Adam Leive

Economic Transition and Health Care Reform: The Experience of Europe and Central Asia

This paper exploits the staggered adoption of major concurrent health reforms in countries in Europe and Central Asia after 1990 to estimate their impact on public health expenditure, utilization, and avoidable deaths. While the health systems all derived from the same paradigm under central planning, they have since introduced changes to policies regarding cost-sharing, provider payment, financing, and the rationalization of hospital infrastructure. Provider payment reforms produce the largest impact on spending, with fee-for-service increasing spending and patient-based payment reducing it. The impact on avoidable deaths is generally negligible, but there is some evidence of improvements due to fee-for-service.

“Sticker Shock” in Individual Insurance under Health Reform?

We provide estimates of changes in the annual expected price for insured medical care—defined as the sum of premiums and expected out-of-pocket payments—after the Affordable Care Act (ACA) among consumers who previously bought individual insurance. Using the best available data from the Current Population Survey (CPS) and the Medical Expenditure Panel Survey (MEPS), we find that average prices did not increase substantially in California and in states with federally run exchanges. Our central estimates based on MEPS data on out-of-pocket payments suggest that average prices would not change significantly if the lowest-priced Bronze plan were selected, whereas prices would increase from 8 to 15 percent if the second-lowest-priced Silver plan were selected. (Alternative estimates using CPS data on out-of-pocket spending suggest somewhat higher price increases.) Potentially offsetting changes in the risk premium associated with moving from pre-reform coverage to either Bronze or Silver coverage are estimated to be generally small for younger buyers, but offset price increases for some older buyers, especially older women.

The unanticipated consequences of postponing the employer mandate.

The Obama administrations delay in implementing the employer mandate affects other provisions of the ACA, particularly subsidies for purchasing insurance, and creates distorted incentives that may leave the government paying significantly more than planned.

Do national cancer screening guidelines reduce mortality

The effectiveness of cancer screening is a salient health policy issue that remains unresolved. This article sheds new light on the benefits of population-wide cancer screening. We investigate changes in mortality after the introduction of screening guidelines for breast and prostate cancers in the USA and UK. We use differences in the timing of guideline adoption, differences in ages recommended for screening, and differences in which cancers are detectable by screening to identify the effect of cancer screening guidelines. Our quadruple-differencing strategy finds a moderately sized mortality benefit from mammography and prostate-specific antigen (PSA) screening guidelines among recommended age groups and little change in mortality rates among age groups not recommended to receive screening. As a falsification test, we verify that prostate cancer rates among men did not fall after the introduction of mammography screening and breast cancer rates among women did not fall after the introduction of the PSA test.