Thomas C. Buchmueller

Switching costs, price sensitivity and health plan choice

We investigate the extent to which sensitivity to health plan premiums differs across individuals according to characteristics related to the cost of switching plans. Our results indicate substantial variation in price sensitivity related to expected health care costs: younger, healthier employees are between two and four times more sensitive to price than employees who are older and who have been recently hospitalized or diagnosed with cancer. We also find evidence of status quo bias: estimated premium elasticities are significantly higher for new hires than for incumbent employees. Simulations combining our results with actuarial data illustrate the cost implications of risk-related differences in price elasticity.

Disparities in Health Insurance Coverage, Access, and Outcomes for Individuals in Same-Sex Versus Different-Sex Relationships, 2000–2007

OBJECTIVES We used data from the Behavioral Risk Factor Surveillance System to compare health insurance coverage, access to care, and womens cancer screenings for individuals in same-sex versus different-sex relationships. METHODS We estimated logistic regression models by using data on 5265 individuals in same-sex relationships and 802,659 individuals in different-sex relationships. RESULTS Compared with women in different-sex relationships, women in same-sex relationships were significantly less likely to have health insurance coverage, were less likely to have had a checkup within the past year, were more likely to report unmet medical needs, and were less likely to have had a recent mammogram or Pap test. Compared with men in different-sex relationships, men in same-sex relationships were significantly less likely to have health insurance coverage and were more likely to report unmet medical needs, although they were more likely to have had a checkup in the past year. CONCLUSIONS In the largest and most recent nationally representative sample, we found important differences in health insurance coverage and access to care between individuals in same-sex relationships and those in different-sex relationships for both men and women.

The effect of price on switching among health plans

A recent policy change by the University of California (UC) provides a unique natural experiment for investigating the sensitivity of consumers to health plan premiums. When the UC moved to a policy of limiting its contribution to the cost of the least expensive plan, out-of-pocket premiums increased for roughly one-third of UC employees. We examine the extent to which UC employees switched plans in response to this change in premiums. Our results indicate a strong response. Individuals facing premium increases of less than

The effect of health insurance on medical care utilization and implications for insurance expansion: a review of the literature.

10 were roughly 5 times as likely to switch plans as those whose premiums remained constant.

Graduate training and the early career productivity of Ph.D. economists

Both the costs and benefits associated with extending health insurance coverage depend on the extent and exact ways in which health insurance affects the utilization of medical care. We review the literature relating to such effects with the goal of informing researchers interested in simulating the impact of policy initiatives aimed at achieving universal coverage. Overall, this literature is quite consistent in finding significant effects of insurance on all types of utilization. Insurance coverage increases outpatient utilization by roughly 1 visit per year for children and between 1 and 2 visits for adults. For both children and adults, these visits are associated with an increased receipt of preventive care. Insurance coverage also increases inpatient utilization for children and adults; for children, there is some evidence that insurance coverage reduces ambulatory care sensitive hospital admissions.

Preferences and choices for care and health insurance

Abstract This paper estimates the relationships among the attributes of graduate economics programs and the occupational choices and publishing proficiency of recent Ph.D.s. The estimates indicate that research experience in graduate school (e.g. working as a research assistant, submitting and publishing articles) is positively associated with subsequent publishing proficiency. Other variables included in the analysis include graduate school ranking, graduate school faculty size and its publishing proficiency, and individual demographic characteristics and academic experiences.

Drug use, drug abuse, and labour market outcomes

Legislation that came into effect in 2006 has dramatically altered the health insurance system in the Netherlands, placing greater emphasis on consumer choice and competition among insurers. The potential for such competition depends largely on consumer preferences for price and quality of service by insurers and quality of affiliated providers. This study provides initial evidence on the preferences of Dutch consumers and how they view trade-offs between various aspects of health insurance product design. A key feature of the analysis is that we compare the responses of high and low risk individuals, where risk is defined by the presence of a costly chronic condition. This contrast is critically important for understanding incentives facing insurers and for identifying potential unanticipated consequences of market competition. The results from our conjoint analysis suggest that not only high risk but also low risk individuals are willing to pay substantially more for insurance products that can be shown to provide better health outcomes. This suggests that insurance products that are more expensive and provide better quality of care may also attract low risk individuals. Therefore, development and dissemination of good, reliable and understandable health plan performance indicators may effectively reduce the problem of adverse selection.

Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage

This paper examines the relationship between illicit drug use and labour market success, and in doing so addresses two shortcomings of the previous literature. First, unlike many previous analyses, ours accounts for differences in intensity of use using clinically based diagnostic measures. Second, while recent studies focus only on young adults, we analyze a prime-age (30-45-year-olds) sample as well. Our results indicate that these differences are important. Similar to previous studies, we find evidence of a positive relationship between drug use and income for young workers. However, we also find some evidence of lower incomes for young workers reporting daily use of illicit drugs. For prime-age men, we find strong evidence that problematic drug use (as indicated by either a diagnosis of pathological use or dependence or by daily use) is negatively related to income. We also find a negative relationship between problematic use and employment among prime-age, but not younger, men.

The Effect of Medicaid Payment Rates on Access to Dental Care among Children

OBJECTIVES To document how health insurance coverage changed for White, Black, and Hispanic adults after the Affordable Care Act (ACA) went into effect. METHODS We used data from the American Community Survey from 2008 to 2014 to examine changes in the percentage of nonelderly adults who were uninsured, covered by Medicaid, or covered by private health insurance. In addition to presenting overall trends by race/ethnicity, we stratified the analysis by income group and state Medicaid expansion status. RESULTS In 2013, 40.5% of Hispanics and 25.8% of Blacks were uninsured, compared with 14.8% of Whites. We found a larger gap in private insurance, which was partially offset by higher rates of public coverage among Blacks and Hispanics. After the main ACA provisions went into effect in 2014, coverage disparities declined slightly as the percentage of adults who were uninsured decreased by 7.1 percentage points for Hispanics, 5.1 percentage points for Blacks, and 3 percentage points for Whites. Coverage gains were greater in states that expanded Medicaid programs. CONCLUSIONS The ACA has reduced racial/ethnic disparities in coverage, although substantial disparities remain. Further increases in coverage will require Medicaid expansion by more states and improved program take-up in states that have already done so.

Health care factors related to stage at diagnosis and survival among medicare patients with colorectal cancer

We examine the effect of payment rates on access to dental care among children on Medicaid and on dentists’ participation in Medicaid. Using data from the Survey of Income and Program Participation combined with data on dental fees from 2001 to 2010 and conditioning on state fixed effects, we find a modest positive relationship between Medicaid payment rates and dental care utilization. We test whether higher fees increase the number of dentists accepting Medicaid patients using data from annual surveys of dentists conducted by the American Dental Association between 1999 and 2009. We find a positive, though small, effect of Medicaid payment rates on whether a dentist treats any publicly insured patients and the percentage of the practice’s patients who have public insurance. The estimates imply that increasing Medicaid payments to the level of private market fees would increase access to care, but at a high cost of inducing additional visits.