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Public health insurance expansions and hospital technology adoption

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  • Freedman, Seth
  • Lin, Haizhen
  • Simon, Kosali
Abstract
This paper explores the effects of public health insurance expansions on hospitals' decisions to adopt medical technology. Specifically, we test whether the expansion of Medicaid eligibility for pregnant women during the 1980s and 1990s affects hospitals' decisions to adopt neonatal intensive care units (NICUs). While Medicaid expansion provided new insurance to a substantial number of pregnant women, prior literature also finds that some newly insured women would otherwise have been covered by more generously reimbursed private sources. Such crowd-out, combined with Medicaid's low reimbursement rats, leads to a theoretically ambiguous net effect of Medicaid expansion on a hospital's incentive to invest in technology. Using American Hospital Association data, we find that on average, Medicaid expansion has no statistically significant effect on NICU adoption. However, we also find that in geographic areas where more of the newly Medicaid-insured may have come from the privately insured population, Medicaid expansion slows NICU adoption. This holds true particularly when Medicaid payment rates are very low relative to private payment rates. Our findings are consistent with prior evidence on reduced NICU adoption from increased managed-care penetration. We conclude by discussing the policy implications of our work for insurance expansions associated with the Affordable Care Act.

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  • Freedman, Seth & Lin, Haizhen & Simon, Kosali, 2015. "Public health insurance expansions and hospital technology adoption," Journal of Public Economics, Elsevier, vol. 121(C), pages 117-131.
    • Handle: RePEc:eee:pubeco:v:121:y:2015:i:c:p:117-131
    DOI: 10.1016/j.jpubeco.2014.10.005
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    2. Stan Veuger & Jeffrey Clemens, 2015. "Innovation and uncertainty in the medical industry: Evidence from the case of Myriad Genetics, Inc," AEI Economics Working Papers 834894, American Enterprise Institute.
    3. Jeffrey Clemens & Stan Veuger, 2017. "Risks To The Returns To Medical Innovation: The Case Of Myriad Genetics," Contemporary Economic Policy, Western Economic Association International, vol. 35(2), pages 345-357, April.
    4. March, Raymond J. & Geloso, Vincent, 2020. "Gordon Tullock meets Phineas Gage: The political economy of lobotomies in the United States," Research Policy, Elsevier, vol. 49(1).
    5. 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.
    6. Noghanibehambari, Hamid, 2022. "Intergenerational health effects of Medicaid," Economics & Human Biology, Elsevier, vol. 45(C).
    7. Whaley, Christopher M. & Brown, Timothy T., 2018. "Firm responses to targeted consumer incentives: Evidence from reference pricing for surgical services," Journal of Health Economics, Elsevier, vol. 61(C), pages 111-133.
    8. Yang, Jinqiu & Hong, Yongmiao & Ma, Shuangge, 2016. "Impact of the new health care reform on hospital expenditure in China: A case study from a pilot city," China Economic Review, Elsevier, vol. 39(C), pages 1-14.
    9. Clayton, Denise Hammock, 2019. "The Effect of Prescription Drug Coverage on Mortality: Evidence from Medicaid Implementation," Journal of Health Economics, Elsevier, vol. 63(C), pages 100-113.
    10. Thompson, Owen, 2017. "The long-term health impacts of Medicaid and CHIP," Journal of Health Economics, Elsevier, vol. 51(C), pages 26-40.
    11. Lieber, Ethan M.J., 2018. "Does health insurance coverage fall when nonprofit insurers become for-profits?," Journal of Health Economics, Elsevier, vol. 57(C), pages 75-88.
    12. Jeffrey Clemens, 2012. "The Effect of U.S. Health Insurance Expansions on Medical Innovation," Discussion Papers 11-016, Stanford Institute for Economic Policy Research.
    13. Huh, Jason, 2021. "Medicaid and provider supply," Journal of Public Economics, Elsevier, vol. 200(C).

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    More about this item

    Keywords

    Insurance expansions; Technology adoption; Medicaid; Crowd-out;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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