IDEAS home Printed from https://ideas.repec.org/p/hcx/wpaper/0902.html
   My bibliography  Save this paper

Health and Utilization Effects of Increased Access to Publicly Provided Health Care: Evidence from the U.S. Department of Veterans Affairs

Author

Listed:
  • Melissa Boyle

    (Department of Economics, College of the Holy Cross)

Abstract

During the mid-1990s, the U.S. Department of Veterans Affairs overhauled its health care system in an attempt to increase quality and efficiency. The restructuring involved the adoption of a capitated payment system and treatment methods based on the managed care model. This reorganization was accompanied by a major expansion in the population eligible to receive VA care. Using the National Health Interview Survey and VA medical claims data, this study analyzes both the efficiency of providing public health care in a managed care setting and the effectiveness of expanding coverage to healthier and wealthier populations. I estimate that between 35 and 70 percent of new take-up of VA care was the result of individuals dropping private health insurance. While utilization of services increased, estimates of the impact on aggregate veteran health imply that the policy change did not result in net health improvements. Regions providing more care to healthier, newly-eligible veterans had bigger reductions in hospital care and larger increases in outpatient services for previously-eligible veterans. This shift away from specialty care may help to explain the aggregate health declines.

Suggested Citation

  • Melissa Boyle, 2009. "Health and Utilization Effects of Increased Access to Publicly Provided Health Care: Evidence from the U.S. Department of Veterans Affairs," Working Papers 0902, College of the Holy Cross, Department of Economics.
  • Handle: RePEc:hcx:wpaper:0902
    as

    Download full text from publisher

    File URL: https://hcapps.holycross.edu/hcs/RePEc/hcx/HC0902-Boyle_VeteransHealthCare.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Eze, Pius & Wolfe, Barbara, 1993. "Is dumping socially inefficient? : An analysis of the effect of Medicare's prospective payment system on the utilization of Veterans Affairs inpatient services," Journal of Public Economics, Elsevier, vol. 52(3), pages 329-344, October.
    2. Duggan, Mark, 2004. "Does contracting out increase the efficiency of government programs? Evidence from Medicaid HMOs," Journal of Public Economics, Elsevier, vol. 88(12), pages 2549-2572, December.
    3. David M. Cutler & Louise Sheiner, 1998. "Managed Care and the Growth of Medical Expenditures," NBER Chapters, in: Frontiers in Health Policy Research, Volume 1, pages 77-116, National Bureau of Economic Research, Inc.
    4. David M. Cutler & Jonathan Gruber, 1996. "Does Public Insurance Crowd out Private Insurance?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 391-430.
    5. Kajal Lahiri & Guibo Xing, 2002. "An Empirical Analysis of Medicare-eligible Veterans' Demand for Outpatient Health Care Services," Discussion Papers 02-01, University at Albany, SUNY, Department of Economics.
    6. David M. Cutler & Mark McClellan & Joseph P. Newhouse, 2000. "How Does Managed Care Do It?," RAND Journal of Economics, The RAND Corporation, vol. 31(3), pages 526-548, Autumn.
    7. McClellan, Mark & Cutler, David & Newhous, Joseph P., 2000. "How Does Managed Care Do It?," Scholarly Articles 2643884, Harvard University Department of Economics.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Boyle, Melissa A. & Lahey, Joanna N., 2016. "Spousal labor market effects from government health insurance: Evidence from a veterans affairs expansion," Journal of Health Economics, Elsevier, vol. 45(C), pages 63-76.
    2. Amanda C. Stype, 2022. "Health Insurance Patterns of Older Veterans: Evidence from the Health and Retirement Study," JRFM, MDPI, vol. 15(8), pages 1-12, July.
    3. Boyle, Melissa A. & Lahey, Joanna N., 2010. "Health insurance and the labor supply decisions of older workers: Evidence from a U.S. Department of Veterans Affairs expansion," Journal of Public Economics, Elsevier, vol. 94(7-8), pages 467-478, August.

    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. Marton, James & Yelowitz, Aaron & Talbert, Jeffery C., 2014. "A tale of two cities? The heterogeneous impact of medicaid managed care," Journal of Health Economics, Elsevier, vol. 36(C), pages 47-68.
    2. David Dranove & Christopher Ody & Amanda Starc, 2021. "A Dose of Managed Care: Controlling Drug Spending in Medicaid," American Economic Journal: Applied Economics, American Economic Association, vol. 13(1), pages 170-197, January.
    3. Sacks, Daniel W., 2018. "Why do HMOs spend less? Patient selection, physician price sensitivity, and prices," Journal of Public Economics, Elsevier, vol. 168(C), pages 146-161.
    4. Henke, Klaus-Dirk & Rich, Robert F. & Steinbach, Axel & Borchardt, Katja, 2004. "Auf dem Wege zu einer integrierten Versorgung: Neue sozialrechtliche Rahmenbedingungen unter Berücksichtigung der Erfahrungen aus den USA und am Beispiel Berlins," Discussion Papers 2004/12, Technische Universität Berlin, School of Economics and Management.
    5. Lee, Ajin, 2020. "How do hospitals respond to managed care? Evidence from at-risk newborns," Journal of Public Economics, Elsevier, vol. 184(C).
    6. Elizabeth L. Munnich & Michael R. Richards, 2020. "Treatment flows after outsourcing public insurance provision: Evidence from Florida Medicaid," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1343-1363, November.
    7. Ed Westerhout & Kees Folmer, 2013. "Why it may hurt to be insured: the effects of capping coinsurance payments," CPB Discussion Paper 239.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    8. Lindsey Woodworth, 2016. "A Leak in the Lifeboat: The effect of Medicaid managed care on the vitality of safety-net hospitals," Journal of Regulatory Economics, Springer, vol. 50(3), pages 251-270, December.
    9. Duggan, Mark, 2004. "Does contracting out increase the efficiency of government programs? Evidence from Medicaid HMOs," Journal of Public Economics, Elsevier, vol. 88(12), pages 2549-2572, December.
    10. Kolstad, Jonathan T. & Kowalski, Amanda E., 2012. "The impact of health care reform on hospital and preventive care: Evidence from Massachusetts," Journal of Public Economics, Elsevier, vol. 96(11), pages 909-929.
    11. Kessler, Daniel & McClellan, Mark, 2002. "Malpractice law and health care reform: optimal liability policy in an era of managed care," Journal of Public Economics, Elsevier, vol. 84(2), pages 175-197, May.
    12. Bradley Herring & E. Kathleen Adams, 2011. "Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?," Health Economics, John Wiley & Sons, Ltd., vol. 20(4), pages 446-460, April.
    13. Leo Turcotte & John Robst & Solomon Polachek, 2005. "Medicaid Coverage and Medical Interventions During Pregnancy," International Journal of Health Economics and Management, Springer, vol. 5(3), pages 255-271, September.
    14. Ding, Yu & Liu, Chenyuan, 2021. "Alternative payment models and physician treatment decisions: Evidence from lower back pain," Journal of Health Economics, Elsevier, vol. 80(C).
    15. Victoria Perez, 2018. "Effect of privatized managed care on public insurance spending and generosity: Evidence from Medicaid," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 557-575, March.
    16. Michael Geruso & Timothy J. Layton & Jacob Wallace, 2023. "What Difference Does a Health Plan Make? Evidence from Random Plan Assignment in Medicaid," American Economic Journal: Applied Economics, American Economic Association, vol. 15(3), pages 341-379, July.
    17. Alex R. Horenstein & Manuel S. Santos, 2012. "A Cross-Country Analysis of Health Care Expenditures," Working Papers 2013-05, University of Miami, Department of Economics.
    18. Müller, Tobias & Schmid, Christian & Gerfin, Michael, 2023. "Rents for Pills: Financial incentives and physician behavior," Journal of Health Economics, Elsevier, vol. 87(C).
    19. Craig, Stuart V. & Ericson, Keith Marzilli & Starc, Amanda, 2021. "How important is price variation between health insurers?," Journal of Health Economics, Elsevier, vol. 77(C).
    20. Magnus Henrekson & Jesper Roine, 2007. "Promoting Entrepreneurship in the Welfare State," Chapters, in: David B. Audretsch & Isabel Grilo & A. Roy Thurik (ed.), Handbook of Research on Entrepreneurship Policy, chapter 5, Edward Elgar Publishing.

    More about this item

    Keywords

    Medicare; elderly; veteran; VA healthcare;
    All these keywords.

    JEL classification:

    • J2 - Labor and Demographic Economics - - Demand and Supply of Labor
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:hcx:wpaper:0902. 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: Victor Matheson (email available below). General contact details of provider: https://edirc.repec.org/data/deholus.html .

    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.