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Prescription Drug Use under Medicare Part D: A Linear Model of Nonlinear Budget Sets

Author

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  • Jason Abaluck
  • Jonathan Gruber
  • Ashley Swanson
Abstract
Medicare Part D enrollees face a complicated decision problem: they must dynamically choose prescription drug consumption in each period given difficult- to-find prices and a non-linear budget set. We use Medicare Part D claims data from 2006-2009 to estimate a flexible model of consumption that accounts for non-linear budget sets, dynamic incentives due to myopia and uncertainty, and price salience. By using variation away from kink points, we are able to estimate structural models with a linear regression of consumption on coverage range prices. We then compare performance under several candidate models of expectations and coverage phase weighting. The estimates suggest small marginal price elasticities and substantial myopia; we also find evidence that salient plan characteristics impact consumption beyond their effect on out-of-pocket prices. A hyperbolic discounting model which allows for salient plan characteristics fits the data well, and outperforms both rational models and alternative behavioral models.

Suggested Citation

  • Jason Abaluck & Jonathan Gruber & Ashley Swanson, 2015. "Prescription Drug Use under Medicare Part D: A Linear Model of Nonlinear Budget Sets," NBER Working Papers 20976, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:20976
    Note: AG EH
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    References listed on IDEAS

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    1. Jason Abaluck & Jonathan Gruber, 2011. "Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program," American Economic Review, American Economic Association, vol. 101(4), pages 1180-1210, June.
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    4. Jonathan D. Ketcham & Claudio Lucarelli & Eugenio J. Miravete & M. Christopher Roebuck, 2012. "Sinking, Swimming, or Learning to Swim in Medicare Part D," American Economic Review, American Economic Association, vol. 102(6), pages 2639-2673, October.
    5. Naomi E. Feldman & Peter Katuscak & Laura Kawano, 2013. "Taxpayer confusion over predictable tax liability changes: evidence from the Child Tax Credit," Finance and Economics Discussion Series 2013-66, Board of Governors of the Federal Reserve System (U.S.).
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    7. Christina M Dalton & Gautam Gowrisankaran & Robert J Town, 2020. "Salience, Myopia, and Complex Dynamic Incentives: Evidence from Medicare Part D," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 87(2), pages 822-869.
    8. Koichiro Ito, 2014. "Do Consumers Respond to Marginal or Average Price? Evidence from Nonlinear Electricity Pricing," American Economic Review, American Economic Association, vol. 104(2), pages 537-563, February.
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    11. Mark Duggan & Patrick Healy & Fiona Scott Morton, 2008. "Providing Prescription Drug Coverage to the Elderly: America's Experiment with Medicare Part D," Journal of Economic Perspectives, American Economic Association, vol. 22(4), pages 69-92, Fall.
    12. Kowalski, Tadeusz, 2011. "Economic policy and the financial and economic crisis," MPRA Paper 33994, University Library of Munich, Germany.
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    Cited by:

    1. Zarek C. Brot-Goldberg & Amitabh Chandra & Benjamin R. Handel & Jonathan T. Kolstad, 2017. "What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 132(3), pages 1261-1318.
    2. Bradley T. Shapiro, 2016. "Estimating the cost of strategic entry delay in pharmaceuticals: The case of Ambien CR," Quantitative Marketing and Economics (QME), Springer, vol. 14(3), pages 201-231, September.
    3. Ulrike Malmendier, 2016. "The Bidder's Curse: Reply," American Economic Review, American Economic Association, vol. 106(4), pages 1195-1213, April.
    4. Olesya Fomenko & Jonathan Gruber, 2019. "Reclassification to Avoid Consumer Cost-Sharing in Group Health Plans," NBER Working Papers 25870, National Bureau of Economic Research, Inc.
    5. Einav, Liran & Finkelstein, Amy & Schrimpf, Paul, 2019. "Reprint of: Bunching at the kink: Implications for spending responses to health insurance contracts," Journal of Public Economics, Elsevier, vol. 171(C), pages 117-130.
    6. Amanda Starc & Robert J. Town, 2015. "Externalities and Benefit Design in Health Insurance," NBER Working Papers 21783, National Bureau of Economic Research, Inc.
    7. David Dranove & Christopher Ody & Amanda Starc, 2021. "A Dose of Managed Care: Controlling Drug Spending in Medicaid," American Economic Journal: Applied Economics, American Economic Association, vol. 13(1), pages 170-197, January.
    8. Hayen, Arthur P. & Klein, Tobias J. & Salm, Martin, 2021. "Does the framing of patient cost-sharing incentives matter? the effects of deductibles vs. no-claim refunds," Journal of Health Economics, Elsevier, vol. 80(C).
    9. Alpert, Abby, 2016. "The anticipatory effects of Medicare Part D on drug utilization," Journal of Health Economics, Elsevier, vol. 49(C), pages 28-45.
    10. Einav, Liran & Finkelstein, Amy & Schrimpf, Paul, 2017. "Bunching at the kink: Implications for spending responses to health insurance contracts," Journal of Public Economics, Elsevier, vol. 146(C), pages 27-40.
    11. Lin, Haizhen & Sacks, Daniel W., 2019. "Intertemporal substitution in health care demand: Evidence from the RAND Health Insurance Experiment," Journal of Public Economics, Elsevier, vol. 175(C), pages 29-43.
    12. Francesco Decarolis & Maria Polyakova & Stephen P. Ryan, 2020. "Subsidy Design in Privately Provided Social Insurance: Lessons from Medicare Part D," Journal of Political Economy, University of Chicago Press, vol. 128(5), pages 1712-1752.
    13. Eliason, Marcus & Johansson, Per & Nilsson, Martin, 2018. "Forward-looking moral hazard in social insurance: evidence from a natural experiment," Working Paper Series 2018:11, IFAU - Institute for Evaluation of Labour Market and Education Policy.
    14. Powell, David & Goldman, Dana, 2021. "Disentangling moral hazard and adverse selection in private health insurance," Journal of Econometrics, Elsevier, vol. 222(1), pages 141-160.
    15. Michael Sinkinson & Amanda Starc, 2015. "Ask Your Doctor? Direct-to-Consumer Advertising of Pharmaceuticals," NBER Working Papers 21045, National Bureau of Economic Research, Inc.
    16. Eliason, Marcus & Johansson, Per & Nilsson, Martin, 2019. "Forward-looking moral hazard in social insurance," Labour Economics, Elsevier, vol. 60(C), pages 84-98.
    17. Haizhen Lin & Daniel W. Sacks, 2016. "Intertemporal Substitution in Health Care Demand: Evidence from the RAND Health Insurance Experiment," NBER Working Papers 22802, National Bureau of Economic Research, Inc.

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    More about this item

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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