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Regression Discontinuity Designs with an Endogenous Forcing Variable and an Application to Contracting in Health Care

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  • Patrick Bajari
  • Han Hong
  • Minjung Park
  • Robert Town

Abstract

Regression discontinuity designs (RDDs) are a popular method to estimate treatment effects. However, RDDs may fail to yield consistent estimates if the forcing variable can be manipulated by the agent. In this paper, we examine one interesting set of economic models with such a feature. Specifically, we examine the case where there is a structural relationship between the forcing variable and the outcome variable because they are determined simultaneously. We propose a modi...ed RDD estimator for such models and derive the conditions under which it is consistent. As an application of our method, we study contracts between a large managed care organization and leading hospitals for the provision of organ and tissue transplants. Exploiting "donut holes" in the reimbursement contracts we estimate how the total claims filed by the hospitals depend on the generosity of the reimbursement structure. Our results show that hospitals submit significantly larger bills when the reimbursement rate is higher, indicating informational asymmetries between the payer and hospitals in this market.

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  • Patrick Bajari & Han Hong & Minjung Park & Robert Town, 2011. "Regression Discontinuity Designs with an Endogenous Forcing Variable and an Application to Contracting in Health Care," NBER Working Papers 17643, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:17643
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    Cited by:

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    6. Matias D. Cattaneo & Rocío Titiunik, 2022. "Regression Discontinuity Designs," Annual Review of Economics, Annual Reviews, vol. 14(1), pages 821-851, August.
    7. Kowalski, Amanda E., 2015. "Estimating the tradeoff between risk protection and moral hazard with a nonlinear budget set model of health insurance," International Journal of Industrial Organization, Elsevier, vol. 43(C), pages 122-135.
    8. Rudy Douven & Minke Remmerswaal & Ilaria Mosca, 2014. "Unintended effects of reimbursement schedules in mental health care," CPB Discussion Paper 292, CPB Netherlands Bureau for Economic Policy Analysis.
    9. Rudy Douven & Minke Remmerswaal & Ilaria Mosca, 2014. "Unintended effects of reimbursement schedules in mental health care," CPB Discussion Paper 292.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    10. Wang, Chu & Xu, Jintao, 2020. "The Effect of a Congestion Charge on Traffic: The Case of London," EfD Discussion Paper 20-11, Environment for Development, University of Gothenburg.
    11. Gerard, Francois & Rokkanen, Miikka & Rothe, Christoph, 2015. "Identification and Inference in Regression Discontinuity Designs with a Manipulated Running Variable," IZA Discussion Papers 9604, Institute of Labor Economics (IZA).
    12. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    13. François Gerard & Miikka Rokkanen & Christoph Rothe, 2020. "Bounds on treatment effects in regression discontinuity designs with a manipulated running variable," Quantitative Economics, Econometric Society, vol. 11(3), pages 839-870, July.
    14. Burgherr, David, 2022. "Behavioral Responses to a Pension Savings Mandate : Quasi-experimental Evidence from Swiss Tax Data," CAGE Online Working Paper Series 645, Competitive Advantage in the Global Economy (CAGE).
    15. Assaad, Ragui & Aydemir, Abdurrahman B. & Dayioglu-Tayfur, Meltem & Kirdar, Murat Güray, 2023. "Wage Returns to Human Capital Resulting from an Extra Year of Primary School: Evidence from Egypt," IZA Discussion Papers 16037, Institute of Labor Economics (IZA).
    16. Kate Ho & Ariel Pakes, 2014. "Hospital Choices, Hospital Prices, and Financial Incentives to Physicians," American Economic Review, American Economic Association, vol. 104(12), pages 3841-3884, December.
    17. Aaron J. Sojourner & Brigham R. Frandsen & Robert J. Town & David C. Grabowski & Min M. Chen, 2015. "Impacts of Unionization on Quality and Productivity," ILR Review, Cornell University, ILR School, vol. 68(4), pages 771-806, August.
    18. Gerard, François & Rothe, Christoph & Rokkanen, Miikka, 2016. "Bounds on Treatment Effects in Regression Discontinuity Designs under Manipulation of the Running Variable, with an Application," CEPR Discussion Papers 11668, C.E.P.R. Discussion Papers.
    19. Douven, Rudy & Remmerswaal, Minke & Mosca, Ilaria, 2015. "Unintended effects of reimbursement schedules in mental health care," Journal of Health Economics, Elsevier, vol. 42(C), pages 139-150.
    20. Dor Leventer & Daniel Nevo, 2024. "Correcting invalid regression discontinuity designs with multiple time period data," Papers 2408.05847, arXiv.org.
    21. Andersson, Josefine, 2018. "Financial incentives to work for disability insurance recipients - Sweden’s special rules for continuous deduction," Working Paper Series 2018:7, IFAU - Institute for Evaluation of Labour Market and Education Policy.
    22. Aydemir, Abdurrahman B. & Kırdar, Murat Güray & Torun, Huzeyfe, 2022. "The effect of education on internal migration of young men and women: incidence, timing, and type of migration," Labour Economics, Elsevier, vol. 74(C).

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    More about this item

    JEL classification:

    • D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design
    • I10 - Health, Education, and Welfare - - Health - - - General
    • L14 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Transactional Relationships; Contracts and Reputation

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