The impact of market forces and public health insurance on inpatient care

This dissertation considers both private and public-sector influences on inpatient care, focusing first on the impact of strategic hospital behavior on entry into new procedure markets, and second on the effect of changes in Medicaid and Medicare on hospital care. Chapter 1, "Entry Deterrence in Hospital Procedure Markets: A Simple Model of Learning-by-Doing," investigates whether incumbent hospitals threatened by entry in profitable procedure markets take advantage of learning-by-doing in these markets to erect barriers to entry. By focusing on incumbent behavior following a positive shock to the profitability of a procedure, and comparing this behavior across markets with different levels of entry-deterrence incentives, I am able to detect limited evidence consistent with entry deterrence through learning-by-doing in three case studies: electrophysiological studies, liver transplants, and prostatectomy. Chapter 2, "Does Public Insurance Improve the Efficiency of Medical Care? Medicaid Expansions and Child Hospitalizations," addresses the relationship between health insurance availability and the nature and frequency of hospitalization. Together with co-author Jonathan Gruber, I find that the Medicaid expansions from 1983 to 1996 were associated with a 22% decline in "avoidable hospitalizations," hospitalizations that can potentially be averted by timely outpatient care. However, the increased insurance coverage had a larger, offsetting impact on other types of hospitalizations, yielding a 10% overall increase in child hospitalizations.

Department dc:contributor.department

Massachusetts Institute of Technology. Dept. of Economics.

Grantor dc:publisher

Massachusetts Institute of Technology

Year dc:date.issued

2001

Author dc:creator

• Dafny, Leemore S. (Leemore Sharon)

Advisor dc:contributor.advisor

• Jonathan Gruber and James M. Poterba.

• Economics.

Statement dc:rights

• M.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.

Licence dc:rights.uri

• http://dspace.mit.edu/handle/1721.1/7582

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/1721.1/8653

OAI identifier oai:identifier

oai:dspace.mit.edu:1721.1/8653