Showing papers by "Richard G. Frank published in 1991"

The supply of charity services by nonprofit hospitals: motives and market structure.

Abstract: This article studies provision of charity care by private, nonprofit hospitals We demonstrate that in the absence of large positive income effects on charity care supply, convex preferences for the nonprofit hospital imply crowding out by other private or government hospitals Extending our model to include impure altruism (rivalry) provides a possible explanation for the previously reported empirical result that both crowding out and income effects on indigent care supply are often weak or insignificant Empirical analysis of data for hospitals in Maryland provides evidence of rivalry on the supply of charity care

Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus.

Abstract: BACKGROUND. Intravenous drug users (IVDUs) with human immunodeficiency virus (HIV) infection and AIDS often have no health insurance or rely on public programs to finance their health care. We examined the independent contributions of HIV serostatus, clinical symptoms, CD4 cell counts, and health insurance to utilization of health services among 1881 intravenous drug users in Baltimore, Maryland. METHODS. Participants in an ongoing natural history study of HIV were informed of HIV serostatus and seropositives were informed of CD4 cell counts; 6 months later, participants were administered a questionnaire concerning self-reported use of health services, insurance coverage, and HIV-related symptoms. RESULTS. Of 1881 participants, 67% had health insurance (including Medicaid), 48% had at least one outpatient visit, and 12% had at least one inpatient visit within the prior 6 months. The proportion of the study population that was HIV-1 seropositive was 32%. In multivariate analysis, the single most important ...

An Assessment of Measurement Error Bias for Estimating the Effect of Mental Distress on Income

Abstract: Analyzing data on 2,225 men and 2,401 women from the National Comorbidity Survey, the authors examine the impact of psychiatric disorders on employment and, among those employed, work hours and income. They find that psychiatric disorders significantly ..

Pricing, Patent Loss and the Market for Pharmaceuticals

Abstract: Empirical studies suggest that entry of generic competitors results in minimal decreases or even increases in brand-name drug prices as well as sharp declines in brand-name advertising This paper examines circumstances under which this empirical pattern could be observed The analysis focuses on models where the demand for brand-name pharmaceuticals is divided into two segments, only one of which is cross-price-sensitive Brand-name firms are assumed to set price and advertising in a Stackelberg context; they allow for responses by generic producers but the latter take decisions by brand-name f inns as given Brand-name price and advertising responses to entry are shown to depend upon the properties of the reduced-form brand-name demand function Conditions for positive price responses and negative advertising responses are derived We also examine the implications for brand-name price levels, and for the brand-name price response to entry, of health sector trends (such as increasing HMO enrollments) that may have the effect of expanding the size of the cross-price-sensitive segment of the market The paper concludes with a review of recent empirical research and suggestions for future work on the effects of generic entry

A New Look At Rising Mental Health Insurance Costs

Abstract: The news media have recently focused a great deal of attention on insurance coverage for treatment of mental disorders. Reports of unusually large increaces in expenditures for mental health care under private insurance plans have appeared in major newspapers and trade publications. These reports have pointed to mental disorders, defined to include psychiatric and substance abuse diagnoses, as disproportionate contributors to rising health insurance premiums. Reports from benefits consulting firms such as A. Foster Higgins have cited increases of between 18 and 27 percent Curing 1987–1989. These data form the basis of proposals to devote special attention to mental health care use via managed care arrangements and to place new limits on insurance coverage for treatment of mental disorders. These claims are based on surveys of insurance benefits managers for major employers, not on any direct observation of use and expenditures. The Foster Higgins survey has attracted the most attention. Only 18 percent of the benefits managers responding to the survey answered the question regarding mental health costs. Among those who did respond, approximately half indicated that they did not know the cost of mental health care. In this DataWatch, we examine recent changes in mental health care spending and usage, using information obtained directly from insurance and hospital records. We address these issues by relying on (1) a sample composed of the claims experience of employees of midto large-sized U.S. firms during 1986–1989, and (2) data from two state hospital discharge abstract data systems. Our review of these data produces a much more complicated view of recent trends in use of mental health care than has appeared in the popular press. The implication here is that solutions to rising expenditures for mental health care require targeted interventions aimed at

Adjustment to spinal cord injury : stage theory revisited

Abstract: To better understand adjustment following spinal cord injury (SCI), 106 subjects from two samples (N = 53 each) were administered the SCL-90-R, a symptom checklist, and the Multidimensional Health Locus of Control scales. Sample 1 subjects were admitted for rehabilitation during 1981 to 1982 and sample 2 subjects were admitted during 1984 to 1986. Sample 2 subjects entered rehabilitation programs more quickly after injury and reported more anxiety, phobic anxiety, and hostility than sample 1 subjects. Within each sample, there was no evidence for a relationship between age or time since injury and health beliefs or psychological distress. This study does not support stage theory for adjustment after catastrophic injury, but does suggest the importance of understanding the impact of social policy changes in adjustment following spinal cord injury.

Benefit flexibility, cost shifting and mandated mental health coverage.

Abstract: This paper presents a policy analysis of options for making a state’s mandated mental health benefit more flexible while maintaining insurance premiums at a constant level. The analysis illustrates the difficult choices facing legislatures that attempt to balance improved coverage for mental health care with concerns about rising health care costs. A sophisticated simulation model is used to assess the costs of four alternative insurance benefit design options.

Non-profit providers of mental health care: Privileges and responsibilities

Abstract: Observers of the mental health services system have commented on trends towards \"privatization\" of mental health care delivery. Some have sounded alarms (Sharfstein, 1988) over these trends, while others have reserved judgment (Dorwart, 1989). An examination of the literature on the subject of privatization quickly reveals that much of the discomfort arises from the rapid growth of for-profit providers of inpatient psychiatric care (Bittner, 1985; Levinson, 1982; Sharfstein). One set of beliefs is that for-profit providers of mental health care will offer fewer community services than do public or non-profit providers of mental health care. Community services include care for individuals unable to pay for care as well as provision of services that have not been traditional profit makers (e.g., partial care programs, hotlines, and educational programs). Viewed in a broader context, public policy concerns with privatization question whether the supply of community services can be maintained as the availability of publicly provided mental health care decreases. The amount of public inpatient psychiatric care has decreased noticeably during

Pricing, Patent Loss and the Market For Pharmaceuticals

Abstract: Empirical studies suggest that entry of generic competitors results in minimal decreases or even increases in brand-name drug prices as well as sharp declines in brand-name advertising. This paper examines circumstances under which this empirical pattern could be observed. The analysis focuses on models where the demand for brand-name pharmaceuticals is divided into two segments, only one of which is cross-price-sensitive. Brand-name firms are assumed to set price and advertising in a Stackelberg context; they allow for responses by generic producers but the latter take decisions by brand-name f inns as given. Brand-name price and advertising responses to entry are shown to depend upon the properties of the reduced-form brand-name demand function. Conditions for positive price responses and negative advertising responses are derived. We also examine the implications for brand-name price levels, and for the brand-name price response to entry, of health sector trends (such as increasing HMO enrollments) that may have the effect of expanding the size of the cross-price-sensitive segment of the market. The paper concludes with a review of recent empirical research and suggestions for future work on the effects of generic entry.