Browsing by Author "Baker Institute for Public Policy"
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Item Association of Level I and II Trauma Center Expansion With Insurer Payments in Texas From 2011 to 2019(American Medical Association, 2022) Ho, Vivian; Short, Marah N.; Coughlin, Maura; McClure, Shara; Suliburk, James W.; Baker Institute for Public PolicyItem Balancing economic and epidemiological interventions in the early stages of pathogen emergence(AAAS, 2023) Dobson, Andy; Ricci, Cristiano; Boucekkine, Raouf; Gozzi, Fausto; Fabbri, Giorgio; Loch-Temzelides, Ted; Pascual, Mercedes; Baker Institute for Public PolicyThe global pandemic of COVID-19 has underlined the need for more coordinated responses to emergent pathogens. These responses need to balance epidemic control in ways that concomitantly minimize hospitalizations and economic damages. We develop a hybrid economic-epidemiological modeling framework that allows us to examine the interaction between economic and health impacts over the first period of pathogen emergence when lockdown, testing, and isolation are the only means of containing the epidemic. This operational mathematical setting allows us to determine the optimal policy interventions under a variety of scenarios that might prevail in the first period of a large-scale epidemic outbreak. Combining testing with isolation emerges as a more effective policy than lockdowns, substantially reducing deaths and the number of infected hosts, at lower economic cost. If a lockdown is put in place early in the course of the epidemic, it always dominates the “laissez-faire” policy of doing nothing.Item Competition in Business Taxes and Public Services: Are Production-Based Taxes Superior to Capital Taxes?(National Tax Association, 2015) Gugl, Elisabeth; Zodrow, George R.; Baker Institute for Public PolicyAlthough most of the tax competition literature focuses on the provision of local public services to households, several papers analyze tax competition when capital taxes are used to finance local public services provided to businesses, examining the conditions under which such services are provided efficiently, under-provided, or over-provided. In addition, several prominent observers have noted that “benefit-related” business taxation is desirable on both efficiency and equity grounds and argued that such taxation should take the form of a tax based on production, such as an origin-based value-added tax. We evaluate this contention in this paper, comparing the relative efficiency properties of these alternative business taxes. Our simulation results suggest that under many, but not all, circumstances it is more efficient to finance business public services with an origin-based production tax rather than a source-based capital tax.Item Employment among Patients Starting Dialysis in the United States(American Society of Nephrology, 2018) Erickson, Kevin F.; Zhao, Bo; Ho, Vivian; Winkelmayer, Wolfgang C.; Baker Institute for Public PolicyBACKGROUND AND OBJECTIVES: Patients with ESRD face significant challenges to remaining employed. It is unknown when in the course of kidney disease patients stop working. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We examined employment trends over time among patients ages 18-54 years old who initiated dialysis in the United States between 1996 and 2013 from a national ESRD registry. We compared unadjusted trends in employment at the start of dialysis and 6 months before ESRD and used linear probability models to estimate changes in employment over time after adjusting for patient characteristics and local unemployment rates in the general population. We also examined employment among selected vulnerable patient populations and changes in employment in the 6 months preceding dialysis initiation. RESULTS: Employment was low among patients starting dialysis throughout the study period at 23%-24%, and 38% of patients who were employed 6 months before ESRD stopped working by dialysis initiation. However, after adjusting for observed characteristics, the probability of employment increased over time; patients starting dialysis between 2008 and 2013 had a 4.7% (95% confidence interval, 4.3% to 5.1%) increase in the absolute probability of employment at the start of dialysis compared with patients starting dialysis between 1996 and 2001. Black and Hispanic patients were less likely to be employed than other patients starting dialysis, but this gap narrowed during the study period. CONCLUSIONS: Although working-aged patients in the United States starting dialysis have experienced increases in the adjusted probability of employment over time, employment at the start of dialysis has remained low.Item Hemodialysis Versus Peritoneal Dialysis Drug Expenditures: A Comparison Within the Private Insurance Market(Elsevier, 2023) Bhatnagar, Anshul; Niu, Jingbo; Ho, Vivian; Winkelmayer, Wolfgang C.; Erickson, Kevin F.; Baker Institute for Public PolicyRationale and Objective Recent initiatives aim to improve patient satisfaction and autonomy by increasing the use of peritoneal dialysis (PD) in the United States. However, limited knowledge is available about the costs of different dialysis modalities, particularly those incurred by private insurers. In this study, we compared the costs of injectable dialysis drugs (and their oral equivalents) paid by insurers between privately insured patients receiving hemodialysis and PD. Study Design A retrospective cohort study. Setting and Participants From a private insurance claims database, we identified patients who started receiving PD or in-center hemodialysis between January 1, 2017, and December 31, 2020. Exposure Patients started receiving PD. Outcomes Average annual injectable drug and aggregate expenditures and expenditure subcategories. Analytical Approach Patients who started receiving PD were propensity matched to similar patients who started receiving hemodialysis based on the year of dialysis initiation, patient demographics, health, geography, and comorbidities. Cost ratios (CRs) were estimated from generalized linear models. Results We matched 284 privately insured patients who started receiving PD 1:1 with patients started receiving in-center hemodialysis. The average annual injectable drug expenditures for hemodialysis were 2-fold higher (CR: 1.99; 95% CI, 1.62-2.44) than that for PD. Compared those receiving PD, patients receiving hemodialysis incurred significantly lower nondrug dialysis-related expenditures (0.85; 95% CI, 0.76-0.94). The average annual expenditures for non–dialysis-dependent outpatient services were significantly higher among patients who underwent in-center hemodialysis (CR: 1.44; 95% CI, 1.10-1.90). Although aggregate and inpatient hospitalization expenditures were higher for in-center hemodialysis, these differences did not reach statistical significance. Limitations Small sample sizes may have restricted our ability to identify differences in some cost categories. Conclusions Compared with privately insured patients who started receiving PD, patients starting in-center hemodialysis incurred higher expenditures for injectable dialysis drugs, whereas differences in other expenditure categories varied. Recent increases in the use of PD may lead to reductions in injectable dialysis drug costs among privately insured patients. Plain Language Summary Recent initiatives aim to improve patient satisfaction and autonomy by increasing the use of peritoneal dialysis (PD) in the United States. However, limited knowledge is available about the costs of different dialysis modalities, particularly those incurred by private insurers. In this study, we compared the costs of injectable dialysis drugs (and their oral equivalents) provided by insurers between privately insured patients receiving hemodialysis and PD. We found that the average annual injectable drug expenditures for hemodialysis were 2.0-fold higher compared with those for PD. These findings suggest that the recent increase in the use of PD may lead to reductions in injectable dialysis drug costs among privately insured patients.Item Refinement of the Affordable Care Act(Annual Reviews, 2018) Ho, Vivian; Baker Institute for Public PolicyRegardless of what legislation the federal government adopts to address health insurance coverage for nonelderly Americans, private insurance will likely play a major role. This article begins by listing some of the major reasons critics dislike the Affordable Care Act (ACA), then discusses the validity of these concerns from an economics perspective. Criticisms of the ACA include the increased role of government in health care, the ACA's implicit income redistribution, and concern about high and rising insurance premiums. Suggestions for refining the ACA and its market-based insurance system are then offered, with the goals of lowering insurance premiums, improving coverage rates, and/or addressing the concerns of ACA critics. Americans favor the increase in insurance coverage that has occurred under the ACA. In order to sustain this level of coverage, steps to lower Marketplace premiums through a variety of strategies affecting potential enrollees, insurers, and healthcare providers are offered.Item The Perils of Complacency: America at a Tipping Point in Science & Engineering(American Academy of Arts & Sciences, 2020) American Academy of Arts & Sciences; Baker Institute for Public PolicyThis consensus report jointly published by the American Academy of Arts & Sciences and Rice University's Baker Institute for Public Policy examines current and historical challenges to America's leadership in scientific research and development and makes recommendations for improving the U.S. science, technology, and innovation policy.