Jaeun Shin

Health care utilization among Medicare-Medicaid dual eligibles: a count data analysis.

BackgroundMedicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI) assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries.MethodsThe household component of the nationally representative Medical Expenditure Panel Survey (MEPS) 1996–2000 is used for the analysis. Total 8,262 Medicare beneficiaries are selected from the MEPS data. The Medicare beneficiary sample includes individuals who are covered by Medicare and do not have private health insurance during a given year. Zero-inflated negative binomial (ZINB) regression model is used to analyse the count data regarding health care utilization: office-based physician visits, hospital inpatient nights, agency-sponsored home health provider days, and total dental visits.ResultsDual eligibility is positively correlated with the likelihood of using hospital inpatient care and agency-sponsored home health services and the frequency of agency-sponsored home health days. Frequency of dental visits is inversely associated with dual eligibility. With respect to racial differences, dually eligible Afro-Americans use more office-based physician and dental services than white duals. Asian duals use more home health services than white duals at the 5% statistical significance level. The dual eligibility programs seem particularly beneficial to Afro-American duals.ConclusionDual eligibility has varied impact on health care utilization across service types. More utilization of home healthcare among dual eligibles appears to be the result of delayed realization of their unmet healthcare needs under the traditional Medicare-only program rather than the result of overutilization in response to the expanded benefits of the dual eligibility program. The dual eligibility program is particularly beneficial to Asian and Afro-American duals in association with the provision of home healthcare and dental benefits.

Private health insurance in South Korea: An international comparison

OBJECTIVES The goal of this study is to present the historical and policy background of the expansion of private health insurance in South Korea in the context of the National Health Insurance (NHI) system, and to provide empirical evidence on whether the increased role of private health insurance may counterbalance government financing, social security contributions, out-of-pocket payments, and help stabilize total health care spending. METHODS Using OECD Health Data 2011, we used a fixed effects model estimation. In this model, we allow error terms to be serially correlated over time in order to capture the association of private health insurance financing with three other components of health care financing and total health care spending. RESULTS The descriptive observation of the South Korean health care financing shows that social security contributions are relatively limited in South Korea, implying that high out-of-pocket payments may be alleviated through the enhancement of NHI benefit coverage and an increase in social security contributions. Estimation results confirm that private health insurance financing is unlikely to reduce government spending on health care and social security contributions. We find evidence that out-of-pocket payments may be offset by private health insurance financing, but to a limited degree. Private health insurance financing is found to have a statistically significant positive association with total spending on health care. This indicates that the duplicated coverage effect on service demand may cancel out the potential efficiency gain from market initiatives driven by the active involvement of private health insurance. CONCLUSIONS This study finds little evidence for the benefit of private insurance initiatives in coping with the fiscal challenges of the South Korean NHI program. Further studies on the managerial interplay among public and private insurers and on behavioral responses of providers and patients to a given structure of private-public financing are warranted to formulate the adequate balance between private health insurance and publicly funded universal coverage.

Direct‐to‐consumer prescription drug advertising: concerns and evidence on consumers' benefit

Purpose – The purpose of this study is to provide an overview of the economic and clinical impacts of direct‐to‐consumer (DTC) advertising on consumers and physicians.Design/methodology/approach – Controversy around the benefits and concerns associated with DTC advertising are summarized. The sources are sorted based on their position toward DTC promotions: defending or opposing. Two recent works by Woloshin et al. and by Weisseman et al. are discussed in depth to provide the empirical evidence for the impacts of DTC promotions.Findings – Notwithstanding many concerns against DTC advertising, evidence‐based papers report that both consumers and physicians are potentially benefited from it. Consumers rate the health‐related information contained in DTC advertising as important. Physicians do not feel that they are pressured to prescribe inappropriate medications driven by DTC advertising. Physicians perceive improved communication and education among DTCA‐influenced patients. However, consumers tend to ove...

Quality of care and role of health insurance among non-elderly women with disabilities.

OBJECTIVES We examined differences in the quality of health care provided by usual source of care providers between women with and without disabilities in the United States. The role of health insurance in ensuring equitable quality of care for women with disabilities was investigated. METHODS A national sample of 12,199 women aged 18-64 was drawn from the 2002 Medical Expenditure Panel Survey. Descriptive and multivariate analyses were performed to investigate the interactive associations of disability and insurance coverage with accessibility, satisfaction and adequacy of care among women. RESULTS Compared with women without disabilities, women with disabilities were more likely to experience lower quality of care in terms of accessibility of care, satisfaction with care, and adequate receipt of care. This diminished quality of care for women with disabilities was alleviated, but only to a limited extent, by health insurance coverage. A significant difference remained in the quality of care between the 2 insured subgroups. CONCLUSIONS Having health insurance was strongly associated with improved access to care and reduced unmet or delayed care among women with disabilities in the United States. In addition to an expansion of public insurance program eligibility, the quality of care provided under the public insurance system needs to be ensured to maximize appropriate and timely care for women with disabilities.

HMO plans, self-selection and utilization of health care services

This study examines the effect of health maintenance organizations (HMOs) on the use of health care services among the privately insured, nonelderly population. To consider jointly the possible self-selection bias and high frequency of zero observations in the applied utilization measures, we accommodate the endogeneity of health plan choice decisions in the censored regression model. Using data from the 2000 Medical Expenditure Panel Survey, we find strong evidence for favourable self-selection into HMO plans. Health maintenance organization enrollment is found to encourage greater use of office-based and hospital outpatient services. Overall satisfaction with the quality of care among HMO members is relatively low compared to that among nonHMO members. These findings suggest that more effort is needed to develop management strategies in HMOs in order to contain the moral hazard in utilization and assure the quality of service provided within the network of HMO providers.

Causal linkages between US and Eurodollar interest rates: further evidence

This study examines causal linkages between US and Eurodollar interest rates during 1983–2002. Recursive cointegration analysis shows that a stable cointegration relationship between the two interest rates emerges only since the early 1990s, when the Fed used federal funds rate targeting and eliminated the reserve requirement on Eurocurrency deposits. The study further reveals that bidirectional causality exists between the two rates over the period of 1993 to 2002, while unidirectional causality from Eurodollar rate to the US rate is found to exist over the period of 1983 to 1991. These findings consistently support increased interest rate linkages especially since the early 1990s.