Three Essays on Health Care
Three Essays on Health Care
Hitoshi Shigeoka
Submitted in partial ful…llment of the requirements for the degree of
Doctor of Philosophy in the Graduate School of Arts and Sciences
COLUMBIA UNIVERSITY
2012
c 2012
Hitoshi Shigeoka
All Rights Reserved
ABSTRACT
Three Essays on Health Care
Hitoshi Shigeoka
This dissertation has been motivated by the question of how countries should optimally structure health care. Especially, there are two important economic and policy questions asked that extend beyond the area of health economics. The
…rst is how the expansion of health insurance coverage a¤ects the utilization and health of its bene…ciaries (extensive margin); the second is how generous should health insurance be (intensive margin) to balance the provision of care and …nancial protection against risk while containing medical expenditures. The three chapters in this dissertation aim to make empirical contributions to these ongoing research questions. First Chapter, “The E¤ect of Patient Cost-Sharing on Utilization, Health and
Risk Protection: Evidence from Japan” addresses the second question. It investigates how cost-sharing, requiring patients to pay a share of the cost of care, a¤ects the demand for care, health itself, and risk protection among the elderly, the largest consumers of health service. Previous studies of cost-sharing have had di¢ culty separating the e¤ect of cost-sharing on patients from the in‡ uence of medical providers and insurers. This paper overcomes that limitation by examining
a sharp reduction in cost-sharing at age 70 in Japan in a regression discontinuity design. I …nd that price elasticities of demand for both inpatient admissions and outpatient visits among the elderly are comparable to prior estimates for the nonelderly. I also …nd that the welfare gain from risk protection is relatively small compared to the deadweight loss of program …nancing, suggesting that the social cost of
Hitoshi Shigeoka
Submitted in partial ful…llment of the requirements for the degree of
Doctor of Philosophy in the Graduate School of Arts and Sciences
COLUMBIA UNIVERSITY
2012
c 2012
Hitoshi Shigeoka
All Rights Reserved
ABSTRACT
Three Essays on Health Care
Hitoshi Shigeoka
This dissertation has been motivated by the question of how countries should optimally structure health care. Especially, there are two important economic and policy questions asked that extend beyond the area of health economics. The
…rst is how the expansion of health insurance coverage a¤ects the utilization and health of its bene…ciaries (extensive margin); the second is how generous should health insurance be (intensive margin) to balance the provision of care and …nancial protection against risk while containing medical expenditures. The three chapters in this dissertation aim to make empirical contributions to these ongoing research questions. First Chapter, “The E¤ect of Patient Cost-Sharing on Utilization, Health and
Risk Protection: Evidence from Japan” addresses the second question. It investigates how cost-sharing, requiring patients to pay a share of the cost of care, a¤ects the demand for care, health itself, and risk protection among the elderly, the largest consumers of health service. Previous studies of cost-sharing have had di¢ culty separating the e¤ect of cost-sharing on patients from the in‡ uence of medical providers and insurers. This paper overcomes that limitation by examining
a sharp reduction in cost-sharing at age 70 in Japan in a regression discontinuity design. I …nd that price elasticities of demand for both inpatient admissions and outpatient visits among the elderly are comparable to prior estimates for the nonelderly. I also …nd that the welfare gain from risk protection is relatively small compared to the deadweight loss of program …nancing, suggesting that the social cost of
References: Age Pro…le of Employment by Gender (1987– 2007 CSLC)