NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

A. Mark Fendrick

University of Michigan
2800 Plymouth Road
Building 16 / Floor 4
Ann Arbor, MI 48109

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NBER Working Papers and Publications

October 2017Effects of Episode-Based Payment on Health Care Spending and Utilization: Evidence from Perinatal Care in Arkansas
with Caitlin Carroll, Michael Chernew, Joe Thompson, Sherri Rose: w23926
We study how physicians respond to financial incentives imposed by episode-based bundled payment (EBP), which encourages lower spending and improved quality for an entire episode of care. Specifically, we study the impact of the Arkansas Health Care Payment Improvement Initiative, a multi-payer program that requires providers in the state to enter into EBP arrangements for perinatal care. Because of its multi-payer nature and the requirement that providers participate, the program covers the vast majority of births in the state. Unlike fee-for-service reimbursement, EBP holds physicians responsible for all care within a discrete clinical episode, rewarding physicians not only for efficient use of their own services but also for efficient management of other health care inputs. In a differ...
September 2012Cost-Sharing and Productivity
with Teresa B. Gibson, Michael E. Chernew: w18402
A growing body of literature examines the cross price elasticities between different health care services. For example, increasing the patient out of pocket price for some health care services increases the utilization of other health care services. Yet, the literature has generally ignored the connection between cost sharing for health care services and labor market outcomes. This paper examines the direction and magnitude of the reduced form relationship between patient cost-sharing and work loss following methods used to study the impact of cost-sharing and medical spending, finding a positive, quantitatively meaningful association between cost-sharing and hours absent. We find no such association between cost-sharing and the probability of incurring short-term disability days. This...
December 2001Payer Type and the Returns to Bypass Surgery: Evidence from Hospital Entry Behavior
with Michael Chernew, Gautam Gowrisankaran: w8632
In this paper we estimate the returns associated with the provision of coronary artery bypass graft (CABG) surgery, by payer type (Medicare, HMO, etc.). Because reliable measures of prices and treatment costs are often unobserved, we seek to infer returns from hospital entry behavior. We estimate a model of patient flows for CABG patients that provides inputs for an entry model. We find that FFS provides a high return throughout the study period. Medicare, which had been generous in the early 1980s, now provides a return that is close to zero. Medicaid appears to reimburse less than average variable costs. HMOs essentially pay at average variable costs, though the return varies inversely with competition.

Published: Chernew, Michael, Gautam Gowrisankaran and A. Mark Fendrick. "Payer Type And The Returns To Bypass Surgery: Evidence From Hospital Entry Behavior," Journal of Health Economics, 2002, v21(3,May), 451-474.

 
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