Batten School of Leadership and Public Policy
University of Virginia
L050 Garrett Hall, 235 McCormick Road
Charlottesville, VA 22904
NBER Working Papers and Publications
|March 2017||A Cautionary Tale in Comparative Effectiveness Research: Pitfalls and Perils of Observational Data Analysis|
with Armando Franco, Dana P. Goldman, Daniel McFadden
in Measuring and Modeling Health Care Costs, Ana Aizcorbe, Colin Baker, Ernst Berndt, and David Cutler, editors
Administrative data such as insurance claims offer a potentially powerful data source to examine the relative benefits and costs of competing drug treatments. Motivated by a 2011 FDA warning about possible side effects of angiotensin-II receptor blockers (ARBs), we analyze the benefits and risks of ARBs compared to other classes of hypertension drugs using Medicare Parts A, B, and D data between 2006 and 2009. We study treatment adherence and crossover as well as non-random treatment assignment in detail and illustrate how different approaches to handling these issues impact our results. We find little evidence that ARBs increase cancer rates and weak evidence that they increase stroke rates, contrary to evidence from randomized controlled trials. Falsification tests raise doubts that any ...
|September 2015||The Price of Responsibility: The Impact of Health Reform on Non-Poor Uninsureds|
with Mark Pauly, Scott Harrington: w21565
This paper estimates the change in net (of subsidy) financial burden (“the price of responsibility”) and in welfare that would be experienced by a large nationally representative sample of the “non-poor” uninsured if they were to purchase Silver or Bronze plans on the ACA exchanges. The sample is the set of full-year uninsured persons represented in the Current Population Survey for the pre-ACA period with incomes above 138 percent of the federal poverty level. The estimated change in financial burden compares out-of-pocket payments by income stratum in the pre-ACA period with the sum of premiums (net of subsidy) and expected cost sharing (net of subsidy) for benchmark Silver and Bronze plans, under various assumptions about the extent of increased spending associated with obtaining cov...
|June 2014||"Sticker Shock" in Individual Insurance under Health Reform|
with Mark Pauly, Scott Harrington: w20223
This paper provides estimates of the changes in premiums, average or expected out of pocket payments, and the sum of premiums and out of pocket payments (total expected price) for a sample of consumers who bought individual insurance in 2010 to 2012, comparing total expected prices before the Affordable Care Act with estimates of total expected prices if they were to purchase silver or bronze coverage after reform, before the effects of any premium subsidies. We provide comparisons for purchasers of self only coverage in California and in 23 states with minimal prior state premium regulation before the ACA now using federally managed exchanges. Using data from the Current Population Survey, we find that the average prices increased by 14 to 28 percent, with similar changes in California ...
Published: Mark Pauly & Scott Harrington & Adam Leive, 2015. "“Sticker Shock” in Individual Insurance under Health Reform?," American Journal of Health Economics, vol 1(4), pages 494-514.
|June 2012||Plan Selection in Medicare Part D: Evidence from Administrative Data|
with Florian Heiss, Daniel McFadden, Joachim Winter: w18166
We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets, focusing on the ability of consumers to evaluate and optimize their choices of plans. Our analysis of administrative data on medical claims in Medicare Part D suggests that less than 10 percent of individuals enroll in plans that are ex post optimal with respect to total cost (premiums and co-payments). Relative to the benchmark of a static decision rule, similar to the Plan Finder provided by the Medicare administration, that conditions next year's plan choice only on the drugs consumed in the current year, enrollees lost on average about $300 per year. These numbers are hard to reconcile with decision costs alone; it appears that unless a sizeab...
Published: Heiss, Florian & Leive, Adam & McFadden, Daniel & Winter, Joachim, 2013. "Plan selection in Medicare Part D: Evidence from administrative data," Journal of Health Economics, Elsevier, vol. 32(6), pages 1325-1344. citation courtesy of