2014 Economics & Healthcare Speaker Series

  • March 28, 2014 - May 02, 2014
  • Queen's School of Business

About the Event

Building on the success of our inaugural series, The Monieson Centre for Business Research in Healthcare presented a second line up of speakers for the Winter and Spring terms in 2014. Below, are abstracts and video interviews with the presenters.

Dr. David Chan, Assistant Professor
School of Medicine, Stanford

University Clocking Out: Shift Work in the Emergency Department

Abstract: I examine strategic behavior that results from work schedules in the emergency department (ED). Consistent with increasing time costs past end of shift (EOS), I find that physicians spend less time on patients as they approach EOS; patients arriving in the last hour prior to EOS are discharged 59% sooner than those arriving in the middle of the shift. Physicians also order more diagnostic tests and are 21% more likely to admit patients arriving in the last hour prior to EOS, suggesting discretion in the production of information for discharge decisions. I exploit variation in the structure of shifts to show that this behavior depends on the structure of shifts, as physicians reduce their acceptance of new patients near EOS but particularly before another physician peer arrives to relieve their work. Shifts with late-arriving peers, in which this reduction is delayed, show the greatest distortion in patient care. This suggests that in scheduled work it may be second-best optimal to allow workers to avoid work if they have discretion in how the work is performed.

Dr. Jonathan Kolstad, Assistant Professor of Health Care Management
Wharton School of the University of Pennsylvania

Adverse Selection and an Individual Mandate: When Theory Meets Practice

Abstract: We develop a model of selection that incorporates a key element of recent health reforms: an individual mandate. We identify a set of key parameters for welfare analysis, allowing us to model the welfare impact of the actual policy as well as to estimate the socially optimal penalty level. Using data from Massachusetts, we estimate the key parameters of the model. We compare health insurance coverage, premiums, and insurer average health claim expenditures between Massachusetts and other states in the periods before and after the passage of Massachusetts health reform. In the individual market for health insurance, we find that premiums and average costs decreased significantly in response to the individual mandate; consistent with an initially adversely selected insurance market. We are also able to recover an estimated willingness-to-pay for health insurance. Combining demand and cost estimates as sufficient statistics for welfare analysis, we find an annual welfare gain of $335 dollars per person or $71 million annually in Massachusetts as a result of the reduction in adverse selection. We also find evidence for smaller post-reform markups in the individual market, which increased welfare by another $107 dollars per person per year and about $23 million per year overall. To put this in perspective, the total welfare gains were 8.4% of medical expenditures paid by insurers. Our model and empirical estimates suggest an optimal mandate penalty of $2,190. A penalty of this magnitude would increase health insurance to near universal levels. Our estimated optimal penalty is higher than the individual mandate penalty adopted in Massachusetts but close to the penalty implemented under the ACA.

Dr. Ching-To Albert Ma, Professor of Economics
Boston University

Uterus at a Price: Disability Insurance and Hysterectomy