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Using RD design to understand heterogeneity in health insurance crowd-out

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  • Koch, Thomas G.

Abstract

Crowd-out, the switching from private to public insurance, is often found, but estimates are rarely consistent with prior measurements. Cutler and Gruber (1996) found crowd-out in up to half of the newly eligible children, while Card and Shore-Sheppard (2004) found almost none. This paper exploits many regression discontinuity (RD) designs to estimate heterogeneous effects of public insurance eligibility. Crowd-out and its impact on spending and utilization is documented across the income spectrum, but effects are smaller at higher income levels. These differences vary by state and correspond to changes in the reimbursement rates of public insurance plans.

Suggested Citation

  • Koch, Thomas G., 2013. "Using RD design to understand heterogeneity in health insurance crowd-out," Journal of Health Economics, Elsevier, vol. 32(3), pages 599-611.
  • Handle: RePEc:eee:jhecon:v:32:y:2013:i:3:p:599-611
    DOI: 10.1016/j.jhealeco.2013.03.002
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    1. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    2. Manning, Willard G. & Basu, Anirban & Mullahy, John, 2005. "Generalized modeling approaches to risk adjustment of skewed outcomes data," Journal of Health Economics, Elsevier, vol. 24(3), pages 465-488, May.
    3. Lo Sasso, Anthony T. & Buchmueller, Thomas C., 2004. "The effect of the state children's health insurance program on health insurance coverage," Journal of Health Economics, Elsevier, vol. 23(5), pages 1059-1082, September.
    4. David Card & Lara D. Shore-Sheppard, 2004. "Using Discontinuous Eligibility Rules to Identify the Effects of the Federal Medicaid Expansions on Low-Income Children," The Review of Economics and Statistics, MIT Press, vol. 86(3), pages 752-766, August.
    5. Imbens, Guido W. & Lemieux, Thomas, 2008. "Regression discontinuity designs: A guide to practice," Journal of Econometrics, Elsevier, vol. 142(2), pages 615-635, February.
    6. John C. Ham & I. Serkan Ozbeklik & Lara Shore-Sheppard, 2010. "Estimating Heterogeneous Treatment Effects of Medicaid Expansions on Take-up and Crowd-out," NBER Working Papers 16112, National Bureau of Economic Research, Inc.
    7. David M. Cutler & Jonathan Gruber, 1996. "Does Public Insurance Crowd out Private Insurance?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 391-430.
    8. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    9. Lee, David S. & Card, David, 2008. "Regression discontinuity inference with specification error," Journal of Econometrics, Elsevier, vol. 142(2), pages 655-674, February.
    10. Currie, Janet & Gruber, Jonathan, 2001. "Public health insurance and medical treatment: the equalizing impact of the Medicaid expansions," Journal of Public Economics, Elsevier, vol. 82(1), pages 63-89, October.
    11. 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.
    12. Peltzman, Sam, 1973. "The Effect of Government Subsidies-in-Kind on Private Expenditures: The Case of Higher Education," Journal of Political Economy, University of Chicago Press, vol. 81(1), pages 1-27, Jan.-Feb..
    13. Laura Dague & Thomas DeLeire & Donna Friedsam & Daphne Kuo & Lindsey Leininger & Sarah Meier & Kristen Voskuil, 2011. "Estimates of Crowd-Out from a Public Health Insurance Expansion Using Administrative Data," NBER Working Papers 17009, National Bureau of Economic Research, Inc.
    14. Michael Anderson & Carlos Dobkin & Tal Gross, 2012. "The Effect of Health Insurance Coverage on the Use of Medical Services," American Economic Journal: Economic Policy, American Economic Association, vol. 4(1), pages 1-27, February.
    15. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 597-636.
    16. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    17. Mark Duggan & Tamara Hayford, 2013. "Has the Shift to Managed Care Reduced Medicaid Expenditures? Evidence from State and Local‐Level Mandates," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 32(3), pages 505-535, June.
    18. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    19. Gruber, Jonathan & Simon, Kosali, 2008. "Crowd-out 10 years later: Have recent public insurance expansions crowded out private health insurance?," Journal of Health Economics, Elsevier, vol. 27(2), pages 201-217, March.
    20. Craig L. Garthwaite, 2011. "The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions," NBER Working Papers 17070, National Bureau of Economic Research, Inc.
    21. Sandra Decker, 2007. "Medicaid physician fees and the quality of medical care of Medicaid patients in the USA," Review of Economics of the Household, Springer, vol. 5(1), pages 95-112, March.
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    Cited by:

    1. Sarah Hamersma & Matthew Kim & Brenden Timpe, 2019. "The Effect Of Parental Medicaid Expansions On Children'S Health Insurance Coverage," Contemporary Economic Policy, Western Economic Association International, vol. 37(2), pages 297-311, April.
    2. Thomas G. Koch, 2015. "All Internal in the Family?: Measuring Spillovers from Public Health Insurance," Journal of Human Resources, University of Wisconsin Press, vol. 50(4), pages 959-979.
    3. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters, in: Economics of Means-Tested Transfer Programs in the United States, Volume 1, pages 21-136, National Bureau of Economic Research, Inc.
    4. Zhuan Pei & Yi Shen, 2017. "The Devil is in the Tails: Regression Discontinuity Design with Measurement Error in the Assignment Variable," Advances in Econometrics, in: Regression Discontinuity Designs, volume 38, pages 455-502, Emerald Group Publishing Limited.
    5. Takahide Yanagi, 2014. "The Effect of Measurement Error in the Sharp Regression Discontinuity Design," KIER Working Papers 910, Kyoto University, Institute of Economic Research.
    6. de la Mata, D, 2011. "The Effect of Medicaid on Children's Health: A Regression Discontinuity Approach," Health, Econometrics and Data Group (HEDG) Working Papers 11/16, HEDG, c/o Department of Economics, University of York.
    7. DiNardi, Michael, 2021. "Aging out of the federal dependent coverage mandate and purchases of prescription drugs with high rates of misuse," Economics & Human Biology, Elsevier, vol. 43(C).
    8. Thomas S. Conkling, 2018. "Crowd‐Out or Affordability? The Lifeline Expansion's Effect on Wireless Service Spending," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 37(2), pages 357-383, March.

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    More about this item

    Keywords

    Heterogeneous treatment effects; SCHIP; Medicaid; Crowd out;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H4 - Public Economics - - Publicly Provided Goods

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