Health care utilization and insurance, consumer choices of pharmaceutical drugs, uncertainty and demand for health care (three essays in health economics).

摘要

Chapter 1 investigates the impact of private insurance, Medicaid or being uninsured on the utilization of ambulatory care, hospitalization, emergency care and prescription drug. Five models are used in estimation: random effect, random effect linear probability, fixed effect, fixed effect linear probability and CLAD fixed effect Tobit. Random effect models are rejected by specification tests. All models conclude that the uninsured people have less use of all categories of health care services than the privately insured; the Medicaid people have more use of all health care services than the privately insured except emergency care. For emergency care, random effect and random effect linear probability models indicate a positive effect of Medicaid on emergency care utilization while fixed effect, fixed effect linear probability and CLAD fixed effect Tobit find Medicaid effect to be insignificant. This suggests that the estimated effect of Medicaid on emergency care utilization using random effect models be biased and have wrong signs due to omitted variables.; In Chapter 2, I study the consumer behavior towards choices of prescription drug brands using a multinomial logit model and 1987 National Medical Expenditure Survey Data. I find that although consumers appear to prefer high priced brand name drugs, they are more likely to choose generic drugs which offer deep discounts relative to brand name drugs. Also, higher percentage of copay by self encourages generic drug utilization by consumers covered by private insurance. These findings suggest that consumers be rational. They can take advantage of lower priced generic drugs.; Chapter 3 tries to explore the impact of medical technology on reducing risks and uncertainty while average outcomes of medical care are unchanged. The findings conclude that to correctly estimate the effects of various socioeconomic factors, technology has to be incorporated into the economic analysis. Medical technology contributes significantly to the escalating national health care expenditure. The weakness of this study is that given the data, it is difficult to identify health care expenditure increases due to technology that only reduces risks and uncertainty, to technology that improves means of quality or to technology that does both.