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The Economics of Organizational Stru...

Cho, Hyein,

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The Economics of Organizational Structure in Healthcare Markets /

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	The Economics of Organizational Structure in Healthcare Markets // Hyein Cho.
作者:	Cho, Hyein,
面頁冊數:	1 electronic resource (228 pages)
附註:	Source: Dissertations Abstracts International, Volume: 86-12, Section: B.
Contained By:	Dissertations Abstracts International86-12B.
標題:	Nursing. -
電子資源:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=31998176
ISBN:	9798315797531

The Economics of Organizational Structure in Healthcare Markets /
Cho, Hyein,

The Economics of Organizational Structure in Healthcare Markets /Hyein Cho. - 1 electronic resource (228 pages)

Source: Dissertations Abstracts International, Volume: 86-12, Section: B.

This dissertation studies the economics of organizational structure in healthcare markets. Across three chapters, I examine how organizational structures adopted by healthcare providers influence their incentives to deliver care, affect patient health outcomes, and interact with regulatory policies.In Chapter 1, I examine how integration between healthcare providers and insurers affects care delivery. Using data from the Massachusetts Individual Exchange, I find that integration reduces overall utilization, primarily by lowering patients' visits to specialists, while increasing the likelihood of patients seeing integrated specialists. This shift is concentrated among patients whose primary care practitioners (PCPs) are integrated with the insurer. To disentangle the mechanisms behind these changes-stricter gatekeeping, improved PCP-specialist coordination, and steering incentives-I develop and estimate a physician referral model. Counterfactual analysis shows that most of the reduction in specialist visits is driven by stricter gatekeeping, two-thirds of the internal referrals are explained by steering incentives, and the remainders are explained by better coordination between referring and referred physicians.In Chapter 2, Hans Zhu and I examine whether for-profit provision in the U.S. nursing home industry should be regulated, given persistent concerns about their lower quality of care relative to not-for-profit providers. Using facility-level data spanning twenty years, we show that welfare effects of such policies are theoretically ambiguous due to a quality vs. access trade-off: for-profit providers offer lower quality services but disproportionately serve consumers with low-socioeconomic statuses. Using a structural model which allows for differences in objective and cost functions based on their for-profit status, we find that for-profit providers choose to serve low-socioeconomic consumers because they have a strong cost advantage for serving residents with weaker preferences for quality. Not-for-profits, in contrast, choose higher quality, not due to their non-pecuniary objectives, but to avoid direct competition with for-profits by targeting residents with stronger quality preferences. Crucially, we find that banning for-profit providers tends to reduce consumer surplus, as not-for-profits that replace for-profits raise prices substantially to cover their higher cost.In Chapter 3, I examine the value of different long-term care delivery modes-facility-based institutional care vs. decentralized home-based care-and their policy implications. To control for patients' selection into different types of care, I exploit a natural experiment in the South Korean national long-term care insurance scheme that allows for a regression discontinuity design. I find that facility-based care increases first-year mortality compared to home-based care, while further expanding home-based care improves chronic care management without increasing spending. These findings suggest that policies subsidizing home-based care would result in better health outcomes at lower costs.

English

ISBN: 9798315797531Subjects--Topical Terms:

528444
Nursing.
Subjects--Index Terms:

Healthcare markets

The Economics of Organizational Structure in Healthcare Markets /
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