IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v30y2021i11p2780-2793.html
   My bibliography  Save this article

Understanding the distributional impacts of health insurance reform: Evidence from a consumer cost‐sharing program

Author

Listed:
  • Marion Aouad
  • Timothy T. Brown
  • Christopher M. Whaley

Abstract

We examine the heterogeneous effects of reference pricing, a health insurance reform introduced by the California Public Employees' Retirement System (CalPERS), on the distribution of spending by patients and insurers. Using medical claims data for CalPERS and a comparison group not subject to reference pricing, we use the changes‐in‐changes approach to estimate the quantile treatment effects of the program across different medical procedures. We find that the quantile treatment effects vary across the patient spending distributions, with a range of positive and negative estimates of the QTE, depending on the medical procedure considered. However, across all procedures, the insurer's spending distributions tend to shift left, with the largest reductions occurring in the right‐tail of the spending distributions. These effects are not captured by mean estimates but have important policy implications.

Suggested Citation

  • Marion Aouad & Timothy T. Brown & Christopher M. Whaley, 2021. "Understanding the distributional impacts of health insurance reform: Evidence from a consumer cost‐sharing program," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2780-2793, November.
    • Handle: RePEc:wly:hlthec:v:30:y:2021:i:11:p:2780-2793
    DOI: 10.1002/hec.4410
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.4410
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.4410?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Ziliak, Stephen T. & McCloskey, Deirdre N., 2004. "Size matters: the standard error of regressions in the American Economic Review," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 33(5), pages 527-546, November.
    2. Susan Athey & Guido W. Imbens, 2006. "Identification and Inference in Nonlinear Difference-in-Differences Models," Econometrica, Econometric Society, vol. 74(2), pages 431-497, March.
    3. Matteo Galizzi & Simone Ghislandi & Marisa Miraldo, 2011. "Effects of Reference Pricing in Pharmaceutical Markets," PharmacoEconomics, Springer, vol. 29(1), pages 17-33, January.
    4. Jonathan Gruber & Robin McKnight, 2016. "Controlling Health Care Costs through Limited Network Insurance Plans: Evidence from Massachusetts State Employees," American Economic Journal: Economic Policy, American Economic Association, vol. 8(2), pages 219-250, May.
    5. Havnes, Tarjei & Mogstad, Magne, 2015. "Is universal child care leveling the playing field?," Journal of Public Economics, Elsevier, vol. 127(C), pages 100-114.
    6. Aouad, Marion & Brown, Timothy T. & Whaley, Christopher M., 2019. "Reference pricing: The case of screening colonoscopies," Journal of Health Economics, Elsevier, vol. 65(C), pages 246-259.
    7. Whaley, Christopher M. & Brown, Timothy T., 2018. "Firm responses to targeted consumer incentives: Evidence from reference pricing for surgical services," Journal of Health Economics, Elsevier, vol. 61(C), pages 111-133.
    8. Whaley, Christopher M. & Guo, Chaoran & Brown, Timothy T., 2017. "The moral hazard effects of consumer responses to targeted cost-sharing," Journal of Health Economics, Elsevier, vol. 56(C), pages 201-221.
    9. Brigham R. Frandsen & Lars J. Lefgren, 2018. "Testing Rank Similarity," The Review of Economics and Statistics, MIT Press, vol. 100(1), pages 86-91, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Aouad, Marion & Brown, Timothy T. & Whaley, Christopher M., 2019. "Reference pricing: The case of screening colonoscopies," Journal of Health Economics, Elsevier, vol. 65(C), pages 246-259.
    2. Huebener, Mathias & Kuger, Susanne & Marcus, Jan, 2017. "Increased instruction hours and the widening gap in student performance," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 47, pages 15-34.
    3. Cremer, Helmuth & Lozachmeur, Jean-Marie, 2022. "Coinsurance vs. co-payments: Reimbursement rules for a monopolistic medical product with competitive health insurers," Journal of Health Economics, Elsevier, vol. 84(C).
    4. Timothy Tyler Brown & Juan Pablo Atal, 2019. "How robust are reference pricing studies on outpatient medical procedures? Three different preprocessing techniques applied to difference‐in differences," Health Economics, John Wiley & Sons, Ltd., vol. 28(2), pages 280-298, February.
    5. Gregory, Terry & Zierahn, Ulrich, 2022. "When the minimum wage really bites hard: The negative spillover effect on high-skilled workers," Journal of Public Economics, Elsevier, vol. 206(C).
    6. David Autor & David Figlio & Krzysztof Karbownik & Jeffrey Roth & Melanie Wasserman, 2023. "Males at the Tails: How Socioeconomic Status Shapes the Gender Gap," The Economic Journal, Royal Economic Society, vol. 133(656), pages 3136-3152.
    7. Emre Akgunduz & Egbert Jongen & Paul P.M. Leseman & Janneke Plantenga, 2015. "Quasi-experimental evidence on the relation between child care subsidies and child care quality," CPB Discussion Paper 310, CPB Netherlands Bureau for Economic Policy Analysis.
    8. Terry Gregory & Ulrich Zierahn, 2020. "When the Minimum Wage Really Bites Hard: Impact on Top Earners and Skill Supply," CESifo Working Paper Series 8540, CESifo.
    9. ANDREOLI Francesco & HAVNES Tarjei & LEFRANC Arnaud, 2014. "Equalization of opportunity: Definitions, implementable conditions and application to early-childhood policy evaluation," LISER Working Paper Series 2014-12, Luxembourg Institute of Socio-Economic Research (LISER).
    10. Hernæs, Øystein M., 2020. "Distributional effects of welfare reform for young adults: An unconditional quantile regression approach," Labour Economics, Elsevier, vol. 65(C).
    11. Francesco Andreoli & Tarjei Havnes & Arnaud Lefranc, 2019. "Robust Inequality of Opportunity Comparisons: Theory and Application to Early Childhood Policy Evaluation," The Review of Economics and Statistics, MIT Press, vol. 101(2), pages 355-369, May.
    12. Emre Akgunduz & Egbert Jongen & Paul P.M. Leseman & Janneke Plantenga, 2015. "Quasi-experimental evidence on the relation between child care subsidies and child care quality," CPB Discussion Paper 310.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    13. Masayuki Sawada, 2019. "Noncompliance in randomized control trials without exclusion restrictions," Papers 1910.03204, arXiv.org, revised Jun 2021.
    14. Battistin, Erich & Meroni, Elena Claudia, 2016. "Should we increase instruction time in low achieving schools? Evidence from Southern Italy," Economics of Education Review, Elsevier, vol. 55(C), pages 39-56.
    15. Callaway, Brantly, 2021. "Bounds on distributional treatment effect parameters using panel data with an application on job displacement," Journal of Econometrics, Elsevier, vol. 222(2), pages 861-881.
    16. Strittmatter, Anthony, 2019. "Heterogeneous earnings effects of the job corps by gender: A translated quantile approach," Labour Economics, Elsevier, vol. 61(C).
    17. Michael J. Kottelenberg & Steven F. Lehrer, 2017. "Targeted or Universal Coverage? Assessing Heterogeneity in the Effects of Universal Child Care," Journal of Labor Economics, University of Chicago Press, vol. 35(3), pages 609-653.
    18. Lechner, Michael, 2011. "The Estimation of Causal Effects by Difference-in-Difference Methods," Foundations and Trends(R) in Econometrics, now publishers, vol. 4(3), pages 165-224, November.
    19. Juliano Assunção & Robert McMillan & Joshua Murphy & Eduardo Souza-Rodrigues, 2019. "Optimal Environmental Targeting in the Amazon Rainforest," NBER Working Papers 25636, National Bureau of Economic Research, Inc.
    20. Christian N. Brinch & Erik Hernæs & Zhiyang Jia, 2017. "Salience and Social Security Benefits," Journal of Labor Economics, University of Chicago Press, vol. 35(1), pages 265-297.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:30:y:2021:i:11:p:2780-2793. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.