Browsing by Author "Dugan, Jerome"

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    Do all chronically ill persons benefit equally from Medicare?
    (James A. Baker III Institute for Public Policy;Baylor College of Medicine, 2012) Dugan, Jerome; Virani, Salim S.; Ho, Vivian; James A. Baker III Institute for Public Policy
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    Essays on Healthcare Access, Use, and Cost Containment
    (2012-09-05) Dugan, Jerome; Ho, Vivian; Boylan, Richard T.; Scott, David W.
    This dissertation is composed of two essays that examine the role of public and private health insurance on healthcare access, use, and cost containment. In Chapter 1, Dugan, Virani, and Ho examine the impact of Medicare eligibility on healthcare utilization and access. Although Medicare eligibility has been shown to generally increase health care utilization, few studies have examined these relationships among the chronically ill. We use a regression-discontinuity framework to compare physician utilization and financial access to care among people before and after the Medicare eligibility threshold at age 65. Specifically, we focus on coronary heart disease and stroke (CHDS) patients. We find that Medicare eligibility improves health care access and physician utilization for many adults with CHDS, but it may not promote appropriate levels of physician use among blacks with CHDS. My second chapter examines the extent to which the managed care backlash affected managed care's ability to contain hospital costs among short-term, non-federal hospitals between 1998 and 2008. My analysis focuses on health maintenance organizations (HMOs), the most aggressive managed care model. Unlike previous studies that use cross-sectional or fixed effects estimators to address the endogeneity of HMO penetration with respect to hospital costs, this study uses a fixed effects instrumental variable approach. The results suggest two conclusions. First, I find the impact of increased HMO penetration on costs declined over the study period, suggesting regulation adversely impacted managed care's ability to contain hospital costs. Second, when costs are decomposed into unit costs by hospital service, I find the impact of increased HMO penetration on inpatient costs reversed over the study period, but HMOs were still effective at containing outpatient costs.
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    Why Are Hospital Prices Rising?
    (2013) Ho, Vivian; Dugan, Jerome; Ku-Goto, Meei-Hsiang; James A. Baker III Institute for Public Policy
    The substantial rise in health care expenditures that has occurred in the U.S. has been accompanied by rapid increases in the prices that hospitals receive for treating privately insured patients. We use data on revenues by payer type to identify the determinants of rising hospital prices in Texas between 2000 and 2007. Approximately two-thirds of the increase in prices can be explained by increases in the costs of care, which may reflect technology growth. Part of this cost increase could also be attributable to sicker patient populations, as patients with less severe conditions are increasingly treated in freestanding facilities. We find little evidence that rising hospital prices are attributable to increased hospital market competition, and no firm evidence that hospitals are raising prices in response to lower reimbursement from Medicare, Medicaid, or uninsured/selfpay patients. We can explain more than half of the observed price increase with hospital, patient, and market characteristics, but a sizable portion remains unexplained. Finding the optimal policies for controlling hospital price increases will require additional research to identify all of the underlying factors determining prices in this market.