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Does Uninsurance Affect the Health Outcomes of the Insured? Evidence from Heart Attack Patients in California

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  • Meltem Daysal, N.

    (Tilburg University, Center For Economic Research)

Abstract

In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome – the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999-2006). My results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection or unobserved trends and that they are robust to a host of specification checks. My results also indicate that the primary channel for the observed spillover effects is increased hospital uncompensated care costs. Although data limitations constrain my capacity to check how hospitals change their provision of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff.
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Suggested Citation

  • Meltem Daysal, N., 2012. "Does Uninsurance Affect the Health Outcomes of the Insured? Evidence from Heart Attack Patients in California," Discussion Paper 2012-027, Tilburg University, Center for Economic Research.
  • Handle: RePEc:tiu:tiucen:381285b5-3225-448b-9461-f1801d848c0e
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    1. Cawley, John & Simon, Kosali I., 2005. "Health insurance coverage and the macroeconomy," Journal of Health Economics, Elsevier, vol. 24(2), pages 299-315, March.
    2. Gruber, Jonathan & Madrian, Brigitte C., 1997. "Employment separation and health insurance coverage," Journal of Public Economics, Elsevier, vol. 66(3), pages 349-382, December.
    3. Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2005. "Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 151-184, February.
    4. Shen, Yu-Chu, 2002. "The effect of hospital ownership choice on patient outcomes after treatment for acute myocardial infarction," Journal of Health Economics, Elsevier, vol. 21(5), pages 901-922, September.
    5. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    6. Carol Propper & John Van Reenen, 2010. "Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labor Markets on Hospital Performance," Journal of Political Economy, University of Chicago Press, vol. 118(2), pages 222-273, April.
    7. Gruber, Jonathan, 1994. "The effect of competitive pressure on charity: Hospital responses to price shopping in California," Journal of Health Economics, Elsevier, vol. 13(2), pages 183-211, July.
    8. Mehdi Farsi & Geert Ridder, 2006. "Estimating the out‐of‐hospital mortality rate using patient discharge data," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 983-995, September.
    9. Mark G. Duggan, 2000. "Hospital Ownership and Public Medical Spending," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(4), pages 1343-1373.
    10. Carol Propper & Simon Burgess & Denise Gossage, 2008. "Competition and Quality: Evidence from the NHS Internal Market 1991–9," Economic Journal, Royal Economic Society, vol. 118(525), pages 138-170, January.
    11. Katherine Baicker & Douglas Staiger, 2005. "Fiscal Shenanigans, Targeted Federal Health Care Funds, and Patient Mortality," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 120(1), pages 345-386.
    12. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    13. Jonathan Guryan, 2004. "Desegregation and Black Dropout Rates," American Economic Review, American Economic Association, vol. 94(4), pages 919-943, September.
    14. Currie, Janet & Fahr, John, 2004. "Hospitals, managed care, and the charity caseload in California," Journal of Health Economics, Elsevier, vol. 23(3), pages 421-442, May.
    15. repec:mpr:mprres:6204 is not listed on IDEAS
    16. Mark McClellan & Douglas Staiger, 1999. "The Quality of Health Care Providers," NBER Working Papers 7327, National Bureau of Economic Research, Inc.
    17. Gruber, Jonathan, 1994. "Erratum to "The effect of competitive pressure on charity: hospital responses to price shopping in California [Journal of Health Economics 13 (1994) 183-212]," Journal of Health Economics, Elsevier, vol. 13(4), pages 503-503.
    18. Moulton, Brent R., 1986. "Random group effects and the precision of regression estimates," Journal of Econometrics, Elsevier, vol. 32(3), pages 385-397, August.
    19. Jonathan Skinner & Douglas Staiger, 2015. "Technology Diffusion and Productivity Growth in Health Care," The Review of Economics and Statistics, MIT Press, vol. 97(5), pages 951-964, December.
    20. Pagán, José A. & Balasubramanian, Lakshmi & Pauly, Mark V., 2007. "Physicians’ career satisfaction, quality of care and patients’ trust: the role of community uninsurance," Health Economics, Policy and Law, Cambridge University Press, vol. 2(4), pages 347-362, October.
    21. Mehdi Farsi, 2004. "Changes in Hospital Quality after Conversion in Ownership Status," International Journal of Health Economics and Management, Springer, vol. 4(3), pages 211-230, September.
    22. Roger Feldman & Bryan Dowd & Scott Leitz & Lynn A. Blewett, 1997. "The Effect of Premiums on the Small Firm's Decision to Offer Health Insurance," Journal of Human Resources, University of Wisconsin Press, vol. 32(4), pages 635-658.
    23. Carrasquillo, O. & Carrasquillo, A.I. & Shea, S., 2000. "Health insurance coverage of immigrants living in the United States: Differences by citizenship status and country of origin," American Journal of Public Health, American Public Health Association, vol. 90(6), pages 917-923.
    24. Moulton, Brent R, 1990. "An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Unit," The Review of Economics and Statistics, MIT Press, vol. 72(2), pages 334-338, May.
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    Cited by:

    1. Hongfeng Zhang & Peng Cheng & Lu Huang, 2023. "The Impact of the Medical Insurance System on the Health of Older Adults in Urban China: Analysis Based on Three-Period Panel Data," IJERPH, MDPI, vol. 20(5), pages 1-17, February.
    2. András Kiss & Norbert Kiss & Balázs Váradi, 2023. "Do budget constraints limit access to health care? Evidence from PCI treatments in Hungary," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 281-302, June.
    3. Kuhlmey, Florian & Minke, Matthias, 2018. "Estimating Survival Times Using Swiss Hospital Data," Working papers 2018/14, Faculty of Business and Economics - University of Basel.

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    More about this item

    Keywords

    Uninsurance; Spillovers; Heart Attack Mortality; Hospitals;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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