Did Dental Insurance Expansion Improve Dental Care Needs Among Korean Adults? Difference in Difference Analysis.

BACKGROUND: In 2012, the Korean government expanded dental insurance for the elderly to promote improved access to dental care. We examined the causal effect of this policy on dental care needs, focusing on low-income older adults. METHODS: We compared data before and after policy implementation using double difference (DD) and triple difference (DDD) analyses. We used the nationally representative data from the Korea National Health and Nutrition Examination Survey from 2010 and 2016-2018. Individuals aged ≥65 years were included in the treatment group, and individuals aged <65 years were included in the control group. RESULTS: Dental insurance expansion was associated with a paradoxical increase in perceived unmet dental needs among elderly individuals (8.8 percentage points increase, 95% CI: 4.7 to 13.0). However, there were improvements in dental prosthetics outcomes (denture wearing [4.0 percentage points, 95% CI: 0.2 to 7.9] and dental implants [5.0 percentage points, 95% CI: 2.1 to 7.9]; P < 0.01). Upon analyzing low-income elderly individuals using DDD analysis, we found that the insurance expansion led to a 21.6% smaller increase in unmet dental needs among low-income adults, compared to high-income adults (95% CI, -35.0 to -8.5; P < 0.01). CONCLUSION: Dental insurance expansion in South Korea resulted in improvements in access to dental prosthetic services overall. It also led to a smaller increase in unmet dental needs among low-income older adults, compared to high-income adults.

Re-examining the effects of public health insurance: The case of nonpoor children in Vietnam.

This paper focuses on the effects of a 2005 health insurance reform in Vietnam. Through this reform, public health insurance was newly offered to nonpoor children under 6 years old, but it required the use of community health facilities. This requirement potentially limited the value of the insurance. Employing difference-in-discontinuities and triple-difference methods and using data from 2002, 2004, and 2006, I show that, despite health coverage among nonpoor children increasing by nearly three times, there is little or no evidence that the reform significantly increased health care utilization, changed care locations from private to public sites, lowered out-of-pocket costs, or improved health status for nonpoor young children. My results suggest a "bypassing" phenomenon whereby nonpoor families skipped free health care at low-quality facilities.

Impact of the Medicare hospital readmissions reduction program on vulnerable populations.

BACKGROUND: The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act (ACA) in an effort to reduce excess hospital readmissions, lower health care costs, and improve patient safety and outcomes. Although studies have examined the policy's overall impacts and differences by hospital types, research is limited on its effects for different types of vulnerable populations. The aim of this study was to analyze the impact of the HRRP on readmissions for three targeted conditions (acute myocardial infarction, heart failure, and pneumonia) among four types of vulnerable populations, including low-income patients, patients served by hospitals that serve a high percentage of low-income or Medicaid patients, and high-risk patients at the highest quartile of the Elixhauser comorbidity index score. METHODS: Data on patient and hospital information came from the Nationwide Readmission Database (NRD), which contained all discharges from community hospitals in 27 states during 2010-2014. Using difference-in-difference (DD) models, linear probability regressions were conducted for the entire sample and sub-samples of patients and hospitals in order to isolate the effect of the HRRP on vulnerable populations. Multiple combinations of treatment and control groups and triple difference (DDD) methods were used for testing the robustness of the results. All models controlled for the patient and hospital characteristics. RESULTS: There have been statistically significant reductions in readmission rates overall as well as for vulnerable populations, especially for acute myocardial infarction patients in hospitals serving the largest percentage of low-income patients and high-risk patients. There is also evidence of spillover effects for non-targeted conditions among Medicare patients compared to privately insured patients. CONCLUSIONS: The HRRP appears to have created the right incentives for reducing readmissions not only overall but also for vulnerable populations, accruing societal benefits in addition to previously found reductions in costs. As the reduction in the rate of readmissions is not consistent across patient and hospital groups, there could be benefits to adjusting the policy according to the socioeconomic status of a hospital's patients and neighborhood.

Sources of health financing and health outcomes: A panel data analysis.

We study the differential impacts of public and private sources of health spending on health outcomes using a triple difference approach. We find that private health spending has on average a higher health-promoting effect than public health spending. This result is robust with respect to the choice of outcome measure and covariates in the regression and driven primarily by the countries with ineffective governments. Once we restrict our sample to countries with effective governments, private health spending is found to be no better than public health spending in improving the health outcome.

The Effect of a Sunday Liquor-Sales Ban Repeal on Crime: A Triple-Difference Analysis.

BACKGROUND: This study investigates whether alcohol availability in state-run liquor stores affects crime nearby. In 2003, Pennsylvania repealed its Sunday alcohol-sales ban for a portion of its state-run liquor stores. We capitalize on this change in alcohol policy to assess the effect of alcohol availability on crime occurring within the vicinity of liquor stores that opened on Sundays in Philadelphia. METHODS: We employed a difference-in-difference-in-differences model that compared reported crime before versus after the change in alcohol policy, Sundays versus other days of the week, and the fraction of liquor stores affected versus not affected by the repeal. We used crime incident data in Philadelphia between 1998 and 2011. RESULTS: The repeal was associated with a significant increase in total and property-crime incidents occurring around Sunday-open state liquor stores in low-socioeconomic-status neighborhoods. We found no evidence of the displacement of crime to nearby areas. CONCLUSIONS: This is the first triple-difference alcohol study that attempts to isolate the micro-spatial effects of a shift in alcohol availability on local crime patterns, and shows that the repeal of Sunday alcohol-sales restrictions may increase crime in poor urban areas.

Can China's carbon trading policy improve the profitability of polluting firms: a retest of Porter's hypothesis.

The future trends and development trajectory of China's carbon emissions trading scheme (ETS), one of the key policy instruments for curbing peak carbon emissions and achieving carbon neutrality, have drawn a lot of interest. However, the Porter hypothesis (PH) and its validity boundary have not been explored sufficiently. We use micro-firm data from 2010 to 2019 to investigate whether the triple-difference (DDD) method could reveal the weak PH on the policy viewing ETS as a quasi-natural experiment in this work. Meanwhile, we use the panel threshold model and the moderated mediation effect model to assess the scientific border of the PH on the ETS. The findings show that by verifying the weak PH, the ETS may greatly enhance investment and foster the inventiveness of heavy-polluting industries (HPE). In contrast, the strong PH on the ETS has unstable validity and has non-linear characteristics. In particular, the ETS shows a U-shaped link between innovation and profitability by first decreasing and then increasing HPE's profitability through R&D. The cost of R&D and compliance costs being combined negatively impacts HPE's profitability. Further analysis shows that ETS will have different effects on the profitability of HPE due to R&D level and the threshold change of the compliance cost. This paper will offer some insightful points of view for the implementation of carbon market mechanisms in developing nations like China.

Green finance and corporate environmental violations: a test from the perspective of illegal pollution discharge behaviors.

Green finance aims to intervene in investment and financing behaviors through financial means, so as to promote upgrading of heavily polluting industries. Whether it can reduce illegal pollution discharge behaviors is the focus of this paper. This paper is to explore the impact of green finance on illegal emissions of heavy polluting firms. Taking green finance pilot zones (GFPZ) in 2017 as a quasi-natural experiment, the paper measures illegal emission behaviors based on day-night difference of PM2.5 at the nearest atmospheric monitoring points and tests the impact of GFPZ on illegal emissions based on triple difference model (DDD). The results show that GFPZ inhibits illegal emissions. Influence path result shows that GFPZ reduces illegal emissions by increasing financing constraint, green innovation, and fulfilling social responsibility. At the same time, this paper also notes that regulatory distance has an interference effect on GFPZ. GFPZ aggravates illegal emission as heavy polluting firms - financial institution's distance is more than 40 km. GFPZ curbs illegal pollution more significantly as heavy polluting firms - environmental protection bureau distance is within 30 km. This paper aims to reveal the guiding effect of green finance on emission behavior of polluting firms and provide policy references for reducing emission and promoting green finance.

Did expansion of insurance coverage for major diseases in Korea induce a positive spillover effect on dental service utilization?

Although people with serious major diseases are disproportionately likely to have poor oral health, they are also more likely to defer treatment for oral health conditions due to financial constraints. The South Korean government introduced a comprehensive benefit expansion policy covering four major disease categories in 2013: cancer, cardiac diseases, cerebrovascular diseases, and rare diseases. Meanwhile, a policy expanding benefits for dental prosthetic services for the elderly was also introduced during the same period. Using nationally representative Korean Health Panel data from 2012 to 2017, we performed a difference-in-difference (DID) analysis to examine the positive spillover effect of insurance expansion for the four major disease categories on encouraging dental service utilization (frequency of dental visits and dental out-of-pocket payments) or decreasing unmet dental needs. Additionally, a triple-difference (TD) analysis was performed to examine whether the effect of coverage expansion of dental prosthetic services on dental service utilization was larger among the beneficiaries of the expansion for the four major disease categories. Benefit expansion for the four major disease categories did not significantly affect dental service utilization among the beneficiaries (DID model) during all study years and slightly increased unmet dental needs in 2014 and 2015. However, the effect of expanded coverage for dental prosthetic services on encouraging dental service utilization was larger (TD model) among the beneficiaries of the policy for the four major disease categories than among non-beneficiaries when we defined the beneficiaries as individuals with two or more household members who had one of the four major diseases. Our results suggest a need to provide more intense coverage for those with comorbidities by embracing the concept of proportionate universalism in the coverage of dental services.

The response to nutritional labels: Evidence from a quasi-experiment.

This paper evaluates a UK policy that aimed to improve dietary information provision by introducing nutrition labelling on retailers' store-brand products. Exploiting the differential timing of the introduction of Front-of-Pack nutrition labels as a quasi-experiment, our findings suggest that labelling led to a reduction in the quantity purchased of labelled store-brand foods, and an improvement in their nutritional composition. More specifically, we find that households reduced the total monthly calories from labelled store-brand foods by 588 kcal, saturated fats by 14 g, sugars by 7 g, and sodium by 0.8 mg.

A Triple-Difference Approach to Re-Evaluating the Impact of China's New Cooperative Medical Scheme on Incidences of Chronic Diseases Among Older Adults in Rural Communities.

BACKGROUND: This paper re-evaluates the impacts of China's New Cooperative Medicine Scheme (NCMS), a social health insurance program targeting China's rural population, on the incidences of chronic diseases among its enrollees. Although coverage under the NCMS expanded rapidly following its implementation in 2003, previous studies have failed to reach a consensus on its health impacts. Existing conflicting results may be due to methodological problems such as implausible identification assumptions and the failure to focus on the most relevant beneficiaries. METHODS: Drawing on data from a longitudinal sample from the China Health and Nutrition Survey (CHNS), we focus on a subgroup of patients over the age of 55 years to re-estimate the NCMS's impact on incidences of chronic disease among enrollees. We adopt a triple-difference (difference-in-difference-in-differences) method, relaxing the parallel-trend assumption commonly invoked in the previous double-difference (difference-in-differences) studies. RESULTS: Our triple-difference estimates suggest that the NCMS has significantly reduced the incidences of apoplexy and diabetes among rural residents aged 55 years or older. The impacts of the NCMS on chronic disease are underestimated by the commonly adopted double-difference method. The triple-difference method allows evaluations to focus on the most relevant subgroups for detecting program impacts. CONCLUSION: Our findings that the NCMS has significantly positive impacts on elderly enrollees' incidences of chronic diseases also suggest the need for examining its impacts on other vulnerable groups, such as low-income individuals, young children, and individuals with poor health conditions.

An evaluation of the 1987 French Disabled Workers Act: better paying than hiring.

This paper presents the first evaluation of the French Disabled Workers Act of 1987, which aimed to promote the employment of disabled people in the private sector. We use a panel data set, which includes both the health and the labour market histories of workers. We account both for unobserved heterogeneity and for the change in the disabled population over time. We find that the law had a negative impact on the employment of disabled workers in the private sector. This counterproductive effect likely comes from the possibility to pay a fine instead of hiring disabled workers.