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Essays in Health Economics

Lin , Lin
http://rave.ohiolink.edu/etdc/view?acc_num=osu1565878672332385

Abstract Details

2019, Doctor of Philosophy, Ohio State University, Economics.
This dissertation consists of two chapters investigating U.S. healthcare issues from economic perspectives. Chapter one estimates the effect of ACA health insurance enrollment expansion on physician relocation. The empirical design used is a DD-IV model that utilizes predicted insurance enrollment changes caused by ACA insurance expansion as instruments. I then quantify how much the ACA-induced physician relocation reduces physician disparity between economically disadvantaged and advantaged markets. I find that private health insurance enrollment plays a role in shaping the geographic distribution of physicians: a market with a 10,000 increase in private enrollment attracts about 1.65 physician relocations from other same-city markets to the expanded market. Such ACA-induced relocation increases physician supply in those economically disadvantaged markets (with lower average income, higher unemployment rate, and fewer white men), leading to a 10\% reduction in physician disparity. Medicaid enrollment also plays a role in affecting physician distribution but only in states that permanently increase Medicaid payment after ACA. The second chapter explores the effect of changing the marketing status of a branded drug from prescription to OTC on price of the drug. I estimate a 40-percent reduction in retail price within four years after an Rx-to-OTC switch using generalized DD model as well as event study model. Back-of-envelope calculations show that the estimated 40-percent drop in retail price due to an Rx-to-OTC switch has different implications on the out-of-pocket payment made by consumers per se and the total spending paid by consumers and insurers combined: medically insured consumers generally have to pay 20 percent more out of pocket once a branded drug switches from prescription to OTC status, while the total price paid by consumers and insurers drops by 20 percent for a branded drug for which insurers were returned a rebate amount that is 20 percent of retail price before the switch.
Kurt Lavetti (Advisor)
Huanxin Yang (Committee Member)
Wendy Xu (Committee Member)
Economics
ACA Insurance Expansion; Physician Relocation; Branded Drug Price; Prescription-to-OTC Switch

Recommended Citations

Citations

  • Lin , L. (2019). Essays in Health Economics [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1565878672332385

    APA Style (7th edition)

  • Lin , Lin . Essays in Health Economics. 2019. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1565878672332385.

    MLA Style (8th edition)

  • Lin , Lin . "Essays in Health Economics." Doctoral dissertation, Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1565878672332385

    Chicago Manual of Style (17th edition)

osu1565878672332385
279
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This open access ETD is published by The Ohio State University and OhioLINK.