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  5. Innovations and Policy in Health Care and Provider Markets
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Innovations and Policy in Health Care and Provider Markets

Paper Session

Sunday, Jan. 7, 2024 1:00 PM - 3:00 PM (CST)

Grand Hyatt, Bonham E
Hosted By: Health Economics Research Organization & American Economic Association
  • Chair: Christopher Whaley, Brown University

Externalities from Medical Innovation: Evidence from Organ Transplantation

Keith Teltser
,
Georgia State University
Kevin Callison
,
Tulane University
Michael Darden
,
Johns Hopkins University

Abstract

We evaluate the introduction of direct-acting antiviral (DAA) therapy for Hepatitis C (HCV) on liver transplant allocation in the United States. We develop a model of listing and organ acceptance behavior for patients with both HCV-positive and HCV-negative end-stage liver disease. In the model, DAAs obviate the need for transplant for some HCV-positive patients, which shortens the waiting list, potentially benefiting HCV-negative registrants and inducing marginal HCV-negative patients to list. Using data from the universe of transplants between 2005 and 2019, we find that DAA availability resulted in an additional 5,682 liver transplants to HCV-negative recipients between 2014 and 2019, driven in part by a 37% average annual increase in HCV-negative waiting list registrations. Our estimates imply that DAAs generated $7.52 billion in positive externalities for HCV-negative patients during this period.

Pricing Innovation in Surgical Care Markets

Alice Chen
,
University of Southern California
Seth Freedman
,
Indiana University
Elizabeth Munnich
,
University of Louisville
Michael Richards
,
Cornell University

Abstract

Pricing Innovation in Surgical Care Markets

Immigration Enforcement and the Home Care Workforce

Amanda Kreider
,
University of Pennsylvania

Abstract

Most older Americans require long-term care at some point in their lifetimes, with many relying on assistance from home health and personal care aides. Since nearly one-third of these workers are foreign-born, it is critical to understand how immigration enforcement policies impact their labor supply. Using data from the American Community Survey, we examine the effect of enforcement on the total number of home care workers in a local area. We exploit temporal and geographic variation in the rollout of a federal enforcement policy, Secure Communities (SC), between 2008-2013, estimating difference-in-differences and event study models with time and location fixed effects to isolate the effect of the policy. We find that SC reduced the overall size of the home care workforce by 8.9%, with 70% of the effect driven by foreign-born workers. On the intensive margin, foreign-born workers scale back their usual hours worked, an effect that is partially offset by native born workers’ increasing their hours. We develop a conceptual framework for examining the impact of the policy on wages in a setting with pre-existing worker shortages, administered prices, and lower reservation wages for immigrant workers. Consistent with the model’s predictions, we find suggestive evidence that SC reduces wages for native-born workers, while increasing wages for foreign-born workers. Preliminary estimates suggest large negative externalities on informal caregivers, with native-born adults substantially increasing their unpaid caregiving hours following SC activation. In subsequent analyses, we will use data from the Health and Retirement Study to better understand the effects of SC on outcomes for older adults and their caregivers.

If You Build it, Will They Vaccinate? The Impact of COVID-19 Vaccine Sites on Vaccination Rates and Outcomes

Christopher Whaley
,
RAND Corporation

Abstract

The Impact of COVID-19 Vaccine Sites on Vaccination Rates and Outcomes To understand how geographic access impacts COVID-19 vaccination take-up rates and COVID-19 health outcomes, we leverage exogenous, pre-existing variation in locations of retail pharmacies participating the U.S. federal government’s vaccine distribution program. A participating vaccination site in a county leads to a 26% increase COVID-19 vaccinations. Increased access reduces COVID-19 cases, hospitalizations, and deaths, with substantial political, income, and racial heterogeneity. Our estimates suggest that averting one COVID-19 case, hospitalization, and death requires approximately 25, 200, and 1,500 county-level vaccine total doses, respectively. These results imply a 9,500% to 22,500% economic return on the full costs of COVID-19 vaccination.

Discussant(s)
Benjamin Chartock
,
Bentley College
Adam Sacarny
,
Columbia University
Sebastian Fleitas
,
Pontifical Catholic University of Chile
Stephen Parente
,
University of Minnesota
JEL Classifications
  • I1 - Health
  • K0 - General