Papers Containing Keywords(s): 'healthcare'
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Authors
Alice Zawacki - 14
G. Edward Miller - 3
Viewing papers 1 through 10 of 24
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Working PaperHow Do Health Insurance Costs Affect Firm Labor Composition and Technology Investment?
September 2023
Working Paper Number:
CES-23-47
Employer-sponsored health insurance is a significant component of labor costs. We examine the causal effect of health insurance premiums on firms' employment, both in terms of quantity and composition, and their technology investment decisions. To address endogeneity concerns, we instrument for insurance premiums using idiosyncratic variation in insurers' recent losses, which is plausibly exogenous to their customers who are employers. Using Census microdata, we show that following an increase in premiums, firms reduce employment. Relative to higher-income coworkers, lower-income workers see a larger increase in their likelihood of being separated from their jobs and becoming unemployed. Firms also invest more in information technology, potentially to substitute labor.View Full Paper PDF
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Working PaperMethodology on Creating the U.S. Linked Retail Health Clinic (LiRHC) Database
March 2023
Working Paper Number:
CES-23-10
Retail health clinics (RHCs) are a relatively new type of health care setting and understanding the role they play as a source of ambulatory care in the United States is important. To better understand these settings, a joint project by the Census Bureau and National Center for Health Statistics used data science techniques to link together data on RHCs from Convenient Care Association, County Business Patterns Business Register, and National Plan and Provider Enumeration System to create the Linked RHC (LiRHC, pronounced 'lyric') database of locations throughout the United States during the years 2018 to 2020. The matching methodology used to perform this linkage is described, as well as the benchmarking, match statistics, and manual review and quality checks used to assess the resulting matched data. The large majority (81%) of matches received quality scores at or above 75/100, and most matches were linked in the first two (of eight) matching passes, indicating high confidence in the final linked dataset. The LiRHC database contained 2,000 RHCs and found that 97% of these clinics were in metropolitan statistical areas and 950 were in the South region of the United States. Through this collaborative effort, the Census Bureau and National Center for Health Statistics strive to understand how RHCs can potentially impact population health as well as the access and provision of health care services across the nation.View Full Paper PDF
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Working PaperThe Underserved Have Less Access to Employer-Sponsored Telemedicine Coverage
September 2022
Working Paper Number:
CES-22-40
Telemedicine has been proposed as one means of improving health care access for underserved communities, and information about insurance coverage for telemedicine (TMC) is important in understanding its utilization and provision. We use 2018-2019 Medical Expenditure Panel Survey-Insurance Component data on employer-sponsored coverage to examine pre-pandemic TMC relative to employer, worker, and health plan characteristics. We find that the share of employees in private sector establishments offering TMC was lower in the most rural counties, in smaller firms, in establishments without unionized employees, and in establishments where most workers were low wage, part-time and older when compared to other establishments. These findings reflect differences across establishments in insurance offers, as well as differences in TMC conditional on an insurance offer, which suggests that TMC may function as a premium plan feature with limited availability and potential support for improving healthcare access for the underserved.View Full Paper PDF
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Working PaperDeveloping Content for the Management and Organizational Practices Survey-Hospitals (MOPS-HP)
September 2021
Working Paper Number:
CES-21-25
Nationally representative U.S. hospital data does not exist on management practices, which have been shown to be related to both clinical and financial performance using past data collected in the World Management Survey (WMS). This paper describes the U.S. Census Bureau's development of content for the Management and Organizational Practices Survey Hospitals (MOPS-HP) that is similar to data collected in the MOPS conducted for the manufacturing sector in 2010 and 2015 and the 2009 WMS. Findings from cognitive testing interviews with 18 chief nursing officers and 13 chief financial officers at 30 different hospitals across 7 states and the District of Columbia led to using industry-tested terminology, to confirming chief nursing officers as MOPS-HP respondents and their ability to provide recall data, and to eliminating questions that tested poorly. Hospital data collected in the MOPS-HP would be the first nationally representative data on management practices with queries on clinical key performance indicators, financial and hospital-wide patient care goals, addressing patient care problems, clinical team interactions and staffing, standardized clinical protocols, and incentives for medical record documentation. The MOPS-HP's purpose is not to collect COVID-19 pandemic information; however, data measuring hospital management practices prior to and during the COVID-19 pandemic are a byproduct of the survey's one-year recall period (2019 and 2020).View Full Paper PDF
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Working PaperWho Values Human Capitalists' Human Capital? Healthcare Spending and Physician Earnings
July 2020
Working Paper Number:
CES-20-23
Is government guiding the invisible hand at the top of the labor market? We study this question among physicians, the most common occupation among the top one percent of income earners, and whose billings comprise one-fifth of healthcare spending. We use a novel linkage of population-wide tax records with the administrative registry of all physicians in the U.S. to study the characteristics of these high earnings, and the influence of government payments in particular. We find a major role for government on the margin, with half of direct changes to government reimbursement rates flowing directly into physicians' incomes. These policies move physicians' relative and absolute incomes more than any reasonable changes to marginal tax rates. At the same time, the overall level of physician earnings can largely be explained by labor market fundamentals of long work and training hours. Competing occupations also pay well and provide a natural lower bound for physician earnings. We conclude that government plays a major role in determining the value of physicians' human capital, but it is unrealistic to use this power to reduce healthcare spending substantially.View Full Paper PDF
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Working PaperAddressing Data Gaps: Four New Lines of Inquiry in the 2017 Economic Census
September 2019
Working Paper Number:
CES-19-28
We describe four new lines of inquiry added to the 2017 Economic Census regarding (i) retail health clinics, (ii) management practices in health care services, (iii) self-service in retail and service industries, and (iv) water use in manufacturing and mining industries. These were proposed by economists from the U.S. Census Bureau's Center for Economic Studies in order to fill data gaps in current Census Bureau products concerning the U.S. economy. The new content addresses such issues as the rise in importance of health care and its complexity, the adoption of automation technologies, and the importance of measuring water, a critical input to many manufacturing and mining industries.View Full Paper PDF
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Working PaperWhy are employer-sponsored health insurance premiums higher in the public sector than in the private sector?
February 2019
Working Paper Number:
CES-19-03
In this article, we examine the factors explaining differences in public and private sector health insurance premiums for enrollees with single coverage. We use data from the 2000 and 2014 Medical Expenditure Panel Survey-Insurance Component, along with decomposition methods, to explore the relative explanatory importance of plan features and benefit generosity, such as deductibles and other forms of cost sharing, basic employee characteristics (e.g., age, gender, and education), and unionization. While there was little difference in public and private sector premiums in 2000, by 2014, public premiums had exceeded private premiums by 14 to 19 percent. We find that differences in plan characteristics played a substantial role in explaining premium differences in 2014, but they were not the only, or even the most important, factor. Differences in worker age, gender, marital status, and educational attainment were also important factors, as was workforce unionization.View Full Paper PDF
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Working PaperReporting of Indian Health Service Coverage in the American Community Survey
May 2018
Working Paper Number:
carra-2018-04
Response error in surveys affects the quality of data which are relied on for numerous research and policy purposes. We use linked survey and administrative records data to examine reporting of a particular item in the American Community Survey (ACS) - health coverage among American Indians and Alaska Natives (AIANs) through the Indian Health Service (IHS). We compare responses to the IHS portion of the 2014 ACS health insurance question to whether or not individuals are in the 2014 IHS Patient Registration data. We evaluate the extent to which individuals misreport their IHS coverage in the ACS as well as the characteristics associated with misreporting. We also assess whether the ACS estimates of AIANs with IHS coverage represent an undercount. Our results will be of interest to researchers who rely on survey responses in general and specifically the ACS health insurance question. Moreover, our analysis contributes to the literature on using administrative records to measure components of survey error.View Full Paper PDF
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Working PaperLabor Market Effects of the Affordable Care Act: Evidence from a Tax Notch
July 2017
Working Paper Number:
carra-2017-07
States that declined to raise their Medicaid income eligibility cutoffs to 138 percent of the federal poverty level (FPL) under the Affordable Care Act (ACA) created a "coverage gap'' between their existing, often much lower Medicaid eligibility cutoffs and the FPL, the lowest level of income at which the ACA provides refundable, advanceable "premium tax credits'' to subsidize the purchase of private insurance. Lacking access to any form of subsidized health insurance, residents of those states with income in that range face a strong incentive, in the form of a large, discrete increase in post-tax income (i.e. an upward notch) at the FPL, to increase their earnings and obtain the premium tax credit. We investigate the extent to which they respond to that incentive. Using the universe of tax returns, we document excess mass, or bunching, in the income distribution surrounding this notch. Consistent with Saez (2010), we find that bunching occurs only among filers with self-employment income. Specifically, filers without children and married filers with three or fewer children exhibit significant bunching. Analysis of tax data linked to labor supply measures from the American Community Survey, however, suggests that this bunching likely reflects a change in reported income rather than a change in true labor supply. We find no evidence that wage and salary workers adjust their labor supply in response to increased availability of directly purchased health insurance.View Full Paper PDF
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Working PaperEstimating the Costs of Covering Dependents through Employer-Sponsored Plans
January 2017
Working Paper Number:
CES-17-48
Several health reform microsimulation models use synthetic firms to estimate how changes in federal and state policies will affect employers' offers of health insurance, as well as the price of health insurance for workers and firms. These models typically rely on distinct measures of the average costs of single and dependent coverage, for employees and employers, which do not capture the joint distribution of these costs. Since some firms pay a large share of the premium for single polices but a lower share for dependent coverage, or the reverse, simulation models that do not account for the joint distribution of premium costs may not be sufficient to answer certain policy questions. To address this issue, we developed a method to extract estimates of the joint distribution of employer and employee costs of health insurance coverage from the Medical Expenditure Panel Survey ' Insurance Component (MEPS-IC). This paper describes how these distributions were constructed and how they were incorporated into the Urban Institute's Health Insurance Policy Simulation Model (HIPSM). The estimates presented in this paper and those available in supplementary datasets may be useful for other simulation models that need to utilize information on the joint distribution of single and dependent employee premium contributions.View Full Paper PDF
