Suchergebnisse

"The NBER Bulletin on Aging and Health provides summaries of publications like this. You can sign up to receive the NBER Bulletin on Aging and Health by email. We analyze whether decreased emergency department access (measured by increased driving time to the nearest ED) results in adverse patient outcomes or changes in the patient health profile for patients suffering from acute myocardial infarction. Data sources include 100% Medicare Provider Analysis and Review, AHA hospital annual surveys, Medicare hospital cost reports, and longitude and latitude information for 1995-2005. We define four ED access change categories and estimate a zip codes fixed-effects regression models on the following AMI outcomes: time-specific mortality rates, age, and probability of PTCA on the day of admission. We find a small increase in 30-day to 1-year mortality rates among patients in communities that experience 30-minute increases in driving time, we find a substantial increase in long-term mortality rates, a shift to younger ages (suggesting that the older ones die en route) and a higher probability of immediate PTCA. Most of the adverse effects disappear after the initial three-year transition window"--National Bureau of Economic Research web site

"We analyze the role of three aspects of HMO market structure -- HMO penetration, HMO plan concentration, and HMO for-profit share on explaining hospital cost and revenue growth during the HMO expansion period (1994-1999) and backlash period (2000-2005). We find that HMO penetration effects differ over time: a 10 percentage point increase in HMO enrollment leads to 2.5 percent reduction in cost and revenues in the expansion period but only 0.4-1 percent reduction in the backlash period. Furthermore, this HMO backlash effect can be attributed to HMO dis-enrollment as well as the changing nature of HMO product. We find that revenue increases at a slower rate (by about 5 percent) in markets with relatively concentrated HMO markets power and more competitive hospital markets. Finally, increased for-profit HMO presence is associated with smaller cost and revenue growth, and the effect differs between low and high penetration markets"--National Bureau of Economic Research web site

This study examines the effect of HMO and for-profit HMO share on the survival of safety net services and profitable services in hospitals. Using data from 1990-2003 and proportional hazard models, I find that hospitals in high HMO markets started out having lower hazard of shutting down services in 1990-1994 than those in low HMO markets, but their hazard rates increase over time. By 2000-2003, hospitals in high HMO markets ended up with higher risk of shutting down profitable services than those in low HMO markets. Conditional on overall HMO penetration, markets with higher for-profit share of HMOs have highr hazard of shutting down services, and the gap in survival between high and low for profit HMO markets is bigger in high HMO areas. Lastly, I find that the hazard rate of shutting down profitable services is comparable among not-for-profit, for-profit, and government hospitals, while the hazard of shutting down safety net services is the highest in for-profit hospitals and lowest in government hospitals.

Yu-Chu Shen (PI), GSBPP Jesse Cunha (Co-PI), GSBPP ; U.S. military suicides have increased significantly over the past decade and currently account for almost 20% of all military deaths. Effective suicide prevention efforts require better information to identify high-risk segments of the population. In this research project, we investigated the associations of suicides and suicide attempts among current and former service members with a comprehensive set of time-varying risk factors including: deployment, diagnoses of major mental disorders, history of unlawful activity, stressful life events, and other demographic and service factor. Importantly, we observe suicide death (although not suicide attempts) of veterans after separating from the military. We estimate all of our analyses for all-service population and Navy-only population. ; Naval Research Program ; Prepared for: N171 Navy Suicide Prevention Office, POC: Steve Holton

In light of the current economic crisis, we estimate hazard models of divorce to determine how state and national unemployment rates affect the likelihood of a divorce or separation. With data in the United States over the 1978–2008 period from the 1979 NLSY, we find some evidence indicating that a higher unemployment rate increases the risk of a marriage ending for couples in years 6–10 of marriage (suggesting counter‐cyclical divorce/separation probabilities) but has no significant effect for couples in years 1–5 of marriage and those married longer than 10 years. The estimates are generally stronger in magnitude when using national instead of state unemployment rates and when considering just divorces rather than the first observed divorce or separation. (JELJ12)

This study estimates the effect of deployment location and length on the risk of being diagnosed with PTSD, relative to what it would be from the normal military operations; and examines the comorbidity distribution within the PTSD population. We use a random sample of active-duty personnel serving between 2001 and 2006. We identify PTSD cases from TRICARE medical records and link deployment information from Contingent Tracking System. We estimate logistic regressions to assess the effect of deployment intensity on the rate of PTSD. Among the enlisted population, comparing to those in other duties around the world, deployment to Iraq/Afghanistan increases the odds of developing PTSD substantially, with the largest effect observed for the Navy (OR=9.06, p<0.01) and the smallest effect for the Air Force (OR=1.25, p<0.01). A deployment longer than 180 days increases the odds of PTSD by 1.11 times to 2.84 times, depending on the service, compared to a tour under 120 days. For the Army and the Navy, a deployment to Iraq/Afghanistan further exacerbates the adverse effect of tour length. We observe similar adverse effects among the officers although the magnitude of the deployment effect is smaller. ; Approved for public release; distribution is unlimited.

A firm's decision to drop the offer of employer-sponsored insurance (ESI), reduce eligibility for ESI, or significantly increase employee costs would have serious implications for the health insurance status of currently covered low-income workers. The authors find that at least a third of currently covered low-income workers do not have affordable insurance options outside of the group market. Furthermore, a simulation analysis shows that 54 percent of those workers would become uninsured if their employers were to drop ESI. This would result in an additional 1 million uninsured adults if 10 percent of low-income workers lost their ESI offer, and at least 350,000 uninsured adults if 10 percent of workers in firms with fewer than 100 employees (the firms most likely to drop coverage) lost their ESI. The authors also find that expanding public programs to cover low-income workers would reduce the high uninsurance rate by half, but substantial minorities would remain uninsured.