Overseas Deployment, Combat Exposure, and Well-Being in the 2010 National Survey of Veterans, by Ryan D. Edwards (The National Bureau of Economic Research)
Recent military engagements in Iraq (OIF) and Afghanistan (OEF) raise questions about the effects on service members of overseas deployment, which can include service in a combat or war zone, exposure to casualties, or both. The 2010 National Survey of Veterans, which asked a broad cross section of living veteran cohorts about deployment to OEF/OIF and combat exposure, provides some new insights into short and long-term relationships between characteristics of military service and outcomes. Analysis of these data suggests that the impacts of deployment and combat on the current socioeconomic well-being of returning OEF/OIF veterans may be relatively small, but the effects of combat exposure on self-reported health and other nonpecuniary indicators of their well-being appear to be negative. Among older veteran cohorts, where there is clearer sorting into treatment and control groups because of strong variation in combat exposure by year of birth, patterns are broadly similar. These results are consistent with a veterans compensation system that replaces lost earnings but does not necessarily compensate for other harms associated with combat exposure such as mental health trauma.
Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California, by N. Meltem Daysa (Journal of Health Economics)
In this paper, I examine the impact of uninsured patients on the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999–2006). My results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection or unobserved trends and that they are robust to a host of specification checks. The primary channel for the observed spillover effects is increased hospital uncompensated care costs. Although data limitations constrain my capacity to check how hospitals change their provision of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff.
The Effect of Medicaid Eligibility on Coverage, Utilization, and Children’s Health by Dolores De La Mata (Health Economics)
I estimate the causal impact of Medicaid eligibility on take up, private health insurance coverage, healthcare utilization, and children’s health by using a regression discontinuity design. In contrast to a standard regression discontinuity design, identification exploits multiple thresholds that arise from variation across states in income eligibility rules. Using data from the Panel Study of Income Dynamics and its Child Development Study supplement, I find that Medicaid eligibility increases take up by 10–13 percentage points on average, rising to 24–29 percentage points at lower income eligibility thresholds. There are significant crowding out effects of the same magnitude as those on take up rates. Medicaid eligibility increases the use of preventive health care by 11–14 percentage points but only at low income thresholds. Finally, I find that Medicaid eligibility has no significant effects on health outcomes in the short and medium run.
The Impact of the Medicaid/CHIP Expansions on Children. A Synthesis of the Evidence, by Embry M. Howell and Genevieve M. Kenney (Medical Care Research and Review)
This article reviews findings from 38 rigorous studies published in the peer-reviewed literature of the impact of the Medicaid/Children’s Health Insurance Program (CHIP) expansions on children. There is strong evidence for increases in enrollment in public programs and reductions in uninsurance following eligibility expansions. Medicaid enrollment continued to increase during the CHIP era (a “spillover effect”). Evidence for improved access to and use of services, particularly for dental care, is also very strong. There are fewer studies of health status impacts, and the evidence is mixed. There is a very wide range in the size of effects estimated in the studies reviewed because of the methods used and the populations studied. The review identifies several important research gaps on this topic, particularly the small number of studies of the effects on health status. Both research methods and findings from the child expansions can provide insights for evaluating the coming expansions for adults under the Affordable Care Act.
The Effect of Adult HIFA Waiver Expansions on Insurance Coverage of Children, by Adam Atherly, Robert F. Coulam, Bryan E. Dowd and Gery Guy (Medical Care Research and Review)
This article evaluates the effect of the Health Insurance Flexibility and Accountability (HIFA) demonstrations on uninsurance rates among children. HIFA could increase the probability that children would have health insurance either by directly enrolling a child into a HIFA program or by creating a “spillover” effect from adults onto children by making parents of children already eligible for public programs eligible for HIFA. Data were drawn from the Current Population Survey from 2000 to 2007. The estimation approach was a probit model using a difference-in-differences approach. The authors find that the HIFA wavier demonstrations had no measureable effect on the uninsurance rate among children, either through direct eligibility or through a “spillover” effect from parental eligibility. This suggests that public programs that integrate family insurance coverage into a single structure are likely to be more effective at reducing the rate of uninsurance than different programs for different members of the same family.
One Fish, Two Fish, Red Fish, Blue Fish. Effects of Price Frames, Brand Names, and Choice Set Size on Medicare Part D Insurance Plan Decisions, by Andrew J. Barnes, Yaniv Hanoch, Stacey Wood, Pi-Ju Liu and Thomas Rice (Medical Care Research and Review)
Because many seniors choose Medicare Part D plans offering poorer coverage at greater cost, the authors examined the effect of price frames, brand names, and choice set size on participants’ ability to choose the lowest cost plan. A 2 × 2 × 2 within-subjects design was used with 126 participants aged 18 to 91 years old. Mouselab, a web-based program, allowed participants to choose drug plans across eight trials that varied using numeric or symbolic prices, real or fictitious drug plan names, and three or nine drug plan options. Results from the multilevel models suggest numeric versus symbolic prices decreased the likelihood of choosing the lowest cost plan (−8.0 percentage points, 95% confidence interval = −14.7 to −0.9). The likelihood of choosing the lowest cost plan decreased as the amount of information increased suggesting that decision cues operated independently and collectively when selecting a drug plan. Redesigning the current Medicare Part D plan decision environment could improve seniors’ drug plan choices.