Does uninsurance affect the health outcomes of the insured? Evidence from heart attack patients in California
In this paper, I examine the impact of uninsured patients on the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999–2006). My results indicate that uninsured patients have an economically significant effect that increases the mortality rate of insured heart attack patients. I show that these results are not driven by alternative explanations, including reverse causality, patient composition effects, sample selection or unobserved trends and that they are robust to a host of specification checks. The primary channel for the observed spillover effects is increased hospital uncompensated care costs. Although data limitations constrain my capacity to check how hospitals change their provision of care to insured heart attack patients in response to reduced revenues, the evidence I have suggests a modest increase in the quantity of cardiac services without a corresponding increase in hospital staff.
If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Volume (Year): 31 (2012)
Issue (Month): 4 ()
|Contact details of provider:|| Web page: http://www.elsevier.com/locate/inca/505560|
References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Moulton, Brent R, 1990. "An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Unit," The Review of Economics and Statistics, MIT Press, vol. 72(2), pages 334-38, May.
- Mehdi Farsi, 2004. "Changes in Hospital Quality after Conversion in Ownership Status," International Journal of Health Economics and Management, Springer, vol. 4(3), pages 211-230, 09.
- Mark G. Duggan, 2000.
"Hospital Ownership and Public Medical Spending,"
The Quarterly Journal of Economics,
Oxford University Press, vol. 115(4), pages 1343-1373.
- Jonathan Guryan, 2004.
"Desegregation and Black Dropout Rates,"
American Economic Review,
American Economic Association, vol. 94(4), pages 919-943, September.
- Pagán, José A. & Balasubramanian, Lakshmi & Pauly, Mark V., 2007. "Physicians’ career satisfaction, quality of care and patients’ trust: the role of community uninsurance," Health Economics, Policy and Law, Cambridge University Press, vol. 2(04), pages 347-362, October.
- Emma Hall & Carol Propper & John Van Reenen, 2008.
"Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labor Markets on Hospital Performance,"
CEP Discussion Papers
dp0843, Centre for Economic Performance, LSE.
- Carol Propper & John Van Reenen, 2010. "Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labor Markets on Hospital Performance," Journal of Political Economy, University of Chicago Press, vol. 118(2), pages 222-273, 04.
- Emma Hall & Carol Propper & John Van Reenen, 2007. "Can pay regulation kill? Panel data evidence on the effect of labor markets on hospital performance," The Centre for Market and Public Organisation 08/184, Department of Economics, University of Bristol, UK.
- Emma Hall & Carol Propper & John Van Reenen, 2008. "Can pay regulation kill? Panel data evidence on the effect of labor markets on hospital performance," LSE Research Online Documents on Economics 3282, London School of Economics and Political Science, LSE Library.
- Emma Hall & Carol Propper & John Van Reenen, 2008. "Can pay regulation kill? Panel data evidence on the effect of labor markets on hospital performance," NBER Working Papers 13776, National Bureau of Economic Research, Inc.
- Hall, Emma & Propper, Carol & Van Reenen, John, 2008. "Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labour Markets on Hospital Performance," CEPR Discussion Papers 6643, C.E.P.R. Discussion Papers.
- Roger Feldman & Bryan Dowd & Scott Leitz & Lynn A. Blewett, 1997. "The Effect of Premiums on the Small Firm's Decision to Offer Health Insurance," Journal of Human Resources, University of Wisconsin Press, vol. 32(4), pages 635-658.
- John Cawley & Kosali I. Simon, 2003.
"Health Insurance Coverage and the Macroeconomy,"
NBER Working Papers
10092, National Bureau of Economic Research, Inc.
- Mehdi Farsi & Geert Ridder, 2006.
"Estimating the Out-of-Hospital Mortality Rate Using Patient Discharge Data,"
IEPR Working Papers
06.45, Institute of Economic Policy Research (IEPR).
- Mehdi Farsi & Geert Ridder, 2006. "Estimating the out-of-hospital mortality rate using patient discharge data," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 983-995.
- Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2005.
"Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools,"
Journal of Political Economy,
University of Chicago Press, vol. 113(1), pages 151-184, February.
- Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2000. "Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools," NBER Working Papers 7831, National Bureau of Economic Research, Inc.
- Shen, Yu-Chu, 2002. "The effect of hospital ownership choice on patient outcomes after treatment for acute myocardial infarction," Journal of Health Economics, Elsevier, vol. 21(5), pages 901-922, September.
- Moulton, Brent R., 1986. "Random group effects and the precision of regression estimates," Journal of Econometrics, Elsevier, vol. 32(3), pages 385-397, August.
- Currie, Janet & Fahr, John, 2004.
"Hospitals, managed care, and the charity caseload in California,"
Journal of Health Economics,
Elsevier, vol. 23(3), pages 421-442, May.
- Janet Currie & John Fahr, 2001. "Hospitals, Managed Care, and the Charity Caseload in California," NBER Working Papers 8621, National Bureau of Economic Research, Inc.
- Jonathan Skinner & Douglas Staiger, 2009. "Technology Diffusion and Productivity Growth in Health Care," NBER Working Papers 14865, National Bureau of Economic Research, Inc.
- Gruber, Jonathan & Madrian, Brigitte C., 1997. "Employment separation and health insurance coverage," Journal of Public Economics, Elsevier, vol. 66(3), pages 349-382, December.
- Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
- repec:mpr:mprres:6204 is not listed on IDEAS
- Mark McClellan & Douglas Staiger, 1999. "The Quality of Health Care Providers," NBER Working Papers 7327, National Bureau of Economic Research, Inc.
- Katherine Baicker & Douglas Staiger, 2005. "Fiscal Shenanigans, Targeted Federal Health Care Funds, and Patient Mortality," The Quarterly Journal of Economics, Oxford University Press, vol. 120(1), pages 345-386.
- Gruber, Jonathan, 1994. "The effect of competitive pressure on charity: Hospital responses to price shopping in California," Journal of Health Economics, Elsevier, vol. 13(2), pages 183-211, July.
When requesting a correction, please mention this item's handle: RePEc:eee:jhecon:v:31:y:2012:i:4:p:545-563. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Shamier, Wendy)
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 references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link 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 profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.