Showing papers by "Dana P. Goldman published in 2006"
TL;DR: The results from this exercise argue in favour of using the multivariate probit rather than the two-step or linear probability model estimators, especially when there is more than one treatment, when the average probability of the dependent variable is close to 0 or 1, or when the data generating process is not normal.
Abstract: Outcomes research often requires estimating the impact of a binary treatment on a binary outcome in a non-randomized setting, such as the effect of taking a drug on mortality. The data often come from self-selected samples, leading to a spurious correlation between the treatment and outcome when standard binary dependent variable techniques, like logit or probit, are used. Intuition suggests that a two-step procedure (analogous to two-stage least squares) might be sufficient to deal with this problem if variables are available that are correlated with the treatment choice but not the outcome. This paper demonstrates the limitations of such a two-step procedure. We show that such estimators will not generally be consistent. We conduct a Monte Carlo exercise to compare the performance of the two-step probit estimator, the two-stage least squares linear probability model estimator, and the multivariate probit. The results from this exercise argue in favour of using the multivariate probit rather than the two-step or linear probability model estimators, especially when there is more than one treatment, when the average probability of the dependent variable is close to 0 or 1, or when the data generating process is not normal. We demonstrate how these different methods perform in an empirical example examining the effect of private and public insurance coverage on the mortality of HIV+ patients.
195 citations
Journal Article•
TL;DR: Although many obstacles exist, varying copayments for CL therapy by therapeutic need would reduce hospitalizations and ED use--with total savings of more than 1 billion dollars annually.
Abstract: OBJECTIVE To determine whether a pharmacy benefit that varies copayments for cholesterol-lowering (CL) therapy according to expected therapeutic benefit would improve compliance and reduce use of other services. METHODS Using claims data from 88 health plans, we studied 62 274 patients aged 20 years and older who initiated CL therapy between 1997 and 2001. We examined the association between copayments and compliance in the year after initiation of therapy, and the association between compliance and subsequent hospital and emergency department (ED) use for up to 4 years after initiation. RESULTS The fraction of fully compliant patients fell by 6 to 10 percentage points when copayments increased from 10 dollars to 20 dollars, depending on patient risk (P < .05). Full compliance was associated with 357 fewer hospitalizations annually per 1000 high-risk patients (P < .01) and 168 fewer ED visits (P < .01) compared with patients not in full compliance. For patients at low risk, full compliance was associated with 42 fewer hospitalizations (P = .02) and 21 fewer ED visits (P = .22). Using these results, we simulated a policy that eliminated copayments for high- and medium-risk patients but raised them (from 10 dollars to 22 dollars) for low-risk patients. Based on a national sample of 6.3 million adults on CL therapy, this policy would avert 79,837 hospitalizations and 31,411 ED admissions annually. CONCLUSION Although many obstacles exist, varying copayments for CL therapy by therapeutic need would reduce hospitalizations and ED use--with total savings of more than 1 billion dollars annually.
174 citations
TL;DR: It is found that treatment results in more sexual risk-taking by HIV+ adults, and possibly more of other risky behaviors like drug abuse, which implies that breakthroughs in treating an incurable disease like HIV can increase precautionary behavior by the uninfected and thus reduce welfare.
Abstract: Recent HIV treatment breakthroughs have lowered HIV mortality in the United States, but have also coincided with increased HIV incidence. The authors argue that these trends are causally linked, because new treatments have improved health and survival for the HIV+, increased their sexual activity, and thus facilitated HIV's spread.
150 citations
TL;DR: The foreign-born (especially the undocumented) use disproportionately fewer medical services and contribute less to health care costs in relation to their population share, likely because of their better relative health and lack of health insurance.
Abstract: Foreign-born adults in Los Angeles County, California, constituted 45 percent of the county’s population ages 18–64 but accounted for 33 percent of health spending in 2000. Similarly, the undocumented constituted 12 percent of the nonelderly adult population but accounted for only 6 percent of spending. Extrapolating to the nation, total spending by the undocumented is $6.4 billion, of which only 17 percent ($1.1 billion) is paid for by public sources. The foreign-born (especially the undocumented) use disproportionately fewer medical services and contribute less to health care costs in relation to their population share, likely because of their better relative health and lack of health insurance.
146 citations
TL;DR: Examination of spending by privately insured patients with four conditions often treated with specialty drugs finds that specialty drug use is largely insensitive to cost sharing, with price elasticities ranging from 0.01 to 0.21.
Abstract: In this paper we examine spending by privately insured patients with four conditions often treated with specialty drugs: cancer, kidney disease, rheumatoid arthritis, and multiple sclerosis. Despite having employer-sponsored health insurance, these patients face substantial risk for high out-of-pocket spending. In contrast to traditional pharmaceuticals, we find that specialty drug use is largely insensitive to cost sharing, with price elasticities ranging from 0.01 to 0.21. Given the expense of many specialty drugs, care management should focus on making sure that patients who will most benefit receive them. Once such patients are identified, it makes little economic sense to limit coverage.
123 citations
TL;DR: Reducing obesity back to levels seen in the 1980's would have little effect on mortality, but yields great improvements in morbidity (especially heart disease and diabetes) with a cost savings of over $1 trillion.
Abstract: Approximately 100 million elderly will enter Medicare over the next 25 years. We consider the potential benefits of interventions that would reduce or eliminate the most important risk factors for disease and spending. Effective control of hypertension could reduce health care spending $890 billion for these cohorts while adding 75 million disability-adjusted life years (DALYs). Eliminating diabetes would add 90 million life-year equivalents at a cost of $2,761 per DALY. Reducing obesity back to levels seen in the 1980's would have little effect on mortality, but yields great improvements in morbidity (especially heart disease and diabetes) with a cost savings of over $1 trillion. Smoking cessation will have the smallest impact, adding 32 million DALYs at a cost of $9.045 per DALY. While smoking cessation reduces lung disease and lung cancer, but these are relatively low prevalence compared to the other diseases. Its impact on heart disease is negligible. The effects on overall social welfare are unknown, since we do not estimate the costs of these interventions, the costs of any behavioral modification, or the welfare loss due to providers from lower medical spending.
33 citations
TL;DR: In this paper, Thorpe and Howard provide an important snapshot of the long-term trends in Medicare beneficiaries' health care spending, and they use clever methods to shed new light on increases in per capita spending, convincingly demonstrating that treatment patterns are a major factor.
Abstract: Kenneth Thorpe and David Howard provide an important snapshot of the long-term trends in Medicare beneficiaries’ health care spending. They use clever methods to shed new light on increases in per capita spending, convincingly demonstrating that treatment patterns are a major factor. But several puzzles remain. Trends in per capita spending differ from other findings in that Thorpe and Howard find costs rising fastest for those with multiple conditions, and it is unclear what would happen if one took lifetime spending into account. Reliable predictions about long-term trends will require information on any health benefits associated with increases in diagnosis and treatment.
7 citations
TL;DR: It is found that beneficiaries in better health were more likely to switch to the new, less generous plans, which suggests that drug coverage may be more susceptible to adverse selection than medical insurance.
Abstract: The authors used claims data from a large U.S. employer that introduced changes in its medical and drug coverage offerings in 2002 for non-Medicare eligible retirees.
7 citations
Journal Article•
4 citations