Assessing the quality of public services: For-profits, chains, and concentration in the hospital market.

We examine variation in US hospital quality across ownership, chain membership, and market concentration. We propose a new measure of quality derived from penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program, and use regression models to risk-adjust for hospital characteristics and county demographics. While the overall association between for-profit ownership and quality is negative, there is evidence of substantial heterogeneity. The quality of for-profit relative to non-profit hospitals declines with increasing market concentration. Moreover, the quality gap is primarily driven by for-profit chains. While the competition result mirrors earlier findings in the literature, the chain result appears to be new: it suggests that any potential quality gains afforded by chains are mostly realized by not-for-profit hospitals.

An Econometric Model of Healthcare Demand With Nonlinear Pricing.

From 2004 to 2012, the German social health insurance levied a co-payment for the first doctor visit in a calendar quarter. We develop a new model for estimating the effect of such a co-payment on the individual number of visits per quarter. The model combines a one-time increase in the otherwise constant hazard rate determining the timing of doctor visits with a difference-in-differences strategy to identify the reform effect. An extended version of the model accounts for a mismatch between reporting period and calendar quarter. Using data from the German Socio-Economic Panel, we do not find an effect of the co-payment on demand for doctor visits. Copyright © 2016 John Wiley & Sons, Ltd.

JUE Insight: Is hospital quality predictive of pandemic deaths? Evidence from US counties.

In the large literature on the spatial-level correlates of COVID-19, the association between quality of hospital care and outcomes has received little attention to date. To examine whether county-level mortality is correlated with measures of hospital performance, we assess daily cumulative deaths and pre-crisis measures of hospital quality, accounting for state fixed-effects and potential confounders. As a measure of quality, we use the pre-pandemic adjusted five-year penalty rates for excess 30-day readmissions following pneumonia admissions for the hospitals accessible to county residents based on ambulance travel patterns. Our adjustment corrects for socio-economic status and down-weighs observations based on small samples. We find that a one-standard-deviation increase in the quality of local hospitals is associated with a 2% lower death rate (relative to the mean of 20 deaths per 10,000 people) one and a half years after the first recorded death.

COVID-19 lockdowns and changes in loneliness among young people in the U.K.

RATIONALE: There has been growing concern that loneliness has increased throughout the COVID-19 lockdowns, and that the burden has fallen heavily on young people. This is important because loneliness is strongly linked to worse health outcomes. OBJECTIVE: We examine whether and how loneliness among young people changed during the pandemic across the different lockdown periods in 2020 and 2021. We also assess differences by gender, socioeconomic status, and economic activity before the COVID-19 outbreak. METHODS: We use nine waves of longitudinal data from the COVID-19 supplement of the UK Household Longitudinal Study (Understanding Society), collected between April 2020 and September 2021. We apply an individual fixed-effects event study design, which compares the loneliness reported by the same individual over lockdown transitions. We focus on loneliness reported by 1870 respondents aged between 16 and 24 years and compare it with pre-pandemic baselines. RESULTS: We find that the loneliness of young people tracked the extent of lockdown restrictions but had returned to baseline levels by September 2021. This loneliness response was more pronounced for females than males but similar for young people across higher and lower socioeconomic backgrounds. CONCLUSIONS: These results suggest that policy interventions aimed at increasing opportunities for in-person social interactions for young people in 'normal' times, might have some success in tackling loneliness, particularly for young females.

Reductions in out-of-pocket prices and forward-looking moral hazard in health care demand.

Little is known about how patients dynamically respond to a forthcoming reduction in health care out-of-pocket prices. Using a kinked Donut Regression Discontinuity design with kinks entering and exiting the donut, we evaluate a Swedish cost-sharing policy, where primary care out-of-pocket prices were eliminated at age 85. We find evidence of forward-looking moral hazard with older adults delaying primary care visits up to four months before the out-of-pocket elimination and shifting these visits until shortly after. These health care delays are driven by non-urgent care: non-physician visits, planned visits and follow up visits. We find no evidence of severe negative health effects in the short-term as a result of the delay. Contrary to our finding of forward-looking behavior with respect to out-of-pocket prices, we do not find evidence of typical moral hazard, as we do not find a persistent increase in primary health care use after the copayment elimination.

Economic Aspects of Loneliness in Australia.

We highlight the problem of loneliness, and argue that it is not only a public health issue but also an economic problem. We provide a brief review of findings from the key literature on the associations between loneliness, mental and physical health, and healthcare costs; and then present some evidence on its trends, the extent of socioeconomic inequalities and its links with health and healthcare usage, in Australia. We hope to encourage further economics research on loneliness, and related issues of social isolation and poor social support, to aid the design of policies and interventions to reduce loneliness.