Working Paper: NBER ID: w7555
Authors: Leemore Dafny; Jonathan Gruber
Abstract: One of the benefits commonly claimed for expanded public health insurance is improved efficiency of medical care delivery, but this claim has little rigorous empirical support. We provide such support by assessing the impact of the Medicaid expansions over the 1983-1996 period on the incidence of avoidable hospitalizations. We find that expanded public insurance eligibility leads to a significant decline in avoidable hospitalization: over this period Medicaid eligibility expansions were associated with a 22% decline in avoidable hospitalization. But we also find that there is a countervailing and larger impact in terms of increased access to hospital care for newly eligible children, so that there is an overall 10% rise in child hospitalizations due to the expansions. The expansions have mixed implications for treatment intensity, but appear to be associated with a significant shift in the types of hospitals at which children are treated, with fewer children treated in public hospitals and more in for-profit facilities.
Keywords: Medicaid; Child Hospitalizations; Public Insurance; Healthcare Efficiency
JEL Codes: I18; H51
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Medicaid expansions (I18) | decline in avoidable hospitalizations (I14) |
| Medicaid expansions (I18) | increase in overall child hospitalizations (I19) |
| decline in avoidable hospitalizations (I14) | increase in overall child hospitalizations (I19) |
| Medicaid expansions (I18) | changes in types of hospitals utilized (I11) |