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Essays in health economics: Empirical studies on employment-based health insurance plans and hospice care.

机译：健康经济学论文：基于就业的健康保险计划和临终关怀的实证研究。

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摘要

This dissertation describes results of empirical studies addressing important issues in the field of health economics. The investigated problems include two major topic areas: employment-based health insurance plans and hospice care. In particular, we empirically examine the determinants of the employers’ contributions towards health insurance premiums, the price elasticity of demand in employer-provided self-insured health plans, and the effects of hospice ownership and certification on the length of hospice use.;We extend previous empirical work on employment-based health insurance to self-insured health plans and show that union membership and self-insurance predict higher amounts of employer’s contribution to health insurance premiums. The obtained empirical evidence also indicates that several socioeconomic characteristics (i.e., family income, poverty level, and employer’s provision of fringe benefits) as well as other factors (i.e., sex, the place of residence, and family coverage) have impact on the employer’s contribution.;The obtained estimates of the price elasticity of demand for self-insured health plans show it to be relatively inelastic. This agrees well with previous literature findings for traditional health insurance plans. The similarity of our results not only provides a relevant re-confirmation for these earlier measures but it also demonstrates that the demand responsiveness to changes in price for self-insured health plans does not differ from estimates of other types of health insurance.;Our analysis of the effects of the ownership form and the certification status on hospice care shows a positive impact of the for-profit organizational form with respect to the length of hospice use as compared to their nonprofit counterparts. In particular, the obtained results suggest that among individuals with short expected length of hospice use, patients at nonprofit hospices have lower mortality while using hospice care. In contrast, among those with long expected length of hospice use, patients at for-profit hospices have longer survival times. There is, however, no evidence of systematic selection of long-stay patients by for-profit hospices or of short-stay patients by nonprofit hospices. Furthermore, the results of the impact of hospice certification show that the length of hospice use is shorter at certified hospices as compared to noncertified ones.;All three problems investigated in this dissertation address key elements of the healthcare system in the US and hence the results reported should be relevant not only to policy makers, but also to parties directly involved in the healthcare system such as employers, insured and uninsured individuals, and insurance companies.
机译：本文介绍了针对健康经济学领域重要问题的实证研究结果。研究的问题包括两个主要主题领域：基于就业的健康保险计划和临终关怀。尤其是，我们从经验上考察了雇主对健康保险费的缴款，雇主提供的自保医疗计划中需求的价格弹性以及临终关怀所有权和证明对临终使用年限的影响的决定因素。将以前基于就业的健康保险的实证工作扩展到自我保险的健康计划，并表明工会会员资格和自我保险可以预测雇主对健康保险保费的缴费额更高。获得的经验证据还表明，若干社会经济特征（即家庭收入，贫困水平和雇主提供的附带福利）以及其他因素（例如性别，居住地和家庭覆盖范围）对雇主的影响所获得的对自我保险医疗计划需求价格弹性的估计表明，它相对缺乏弹性。这与传统健康保险计划的先前文献发现非常吻合。我们结果的相似性不仅为这些较早的措施提供了相关的重新确认，而且还表明，自保医疗计划对价格变化的需求响应能力与其他类型的医疗保险的估算没有差异。所有权形式和认证状态对临终关怀服务的影响显示，与非营利组织相比，营利性组织形式对临终关怀使用时间的积极影响。尤其是，获得的结果表明，在预期使用临终关怀的时间较短的个体中，非营利性临终关怀的患者在使用临终关怀时的死亡率较低。相反，在预期使用临终关怀的时间长的人群中，营利性临终关怀的患者的生存时间更长。但是，没有证据表明以营利为目的的收容所系统地选择长期住院病人或以非营利性为目的的住院病人来短期停留病人。此外，临终关怀机构认证的影响结果表明，经过认证的临终关怀机构使用临终关怀的时间要短于未经认证的临终关怀机构。本论文研究的所有三个问题均针对美国医疗体系的关键要素，因此得出的结果是报告的内容不仅应与决策者有关，而且还应与直接参与医疗保健系统的各方有关，例如雇主，有保险和无保险的个人以及保险公司。

著录项

  • 作者

    Kicinger, Iwona M.;

  • 作者单位

    George Mason University.;

  • 授予单位 George Mason University.;
  • 学科 Economics General.;Economics Labor.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 191 p.
  • 总页数 191
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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