Economía de la Salud


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Econom�a de la Salud <[log in para visualizar]>
Wed, 2 Feb 2005 23:36:29 +0100
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1. Did the HMO Revolution Cause Hospital Consolidation?
by Robert Town, Douglas Wholey, Roger Feldman, Lawton R. Burns  -  #11087


During the 1990s US healthcare markets underwent a significant
transformation. Managed care rose to become the dominant form of
insurance in the private sector. Also, a wave of hospital
consolidation occurred. In 1990, the mean population-weighted
hospital Herfindahl-Hirschman Index (HHI) in a Health Services Area
(HSA) was .19. By 2000, the HHI had risen to .26. This paper explores
whether the rise in managed care caused the increase in hospital
concentration. We use an instrumental variables approach with 10-year
differences to identify the relationship between managed care
penetration and hospital consolidation. Our results strongly imply
that the rise of managed care did not cause the hospital
consolidation wave. This finding is robust to a number of different

2.  Why Has Black-White Skill Convergence Stopped?
by Derek Neal  -  #11090 (ED LS)


All data sources indicate that black-white skill gaps diminished over
most of the 20th century, but black-white skill gaps as measured by
test scores among youth and educational attainment among young adults
have remained constant or increased in absolute value since the late
1980s. I examine the potential importance of discrimination against
skilled black workers, changes in black family structures, changes in
black household incomes, black-white differences in parenting norms,
and education policy as factors that may contribute to the recent
stability of black-white skill gaps.  Absent changes in public policy
or the economy that facilitate investment in black children, best
case scenarios suggest that even approximate black-white skill parity
is not possible before 2050, and equally plausible scenarios imply
that the black-white skill gap will remain quite significant
throughout the 21st century.

3.  Steming the Tide? The Effect of Expanding Medicaid Eligibility
on Health Insurance
by Lara D. Shore-Sheppard  -  #11091 (CH HC)


Despite considerable research, there is little consensus about the
impact of Medicaid eligibility expansions for low-income children. In
this paper, I reexamine the expansions' impact on Medicaid take-up
and private insurance "crowd-out." Focusing on the most influential
estimates of the expansions' impact, I show that while many of the
critiques leveled at these estimates have little effect on their
magnitude, accounting for age-specific trends in coverage produces
estimates similar to others in the literature. Estimating the impact
of later expansions using additional years of data, I find low rates
of take-up and no evidence of crowding out.

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