卷对山西某村农民进行调查。[结果]农民在总体上对生活是满意的。在婚姻状况、不同年龄阶段和收入水平上,农民生活满意度存在显著性差异;而在文化程度和性别上不存在显著性差异。特别发现婚姻与性别的交互作用对生活满意度具有显著性作用。在分析影响生活满意度的因素时采用了逐步回归分析的方法,发现只有满足,自由,婚姻状况,收入状况四个因素进入了回归方程。[结论]农民对现在的生活是比较满意的,但在某些方面与城市居民还是有差异。     

Will the Needs‐Based Planning of Health Human Resources Currently Undertaken in Several Countries Lead to Excess Supply and Inefficiency?

Recently, the emphasis on health human resources (HHR) planning has shifted away from a utilization‐based approach toward a needs‐based one in which planning is based on the projected health needs of the population. However, needs‐based models that are currently in use rely on a definition of ‘needs’ that include only the medical circumstances of individuals and not personal preferences or other socio‐economic factors. We examine whether planning based on such a narrow definition will maximize social welfare. We show that, in a publicly funded healthcare system, if the planner seeks to meet the aggregate need without taking utilization into consideration, then oversupply of HHR is likely because ‘needs’ do not necessarily translate into ‘usage.’ Our result suggests that HHR planning should track the healthcare system as access gradually improves because, even if health care is fully accessible, individuals may not fully utilize it to the degree prescribed by their medical circumstances. Copyright © 2014 John Wiley & Sons, Ltd.     

Welfare Reform and Children's Health

This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children's health outcomes using data from the Survey of Income and Program Participation over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children's medical utilization among low‐income families. These health measures include a rating of the child's health status reported by the parents, the number of times that parents consulted a doctor, and the number of nights that the child stayed in a hospital. We compare the overall changes of health status and medical utilization for children with working and nonworking mothers. We find that the child's health status as reported by the parents is affected by the maternal employment status. Copyright © 2014 John Wiley & Sons, Ltd.