IDEAS home Printed from https://ideas.repec.org/p/iza/izadps/dp15192.html
   My bibliography  Save this paper

Who Increases Emergency Department Use? New Insights from the Oregon Health Insurance Experiment

Author

Listed:
  • Denteh, Augustine

    (Georgia State University)

  • Liebert, Helge

    (Swiss National Bank)

Abstract

We provide new insights regarding the finding that Medicaid increased emergency department (ED) use from the Oregon experiment. We find meaningful heterogeneous impacts of Medicaid on ED use using causal machine learning methods. The treatment effect distribution is widely dispersed, and the average effect is not representative of most individualized treatment effects. A small group—about 14% of participants—in the right tail of the distribution drives the overall effect. We identify priority groups with economically significant increases in ED usage based on demographics and prior utilization. Intensive margin effects are an important driver of increases in ED utilization.

Suggested Citation

  • Denteh, Augustine & Liebert, Helge, 2022. "Who Increases Emergency Department Use? New Insights from the Oregon Health Insurance Experiment," IZA Discussion Papers 15192, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp15192
    as

    Download full text from publisher

    File URL: https://docs.iza.org/dp15192.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Angus Deaton, 2010. "Instruments, Randomization, and Learning about Development," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 424-455, June.
    2. Woodworth, Lindsey, 2020. "Swamped: Emergency Department Crowding and Patient Mortality," Journal of Health Economics, Elsevier, vol. 70(C).
    3. Arthur Lewbel & Yingying Dong & Thomas Tao Yang, 2012. "Comparing features of convenient estimators for binary choice models with endogenous regressors," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 45(3), pages 809-829, August.
    4. Victor Chernozhukov & Denis Chetverikov & Mert Demirer & Esther Duflo & Christian Hansen & Whitney Newey & James Robins, 2018. "Double/debiased machine learning for treatment and structural parameters," Econometrics Journal, Royal Economic Society, vol. 21(1), pages 1-68, February.
    5. Liran Einav & Amy Finkelstein & Stephen P. Ryan & Paul Schrimpf & Mark R. Cullen, 2013. "Selection on Moral Hazard in Health Insurance," American Economic Review, American Economic Association, vol. 103(1), pages 178-219, February.
    6. Amanda E. Kowalski, 2023. "Reconciling Seemingly Contradictory Results from the Oregon Health Insurance Experiment and the Massachusetts Health Reform," The Review of Economics and Statistics, MIT Press, vol. 105(3), pages 646-664, May.
    7. James J. Heckman & Jeffrey Smith & Nancy Clements, 1997. "Making The Most Out Of Programme Evaluations and Social Experiments: Accounting For Heterogeneity in Programme Impacts," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 64(4), pages 487-535.
    8. Toru Kitagawa & Aleksey Tetenov, 2018. "Who Should Be Treated? Empirical Welfare Maximization Methods for Treatment Choice," Econometrica, Econometric Society, vol. 86(2), pages 591-616, March.
    9. Joshua D. Angrist, 2004. "Treatment effect heterogeneity in theory and practice," Economic Journal, Royal Economic Society, vol. 114(494), pages 52-83, March.
    10. Stefan Wager & Susan Athey, 2018. "Estimation and Inference of Heterogeneous Treatment Effects using Random Forests," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 113(523), pages 1228-1242, July.
    11. Susan Athey & Stefan Wager, 2021. "Policy Learning With Observational Data," Econometrica, Econometric Society, vol. 89(1), pages 133-161, January.
    12. Imbens, Guido W & Angrist, Joshua D, 1994. "Identification and Estimation of Local Average Treatment Effects," Econometrica, Econometric Society, vol. 62(2), pages 467-475, March.
    13. Abadie, Alberto, 2003. "Semiparametric instrumental variable estimation of treatment response models," Journal of Econometrics, Elsevier, vol. 113(2), pages 231-263, April.
    14. G�nther Fink & Margaret McConnell & Sebastian Vollmer, 2014. "Testing for heterogeneous treatment effects in experimental data: false discovery risks and correction procedures," Journal of Development Effectiveness, Taylor & Francis Journals, vol. 6(1), pages 44-57, January.
    15. Yingqi Zhao & Donglin Zeng & A. John Rush & Michael R. Kosorok, 2012. "Estimating Individualized Treatment Rules Using Outcome Weighted Learning," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 107(499), pages 1106-1118, September.
    16. Stoye, Jörg, 2009. "Minimax regret treatment choice with finite samples," Journal of Econometrics, Elsevier, vol. 151(1), pages 70-81, July.
    17. Young, Alwyn, 2019. "Channeling Fisher: randomization tests and the statistical insignificance of seemingly significant experimental results," LSE Research Online Documents on Economics 101401, London School of Economics and Political Science, LSE Library.
    18. Keisuke Hirano & Jack R. Porter, 2009. "Asymptotics for Statistical Treatment Rules," Econometrica, Econometric Society, vol. 77(5), pages 1683-1701, September.
    19. Athey, Susan & Imbens, Guido W., 2019. "Machine Learning Methods Economists Should Know About," Research Papers 3776, Stanford University, Graduate School of Business.
    20. John A. List & Azeem M. Shaikh & Yang Xu, 2019. "Multiple hypothesis testing in experimental economics," Experimental Economics, Springer;Economic Science Association, vol. 22(4), pages 773-793, December.
    21. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    22. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    23. Stoye, Jörg, 2012. "Minimax regret treatment choice with covariates or with limited validity of experiments," Journal of Econometrics, Elsevier, vol. 166(1), pages 138-156.
    24. Sexton, Joseph & Laake, Petter, 2009. "Standard errors for bagged and random forest estimators," Computational Statistics & Data Analysis, Elsevier, vol. 53(3), pages 801-811, January.
    25. Susan Athey & Guido W. Imbens, 2019. "Machine Learning Methods That Economists Should Know About," Annual Review of Economics, Annual Reviews, vol. 11(1), pages 685-725, August.
    26. Charles F. Manski, 2004. "Statistical Treatment Rules for Heterogeneous Populations," Econometrica, Econometric Society, vol. 72(4), pages 1221-1246, July.
    27. Miller, Sarah, 2012. "The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform," Journal of Public Economics, Elsevier, vol. 96(11), pages 893-908.
    28. Dehejia, Rajeev H., 2005. "Program evaluation as a decision problem," Journal of Econometrics, Elsevier, vol. 125(1-2), pages 141-173.
    29. Arthur Lewbel & Yingying Dong & Thomas Tao Yang, 2012. "Viewpoint: Comparing features of convenient estimators for binary choice models with endogenous regressors," Canadian Journal of Economics, Canadian Economics Association, vol. 45(3), pages 809-829, August.
    30. Alwyn Young, 2019. "Channeling Fisher: Randomization Tests and the Statistical Insignificance of Seemingly Significant Experimental Results," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(2), pages 557-598.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Tymon S{l}oczy'nski & S. Derya Uysal & Jeffrey M. Wooldridge, 2022. "Doubly Robust Estimation of Local Average Treatment Effects Using Inverse Probability Weighted Regression Adjustment," Papers 2208.01300, arXiv.org, revised Nov 2022.
    2. Sloczynski, Tymon & Uysal, Derya & Wooldridge, Jeffrey M., 2022. "Doubly Robust Estimation of Local Average Treatment Effects Using Inverse Probability Weighted Regression Adjustment," IZA Discussion Papers 15727, Institute of Labor Economics (IZA).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Susan Athey & Stefan Wager, 2021. "Policy Learning With Observational Data," Econometrica, Econometric Society, vol. 89(1), pages 133-161, January.
    2. Huber, Martin, 2019. "An introduction to flexible methods for policy evaluation," FSES Working Papers 504, Faculty of Economics and Social Sciences, University of Freiburg/Fribourg Switzerland.
    3. Michael C Knaus, 2022. "Double machine learning-based programme evaluation under unconfoundedness [Econometric methods for program evaluation]," The Econometrics Journal, Royal Economic Society, vol. 25(3), pages 602-627.
    4. Takanori Ida & Takunori Ishihara & Koichiro Ito & Daido Kido & Toru Kitagawa & Shosei Sakaguchi & Shusaku Sasaki, 2021. "Paternalism, Autonomy, or Both? Experimental Evidence from Energy Saving Programs," Papers 2112.09850, arXiv.org.
    5. Carlos Fernández-Loría & Foster Provost & Jesse Anderton & Benjamin Carterette & Praveen Chandar, 2023. "A Comparison of Methods for Treatment Assignment with an Application to Playlist Generation," Information Systems Research, INFORMS, vol. 34(2), pages 786-803, June.
    6. Kitagawa, Toru & Wang, Guanyi, 2023. "Who should get vaccinated? Individualized allocation of vaccines over SIR network," Journal of Econometrics, Elsevier, vol. 232(1), pages 109-131.
    7. Davide Viviano, 2019. "Policy Targeting under Network Interference," Papers 1906.10258, arXiv.org, revised Apr 2024.
    8. Takanori Ida & Takunori Ishihara & Koichiro Ito & Daido Kido & Toru Kitagawa & Shosei Sakaguchi & Shusaku Sasaki, 2022. "Choosing Who Chooses: Selection-Driven Targeting in Energy Rebate Programs," NBER Working Papers 30469, National Bureau of Economic Research, Inc.
    9. Christopher Adjaho & Timothy Christensen, 2022. "Externally Valid Policy Choice," Papers 2205.05561, arXiv.org, revised Jul 2023.
    10. Kock, Anders Bredahl & Preinerstorfer, David & Veliyev, Bezirgen, 2023. "Treatment recommendation with distributional targets," Journal of Econometrics, Elsevier, vol. 234(2), pages 624-646.
    11. Kyle Colangelo & Ying-Ying Lee, 2020. "Double Debiased Machine Learning Nonparametric Inference with Continuous Treatments," Papers 2004.03036, arXiv.org, revised Sep 2023.
    12. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    13. Henrika Langen & Martin Huber, 2022. "How causal machine learning can leverage marketing strategies: Assessing and improving the performance of a coupon campaign," Papers 2204.10820, arXiv.org, revised Jun 2022.
    14. Yu-Chang Chen & Haitian Xie, 2022. "Personalized Subsidy Rules," Papers 2202.13545, arXiv.org, revised Mar 2022.
    15. Davide Viviano & Jess Rudder, 2020. "Policy design in experiments with unknown interference," Papers 2011.08174, arXiv.org, revised Dec 2023.
    16. Daniel F. Pellatt, 2022. "PAC-Bayesian Treatment Allocation Under Budget Constraints," Papers 2212.09007, arXiv.org, revised Jun 2023.
    17. Susan Athey & Guido Imbens, 2016. "The Econometrics of Randomized Experiments," Papers 1607.00698, arXiv.org.
    18. Toru Kitagawa & Sokbae Lee & Chen Qiu, 2022. "Treatment Choice with Nonlinear Regret," Papers 2205.08586, arXiv.org, revised Feb 2024.
    19. Charles F. Manski, 2021. "Econometrics for Decision Making: Building Foundations Sketched by Haavelmo and Wald," Econometrica, Econometric Society, vol. 89(6), pages 2827-2853, November.
    20. Kyle Colangelo & Ying-Ying Lee, 2019. "Double debiased machine learning nonparametric inference with continuous treatments," CeMMAP working papers CWP72/19, Centre for Microdata Methods and Practice, Institute for Fiscal Studies.

    More about this item

    Keywords

    Medicaid; ED use; effect heterogeneity; causal machine learning; optimal policy;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:iza:izadps:dp15192. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Holger Hinte (email available below). General contact details of provider: https://edirc.repec.org/data/izaaade.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.