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. 2022 Nov;14(4):397-431.
doi: 10.1257/pol.20190628.

Healthcare Rationing in Public Insurance Programs: Evidence from Medicaid

Timothy J Layton  1 , Nicole Maestas  1 , Daniel Prinz  2 , Boris Vabson  3
Affiliations

Healthcare Rationing in Public Insurance Programs: Evidence from Medicaid

Timothy J Layton et al. Am Econ J Econ Policy. 2022 Nov.
No abstract available

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Figures

Figure 1. :
Figure 1. :. Counties and First Stage
Note: Figure shows the counties that we include in our sample as treatment and control counties and Medicaid managed care enrollment in the two groups of counties. In both panels, control counties are in light blue and treatment counties are in dark red. In Panel (b), the red vertical line between January and February 2007 corresponds to the date of the introduction of the STAR+Plus Medicaid managed care program in the treatment counties. For more details, see Section III.
Figure 2. :
Figure 2. :. Main Outcomes
Note: Figure shows control-treatment differences in the main outcomes in percent terms relative to the treatment mean in the pre-period. These coefficients are from estimating the event study difference-in-differences specification in Equation (1), including individual fixed effects. For more details, see Section III. (N = 643; 751 beneficiary-quarters.)
Figure 3. :
Figure 3. :. Heterogeneity by Age and Health Status (Number of Comorbidities)
Note: Figure shows the impact of Medicaid managed care on inpatient spending, outpatient spending, and prescription drug spending by age and health status. Health status is measured as the average number of comorbidities during the pre-period, limiting our sample to beneficiaries for whom this measure can be generated. These coefficients are from estimating our instrumental variable specification separately for each age (20–34, 35–49, 50–64) by comorbidity group (no comorbidities, 1 to 3 comorbidities, at least 4 comorbidities). For more details, see Section III (N = 478, 938 beneficiary-quarters.)
Figure 4. :
Figure 4. :. Prescription Drug and Inpatient Spending by Category
Note: Figure shows the impact of Medicaid managed care on prescription drug spending and inpatient spending. Panel (a) shows estimates for prescription drug spending by Redbook therapeutic category. Panel (b) shows estimates for inpatient spending by CCS category. These coefficients are from estimating our instrumental variable specification in separately for each of the categories. For more details, see Section III. (N = 643, 751 beneficiary-quarters.)
Figure 5. :
Figure 5. :. Number of Months With More Than a Given Number of Unique Drugs
Note: Figure shows control-treatment differences in the number of months during which more than a given number of unique drugs was prescribed. These coefficients are from estimating the event study difference-in-differences specification in Equation (1), including individual fixed effects. For more details, see Section III. (N = 643, 751 beneficiary-quarters.)
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References

    1. Aizer Anna, Currie Janet, and Moretti Enrico. 2007. “Does Managed Care Hurt Health? Evidence from Medicaid Mothers.” Review of Economics and Statistics, 89(3): 385–399.
    1. Alexander Diane, and Schnell Molly. 2019. “The Impacts of Physician Payments on Patient Access, Use, and Health.” National Bureau of Economic Research Working Paper 26095.
    1. Alpert Abby, Duggan Mark, and Hellerstein Judith. 2013. “Perverse Reverse Price Competition: Average Wholesale Prices and Medicaid Pharmaceutical Spending.” Journal of Public Economics, 108(1): 44–62.
    1. Baicker Katherine, Mullainathan Sendhil, and Schwartzstein Joshua. 2015. “Behavioral Hazard in Health Insurance.” Quarterly Journal of Economics, 130(4): 1623–1667. - PMC - PubMed
    1. Brot-Goldberg Zarek C. Chandra Amitabh, Handel Benjamin R. and Kolstad Jonathan T.. 2017. “What Does a Deductible Do? The Impact of Cost–Sharing on Health Care Prices, Quantities, and Spending Dynamics.” Quarterly Journal of Economics, 132(3): 1261–1318.

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