Andrew Sfekas

Does major illness cause financial catastrophe

OBJECTIVE We examine the financial impact of major illnesses on the near-elderly and how this impact is affected by health insurance. DATA SOURCES We use RAND Corporation extracts from the Health and Retirement Study from 1992 to 2006.(1) STUDY DESIGN Our dependent variable is the change in household assets, excluding the value of the primary home. We use triple difference median regressions on a sample of newly ill/uninsured near elderly (under age 65) matched to newly ill/insured near elderly. We also include a matched control group of households whose members are not ill. RESULTS Controlling for the effects of insurance status and illness, we find that the median household with a newly ill, uninsured individual suffers a statistically significant decline in household assets of between 30 and 50 percent relative to households with matched insured individuals. Newly ill, insured individuals do not experience a decline in wealth. CONCLUSIONS Newly ill/uninsured households appear to be one illness away from financial catastrophe. Newly ill insured households who are matched to uninsured households appear to be protected against financial loss, at least in the near term.

Learning, forgetting, and hospital quality: an empirical analysis of cardiac procedures in Maryland and Arizona

This paper sets out an empirical model of learning with forgetting and uses it to estimate how much hospital quality improves with experience. The size of the learning effect and the depreciation rate are estimated for two cardiac procedures in Maryland and Arizona. Models are estimated using patient survival as the outcome of interest. The results show that learning does not appear to be a factor in hospital quality for either procedure or for surgery generally. From a policy standpoint, based on these results, regulations in Maryland that seek to concentrate these two procedures among a small number of providers could not be justified on the grounds that higher volume would increase the quality of care.

Just passing through: the effect of the Master Settlement Agreement on estimated cigarette tax price pass-through

In 1998, cigarette manufacturers and state attorneys general in the United States settled a group of lawsuits in an agreement known as the Master Settlement Agreement (MSA). Among the provisions of this agreement were a set of mandated escrow payments to the states that would be based on cigarette sales. The result of these provisions is that the apparent relationship between taxes and prices changed substantially following implementation of the MSA. This article estimates whether the MSA escrow amounts are reflected in prices and compares the pass-through rate of state and federal cigarette taxes only and the rate when one adds escrow payments. We find much different pass-through rates for the two measures. State and federal taxes are not fully passed to smokers. In years that escrow payments were made, cigarette prices increased by more than the sum of the state and federal taxes and the escrow payments.

Determinants of pharmaceutical sales representative access limits to physicians

Pharmaceutical companies have traditionally relied on product-specific in-person calls to physicians (detailing) to market their drugs. However, US pharmaceutical sales representative access to phy...

Anticipating Ovarian Tissue Cryopreservation in the Health-Care Marketplace: A Willingness to Pay Assessment

The developing fertility preservation technologies offer new options, but not without a cost. As the technologies become integrated into the healthcare marketplace, cost will become an even greater issue. A critical question in this discussion is whether young women and their parents would be willing to pay for insurance to cover the cost of these procedures.