Andrew Friedson

Recessions and health revisited: New findings for working age adults

HighlightsUnemployment increases mortality for the working age population.The increase is driven by education group specific unemployment, not state level unemployment.This connects two strands of the literature that show general unemployment as bad for the health of the elderly and job loss as bad for the health of the working aged. ABSTRACT A series of influential papers have documented that state level mortality rates decrease during economic downturns. In this paper, we estimate the effect of education specific unemployment rates on mortality, which provide a more exact measure of the likelihood of being directly impacted by a recession. We find that the unemployment rate of an education group in a given state is positively related to mortality in that group. A 1% increase in the group‐specific unemployment rate is associated with an approximately 0.015% increase in the group‐specific mortality rate, which is consistent with the hypothesis that, while state‐level unemployment may have indirect health benefits, being personally affected by a recession has a detrimental effect on health.

Medical Malpractice Damage Caps and Provider Reimbursement

A common state legislative maneuver to combat rising healthcare costs is to reform the tort system by implementing caps on noneconomic damages awardable in medical malpractice cases. Using the implementation of caps in several states and large database of private insurance claims, I estimate the effect of damage caps on the amount providers charge to insurance companies as well as the amount that insurance companies reimburse providers for medical services. The amount providers charge insurers is unresponsive to tort reform, but the amount that insurers reimburse providers decreases for some procedures. Copyright

The Affordable Care Act and Ambulance Response Times

This study contributes to the literature on supply-side adjustments to insurance expansions by examining the effect of the Affordable Care Act (ACA) on ambulance response times. Exploiting temporal and geographic variation in the implementation of the ACA as well as pre-treatment differences in uninsured rates, we estimate that the expansions of private and Medicaid coverage under the ACA combined to slow ambulance response times by an average of 19%. We conclude that, through extending coverage to individuals who, in its absence, would not have availed themselves of emergency medical services, the ACA added strain to emergency response systems.

Mandated Health Insurance and Provider Reimbursement via Private Insurance: Evidence From the Massachusetts Health Reform

In 2006, Massachusetts passed a reform that required individuals to purchase health insurance and provided subsidized health insurance to low-income individuals. The US Patient Protection and Affordable Care Act (ACA) was modeled after this reform, making Massachusetts an ideal place to look at potential outcomes from the ACA. Postreform, the proportion of the health-insured population in Massachusetts greatly increased, which potentially changed physician reimbursement for procedures as usage of care, particularly preventative care for children increased. We find that reimbursement for well-infant visits rose temporarily by approximately 4% the year after the reform but that the effective price increase did not persist. It is likely that this lack of persistence is due to an increase in the supply of physicians. This has important implications for the ACA, as expanding physician capacity is more difficult on a national level.

Medical Scribes as an Input in Health-Care Production: Evidence from a Randomized Experiment

Medical scribes are charting specialists who prepare patient charts in the physicians stead, creating efficiency gains in production via specialization of labor. The scribe industry has grown rapidly in recent years, but relatively little is known about its impact on health-care production. I use data from a randomized experiment in which scribes were assigned to some, but not all, physician shifts in three emergency rooms over nine months. Generally, I find that scribes significantly decrease physician overtime usage, increase the number of relative value units per shift, and decrease patient wait times. The size of the benefits of scribes varies considerably based on the types of shifts worked and characteristics of the physician matched with the scribe.

Gains from Specialization with Medical Scribes: Evidence from a Randomized Experiment

This paper estimates the impact of medical scribes on various measures of physician productivity. Scribes are charting specialists who prepare patient charts in the physician’s stead, potentially creating efficiency gains in productivity via specialization of labor. The scribe industry has grown rapidly in recent years, but relatively little is known about its effects. I use data from a randomized experiment in which scribes were assigned to some, but not all, physician shifts in three emergency rooms over nine months. I find that scribes significantly decrease physician overtime usage and increase the number of relative value units per shift.

The impact of agglomeration economies on hospital input prices

This paper examines the extent to which agglomeration of the hospital service industry enhances the productivity of producing health care. Specifically, we use a large set of private insurance claims from the FAIR Health database to show that an increasing spatial concentration of hospital services results in a decreased cost of obtaining intermediate medical services. We explicitly test whether the reduced cost at concentrated locations arises from the ability to share intermediate service providers. The identification relies on state variation in medical lab technician licensure requirements, which influence the cost of intermediate services only through the cost of running a lab. Our findings suggest that agglomeration of the hospital service industry attracts specialized medical labs, which in turn help to reduce the cost of producing laboratory tests.