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The link between public and private insurance and HIV-related mortality

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  • Bhattacharya, Jayanta
  • Goldman, Dana
  • Sood, Neeraj

Abstract

As policymakers consider expanding insurance coverage for HIV+ individuals, it is useful to ask if insurance has any affect on health outcomes; and, if so, whether public insurance is as efficacious as private insurance in preventing premature deaths among HIV+ patients. Using data from a nationally representative cohort of HIV-infected persons receiving regular medical care, we estimate the impact of different types of insurance on mortality in this population. We find that ignoring observed and unobserved health status leads one to conclude (misleadingly) that insurance may not be protective for HIV patients. After accounting for observed and unobserved heterogeneity, insurance does protect against premature death, but private insurance is more effective than public coverage. The better outcomes associated with private insurance are attributable to the more restrictive prescription drug policies of Medicaid.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 22 (2003)
Issue (Month): 6 (November)
Pages: 1105-1122

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Handle: RePEc:eee:jhecon:v:22:y:2003:i:6:p:1105-1122

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Web page: http://www.elsevier.com/locate/inca/505560

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References

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  1. Kate Bundorf, M., 2002. "Employee demand for health insurance and employer health plan choices," Journal of Health Economics, Elsevier, vol. 21(1), pages 65-88, January.
  2. Nelson, Charles R & Startz, Richard, 1990. "Some Further Results on the Exact Small Sample Properties of the Instrumental Variable Estimator," Econometrica, Econometric Society, vol. 58(4), pages 967-76, July.
  3. Nyman, John A., 1999. "The value of health insurance: the access motive," Journal of Health Economics, Elsevier, vol. 18(2), pages 141-152, April.
  4. Cutler, David M & Gruber, Jonathan, 1996. "Does Public Insurance Crowd Out Private Insurance?," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 391-430, May.
  5. Douglas Staiger & James H. Stock, 1997. "Instrumental Variables Regression with Weak Instruments," Econometrica, Econometric Society, vol. 65(3), pages 557-586, May.
  6. Mroz, Thomas A., 1999. "Discrete factor approximations in simultaneous equation models: Estimating the impact of a dummy endogenous variable on a continuous outcome," Journal of Econometrics, Elsevier, vol. 92(2), pages 233-274, October.
  7. Dana P. Goldman, 1995. "Managed Care as a Public Cost-Containment Mechanism," RAND Journal of Economics, The RAND Corporation, vol. 26(2), pages 277-295, Summer.
  8. Goldman D. P. & Bhattacharya J. & McCaffrey D. F. & Duan N. & Leibowitz A. A. & Joyce G. F. & Morton S. C., 2001. "Effect of Insurance on Mortality in an HIV-Positive Population in Care," Journal of the American Statistical Association, American Statistical Association, vol. 96, pages 883-894, September.
  9. Cutler, D.M., 1992. "The Incidence of Adverse Medical Outcome Under Prospective Payment," Harvard Institute of Economic Research Working Papers 1603, Harvard - Institute of Economic Research.
  10. James J. Heckman, 2001. "Micro Data, Heterogeneity, and the Evaluation of Public Policy: Nobel Lecture," Journal of Political Economy, University of Chicago Press, vol. 109(4), pages 673-748, August.
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Citations

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Cited by:
  1. Mark G. Duggan & William N. Evans, 2005. "Estimating the Impact of Medical Innovation: A Case Study of HIV Antiretroviral Treatments," NBER Working Papers 11109, National Bureau of Economic Research, Inc.
  2. Tomas J. Philipson & Anupam B. Jena, 2005. "Who Benefits from New Medical Technologies? Estimates of Consumer and Producer Surpluses for HIV/AIDS Drugs," NBER Working Papers 11810, National Bureau of Economic Research, Inc.
  3. Neeraj Sood & Yanyu Wu, 2013. "The Impact of Insurance and HIV Treatment Technology on HIV Testing," NBER Working Papers 19397, National Bureau of Economic Research, Inc.
  4. Dana P. Goldman & Nicole Maestas, 2007. "Medical Expenditure Risk and Household Portfolio Choice," Working Papers 325-1, RAND Corporation Publications Department.
  5. Dana Goldman & Nicole Maestas, 2005. "Medical Expenditure Risk and Household Portfolio Choice," NBER Working Papers 11818, National Bureau of Economic Research, Inc.
  6. PAN, Jay & QIN, Xuezheng & LIU, Gordon G., 2013. "The impact of body size on urban employment: Evidence from China," China Economic Review, Elsevier, vol. 27(C), pages 249-263.

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