Shin-Yi Chou

Fast-Food Restaurant Advertising on Television and its Influence on Childhood Obesity

Childhood obesity is an escalating problem around the world that is especially detrimental as its effects carry on into adulthood. In this paper we employ the 1979 Child–Young Adult National Longitudinal Survey of Youth and the 1997 National Longitudinal Survey of Youth to estimate the effects of television fast‐food restaurant advertising on children and adolescents with respect to being overweight. A ban on these advertisements would reduce the number of overweight children ages 3–11 in a fixed population by 18 percent and would reduce the number of overweight adolescents ages 12–18 by 14 percent. The elimination of the tax deductibility of this type of advertising would produce smaller declines of between 5 and 7 percent in these outcomes but would impose lower costs on children and adults who consume fast food in moderation because positive information about restaurants that supply this type of food would not be completely banned from television.

Hospital Ownership and Cost and Quality of Care: is There a Dime's Worth of Difference?

Nonprofit organizations may predominate when output quality is difficult to monitor. Hospital care has this characteristic. This study compared program cost and quality of care for Medicare patients hospitalized following onset of four common conditions by hospital ownership. Payments on behalf of Medicare patients admitted to for-profit hospitals during the first 6 months following a health shock were higher than for those admitted to other hospitals. With quality measured in terms of survival, changes in functional and cognitive status, and living arrangements, we found no differences in outcomes by hospital ownership.

Asymmetric information, ownership and quality of care: an empirical analysis of nursing homes

Theoretically, when asymmetric information exists, nonprofit organizations, due to the attenuation of the property right, provide better quality of service than do the for-profits. Despite extensive theoretical examination of the behavior of nonprofits, there has been very little empirical testing of the plausibility of these theories. This article addresses the effect of ownership type on the quality of service in the nursing home industry, an environment particularly conducive to identifying the existence of asymmetric information. The study shows that the differences between for-profit and nonprofit homes do become manifest when asymmetric information is present.

National Health Insurance and precautionary saving: evidence from Taiwan

Abstract By reducing uncertainty about future medical expenses, comprehensive health insurance can reduce households’ precautionary saving. We examine this effect using Taiwan micro-data spanning the 1995 introduction of National Health Insurance. The effects of National Health Insurance are identified using employment-based variation in prior insurance coverage. Replacement of the households’ prior insurance coverage with National Health Insurance is exogenous to the household, so our estimates are not subject to selection bias. Compared with the preceding government insurance programs, National Health Insurance reduced saving by an average of 8.6–13.7% with the largest effects for households with the smallest saving.

Hospital ownership and performance: Evidence from stroke and cardiac treatment in Taiwan

This paper compares program expenditure and treatment quality of stroke and cardiac patients between 1997 and 2000 across hospitals of various ownership types in Taiwan. Because Taiwan implemented national health insurance in 1995, the analysis is immune from problems arising from the complex setting of the U.S. health care market, such as segmentation of insurance status or multiple payers. Because patients may select admitted hospitals based on their observed and unobserved characteristics, we employ instrument variable (IV) estimation to account for the endogeneity of ownership status. Results of IV estimation find that patients admitted to non-profit hospitals receive better quality care, either measured by 1- or 12-month mortality rates. In terms of treatment expenditure, our results indicate no difference between non-profits and for-profits index admission expenditures, and at most 10% higher long-term expenditure for patients admitted to non-profits than to for-profits.

Does Higher Hospital Cost Imply Higher Quality of Care

This study investigates whether higher input use per stay in the hospital (treatment intensity) and longer length of stay improve outcomes of care. We allow for endogeneity of intensity and length of stay by estimating a quasi-maximum-likelihood discrete factor model, where the distribution of the unmeasured variable is modeled using a discrete distribution. Data on elderly persons come from several waves of the National Long-Term Care Survey merged with Medicare claims data for 19841995 and the National Death Index. We find that higher intensity improves patient survival and some dimensions of functional status among those who survive.

Incorporating health outcomes in Pennsylvania hospital efficiency: an additive super-efficiency DEA approach

The health care sector is one of the fastest growing sectors in the United States. Researchers are interested in conducting studies in the area of health economics in order to propose solutions to curb the rapid increase in health care spending and to improve the efficiency of the health care system in the United States. Specifically, hospital efficiency is one important research area in health economics. In this paper, data envelopment analysis (DEA) is used to assess hospital efficiency. An additive super-efficiency model is presented and applied to a sample of general acute care hospitals in Pennsylvania. In addition to the conventional choice of input and output variables, we include the survival rate as a quality measure of health outcome in the set of output variables. Thus our model takes both the quantity and the quality of the output into account. With the results obtained from our proposed DEA model, inefficiencies can be identified for hospitals to address without sacrificing the quality of care.

Travel distance and health outcomes for scheduled surgery.

Background:Changes in the location and availability of surgical services change the distances that patients must travel for surgery. Identifying health effects related to travel distance is therefore crucial to evaluating policies that affect the geographic distribution of these services. We examine the health outcomes of coronary artery bypass graft (CABG) patients in Pennsylvania for evidence that traveling further to a hospital for a one-time, scheduled surgical procedure causes harm. Methods:We perform instrumental-variable regressions to test for the effect of distance to the admitting hospital on the in-hospital mortality and readmission rates of 102,858 CABG patients in Pennsylvania during 1995–2005, where the instrumental variables are constructed based on the quality of and distance to nearby CABG hospitals. Results:We found that patients living near a CABG hospital with acceptable quality traveled significantly less and if they were high-risk, had lower in-hospital mortality rates. Readmission rates in general are not affected by patients’ travel distance. Discussion:The positive correlation between travel distance and health outcomes observed by previous studies may reflect the confounding effects of behavioral factors and patient health risks. We found instead that living further from the admitting hospital increases in-hospital mortality for high-risk CABG patients. More research on the possible causes of these effects is necessary to identify optimal policy responses.

As low birth weight babies grow, can well-educated parents buffer this adverse factor? A research note

This research note combines two national Taiwanese data sets to investigate the relationships among low birth weight (LBW) babies, their parents’ educational levels, and their future academic outcomes. We find that LBW is negatively correlated with the probability of such children attending college at age 18; however, when both parents are college or high school graduates, such negative effects may be partially offset. We also show that discrimination against daughters occurs, but only for daughters who were LBW babies. Moreover, high parental education can buffer the LBW shock only among moderately LBW children (as compared with very LBW children) and full-term LBW children (as compared with preterm LBW children).

Surgeon and Hospital Volume as Quality Indicators for CABG in Taiwan: Examining Hazard to Mortality and Accounting for Unobserved Heterogeneity

OBJECTIVE To investigate whether provider volume has an impact on the hazard of mortality for coronary artery bypass grafting (CABG) patients in Taiwan. DATA SOURCES/STUDY SETTING Multiple sources of linked data from the National Health Insurance Program in Taiwan. STUDY DESIGN The linked data were used to identify 27,463 patients who underwent CABG without concomitant angioplasty or valve procedures and the surgeon and hospital volumes. Generalized estimating equations and hazard models were estimated to assess the impact of volume on mortality. The hazard modeling technique used accounts for bias stemming from unobserved heterogeneity. PRINCIPAL FINDINGS Both surgeon and hospital volume quartiles are inversely related to the hazard of mortality after CABG. Patients whose surgeon is in the three higher volume quartiles have lower 1-, 3-, 6-, and 12-month mortality after CABG, while only those having their procedure performed at the highest quartile of volume hospitals have lower mortality outcomes. CONCLUSIONS Mortality outcomes are related to provider CABG volume in Taiwan. Unobserved heterogeneity is a concern in the volume-outcome relationship; after accounting for it, surgeon volume effects on short-term mortality are large. Using models controlling for unobserved heterogeneity and examining longer term mortality may still differentiate provider quality by volume.