The Role of Hospital Networks in Individual Mortality

Las redes hospitalarias estrechas han proliferado en los sistemas sanitarios con competencia de asistencia gestionada. En este trabajo investigamos el efecto causal de la amplitud de la red hospitalaria en la mortalidad de los pacientes. Para identificar este efecto, aprovechamos las cancelaciones d...

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Fecha de publicación:: 2023

Institución:: Universidad del Rosario

Repositorio:: Repositorio EdocUR - U. Rosario

Idioma:: spa

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dc.title.none.fl_str_mv	The Role of Hospital Networks in Individual Mortality
title	The Role of Hospital Networks in Individual Mortality
spellingShingle	The Role of Hospital Networks in Individual Mortality Mortalidad Redes hospitalarias Seguro de enfermedad Coste sanitario Saludcoop I10, I11, I13, I18 Mortality Hospital networks Health Insurance Healthcare cost
title_short	The Role of Hospital Networks in Individual Mortality
title_full	The Role of Hospital Networks in Individual Mortality
title_fullStr	The Role of Hospital Networks in Individual Mortality
title_full_unstemmed	The Role of Hospital Networks in Individual Mortality
title_sort	The Role of Hospital Networks in Individual Mortality
dc.subject.none.fl_str_mv	Mortalidad Redes hospitalarias Seguro de enfermedad Coste sanitario Saludcoop I10, I11, I13, I18 Mortality Hospital networks Health Insurance Healthcare cost
topic	Mortalidad Redes hospitalarias Seguro de enfermedad Coste sanitario Saludcoop I10, I11, I13, I18 Mortality Hospital networks Health Insurance Healthcare cost
description	Las redes hospitalarias estrechas han proliferado en los sistemas sanitarios con competencia de asistencia gestionada. En este trabajo investigamos el efecto causal de la amplitud de la red hospitalaria en la mortalidad de los pacientes. Para identificar este efecto, aprovechamos las cancelaciones de aseguradoras y las posteriores cancelaciones de hospitales integrados verticalmente. Utilizamos datos del sistema sanitario colombiano, donde la mayor aseguradora de salud (Saludcoop) y sus hospitales fueron dados de baja a finales de 2015. Los resultados muestran que las aseguradoras de red amplia reducen la mortalidad de los pacientes porque incluyen hospitales de alta calidad y pueden tratar más condiciones de salud. Nuestros resultados sugieren que, en un entorno sin competencia de precios, el acceso a la atención sanitaria a través de unas pocas aseguradoras con redes amplias es mejor para la salud de los pacientes que el acceso a la atención sanitaria a través de muchas aseguradoras con redes estrechas.
publishDate	2023
dc.date.none.fl_str_mv	2023-11-21T20:21:54Z
dc.type.none.fl_str_mv	info:eu-repo/semantics/workingPaper
dc.type.coarversion.fl_str_mv	http://purl.org/coar/version/c_b1a7d7d4d402bcce
dc.type.coar.fl_str_mv	http://purl.org/coar/resource_type/c_8042
dc.identifier.none.fl_str_mv	https://doi.org/10.48713/10336_41745 https://repository.urosario.edu.co/handle/10336/41745
url	https://doi.org/10.48713/10336_41745 https://repository.urosario.edu.co/handle/10336/41745
dc.language.none.fl_str_mv	spa
language	spa
dc.rights.none.fl_str_mv	http://creativecommons.org/licenses/by-nc-nd/4.0/
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rights_invalid_str_mv	http://creativecommons.org/licenses/by-nc-nd/4.0/ http://purl.org/coar/access_right/c_abf2
dc.format.none.fl_str_mv	54 pp application/pdf
dc.publisher.none.fl_str_mv	Universidad del Rosario Facultad de Economía
publisher.none.fl_str_mv	Universidad del Rosario Facultad de Economía
dc.source.none.fl_str_mv	Abaluck, J., M. Caceres, P. Hull, and A. Starc (2021): “Mortality Effects and Choice Across Private Health Insurance Plans,” The Quarterly Journal of Economics, 136, 1557–1610. Atwood, A. and A. T. L. Sasso (2016): “The Effect of Narrow Provider Networks on Health Care Use,” Journal of Health Economics, 50, 86–98. Cooper, Z., F. Scott Morton, and N. Shekita (2020): “Surprise! Out-ofNetwork Billing for Emergency Care in the United States,” Journal of Political Economy, 128, 3626–3677. Dafny, L., I. Hendel, and N. Wilson (2015): “Narrow Networks on the Health Insurance Exchanges: What Do They Look Like and How Do They Affect Pricing? A Case Study of Texas,” American Economic Review, 105, 110–114. Dafny, L. S., I. Hendel, V. Marone, and C. Ody (2017): “Narrow Networks on the Health Insurance Marketplaces: Prevalence, Pricing, and the Cost of Network Breadth,” Health Affairs, 36, 1606–1614. Ericson, K. M. and A. Starc (2015): “Measuring Consumer Valuation of Limited Provider Networks,” American Economic Review, 105, 115–119. Finkelstein, A., M. Gentzkow, and H. Williams (2021): “Place-Based Drivers of Mortality: Evidence from Migration,” American Economic Review, 111, 2697– 2735. Ghili, S. (2022): “Network Formation and Bargaining in Vertical Markets: The Case of Narrow Networks in Health Insurance,” Marketing Science, 41, 433–662. Ho, K. (2009): “Insurer-provider networks in the medical care market,” American Economic, 99, 393–430. Ho, K. and R. S. Lee (2017): “Insurer Competition in Health Care Markets,” Econometrica, 85, 379–417. Liebman, E. (2018): “Bargaining in Markets with Exclusion: An Analysis of Health Insurance Networks,” . Miller, S., N. Johnson, and L. R. Wherry (2021): “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” The Quarterly Journal of Economics, 136, 1783–1829. Morris, C. N. (1983): “Parametric Empirical Bayes inference: Theory and Applications,” Journal of the American statistical Association, 78, 47–55. Politzer, E. (2021): “A Change of Plans: The Impact of Involuntary Switching in Health Insurance,” . Prager, E. and N. Tilipman (2020): “Regulating Out-of-Network Hospital Payments: Disagreement Payoffs, Negotiated Prices, and Access,” Tech. rep., Working Paper. Serna, N. (2023): “Non-Price Competition and Risk Selection Through Hospital Networks,” . Shepard, M. (2022): “Hospital Network Competition and Adverse Selection: Evidence from the Massachusetts Health Insurance Exchange,” American Economic Review, 112, 578–615. Sommers, B. D., K. Baicker, and A. M. Epstein (2012): “Mortality and Access to Care Among Adults After State Medicaid Expansions,” New England Journal of Medicine, 367, 1025–1034. Wherry, L. R. and S. Miller (2016): “Early Coverage, Access, Utilization, and Health Effects Associated with the Affordable Care Act Medicaid Expansions: A Quasi-Experimental Study,” Annals of internal medicine, 164, 795–803. Yasaitis, L., J. E. Bekelman, and D. Polsky (2017): “Relation Between Narrow Networks and Providers of Cancer Care,” Journal of Clinical Oncology, 35, 3131. Zhu, J. M., J. Breslau, and K. J. McConnell (2021): “Medicaid Managed Care Network Adequacy Standards for Mental Health Care Access: Balancing Flexibility and Accountability,” JAMA Health Forum, 2, e210280–e210280. Zhu, J. M., D. Polsky, C. Johnstone, and K. J. McConnell (2022): “Variation in Network Adequacy Standards in Medicaid Managed Care,” The American Journal of Managed Care, 28, 288. instname:Universidad del Rosario reponame:Repositorio Institucional EdocUR
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spelling	The Role of Hospital Networks in Individual MortalityMortalidadRedes hospitalariasSeguro de enfermedadCoste sanitarioSaludcoopI10, I11, I13, I18MortalityHospital networksHealth InsuranceHealthcare costLas redes hospitalarias estrechas han proliferado en los sistemas sanitarios con competencia de asistencia gestionada. En este trabajo investigamos el efecto causal de la amplitud de la red hospitalaria en la mortalidad de los pacientes. Para identificar este efecto, aprovechamos las cancelaciones de aseguradoras y las posteriores cancelaciones de hospitales integrados verticalmente. Utilizamos datos del sistema sanitario colombiano, donde la mayor aseguradora de salud (Saludcoop) y sus hospitales fueron dados de baja a finales de 2015. Los resultados muestran que las aseguradoras de red amplia reducen la mortalidad de los pacientes porque incluyen hospitales de alta calidad y pueden tratar más condiciones de salud. Nuestros resultados sugieren que, en un entorno sin competencia de precios, el acceso a la atención sanitaria a través de unas pocas aseguradoras con redes amplias es mejor para la salud de los pacientes que el acceso a la atención sanitaria a través de muchas aseguradoras con redes estrechas.Narrow hospital networks have proliferated in health systems with managed care competition. In this paper, we investigate the causal effect of hospital network breadth on patient mortality. We leverage insurer terminations and subsequent hospital terminations for vertically integrated hospitals to identify this effect. We use data from the Colombian healthcare system where the largest health insurer (Saludcoop) and its hospitals were terminated by the end of 2015. Findings show that broad-network insurers reduce patient mortality because they include high-quality hospitals and can treat more health conditions. Our results suggest that in a setting without price competition, access to health care through a few insurers with broad networks is better for patient health than access to health care through many insurers with narrow networks.Universidad del RosarioFacultad de Economía2023-11-21T20:21:54Zinfo:eu-repo/semantics/workingPaperhttp://purl.org/coar/version/c_b1a7d7d4d402bccehttp://purl.org/coar/resource_type/c_804254 ppapplication/pdfhttps://doi.org/10.48713/10336_41745 https://repository.urosario.edu.co/handle/10336/41745Abaluck, J., M. Caceres, P. Hull, and A. Starc (2021): “Mortality Effects and Choice Across Private Health Insurance Plans,” The Quarterly Journal of Economics, 136, 1557–1610.Atwood, A. and A. T. L. Sasso (2016): “The Effect of Narrow Provider Networks on Health Care Use,” Journal of Health Economics, 50, 86–98.Cooper, Z., F. Scott Morton, and N. Shekita (2020): “Surprise! Out-ofNetwork Billing for Emergency Care in the United States,” Journal of Political Economy, 128, 3626–3677.Dafny, L., I. Hendel, and N. Wilson (2015): “Narrow Networks on the Health Insurance Exchanges: What Do They Look Like and How Do They Affect Pricing? A Case Study of Texas,” American Economic Review, 105, 110–114.Dafny, L. S., I. Hendel, V. Marone, and C. Ody (2017): “Narrow Networks on the Health Insurance Marketplaces: Prevalence, Pricing, and the Cost of Network Breadth,” Health Affairs, 36, 1606–1614.Ericson, K. M. and A. Starc (2015): “Measuring Consumer Valuation of Limited Provider Networks,” American Economic Review, 105, 115–119.Finkelstein, A., M. Gentzkow, and H. Williams (2021): “Place-Based Drivers of Mortality: Evidence from Migration,” American Economic Review, 111, 2697– 2735.Ghili, S. (2022): “Network Formation and Bargaining in Vertical Markets: The Case of Narrow Networks in Health Insurance,” Marketing Science, 41, 433–662.Ho, K. (2009): “Insurer-provider networks in the medical care market,” American Economic, 99, 393–430.Ho, K. and R. S. Lee (2017): “Insurer Competition in Health Care Markets,” Econometrica, 85, 379–417.Liebman, E. (2018): “Bargaining in Markets with Exclusion: An Analysis of Health Insurance Networks,” .Miller, S., N. Johnson, and L. R. Wherry (2021): “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” The Quarterly Journal of Economics, 136, 1783–1829.Morris, C. N. (1983): “Parametric Empirical Bayes inference: Theory and Applications,” Journal of the American statistical Association, 78, 47–55.Politzer, E. (2021): “A Change of Plans: The Impact of Involuntary Switching in Health Insurance,” .Prager, E. and N. Tilipman (2020): “Regulating Out-of-Network Hospital Payments: Disagreement Payoffs, Negotiated Prices, and Access,” Tech. rep., Working Paper.Serna, N. (2023): “Non-Price Competition and Risk Selection Through Hospital Networks,” .Shepard, M. (2022): “Hospital Network Competition and Adverse Selection: Evidence from the Massachusetts Health Insurance Exchange,” American Economic Review, 112, 578–615.Sommers, B. D., K. Baicker, and A. M. Epstein (2012): “Mortality and Access to Care Among Adults After State Medicaid Expansions,” New England Journal of Medicine, 367, 1025–1034.Wherry, L. R. and S. Miller (2016): “Early Coverage, Access, Utilization, and Health Effects Associated with the Affordable Care Act Medicaid Expansions: A Quasi-Experimental Study,” Annals of internal medicine, 164, 795–803.Yasaitis, L., J. E. Bekelman, and D. Polsky (2017): “Relation Between Narrow Networks and Providers of Cancer Care,” Journal of Clinical Oncology, 35, 3131.Zhu, J. M., J. Breslau, and K. J. McConnell (2021): “Medicaid Managed Care Network Adequacy Standards for Mental Health Care Access: Balancing Flexibility and Accountability,” JAMA Health Forum, 2, e210280–e210280.Zhu, J. M., D. Polsky, C. Johnstone, and K. J. McConnell (2022): “Variation in Network Adequacy Standards in Medicaid Managed Care,” The American Journal of Managed Care, 28, 288.instname:Universidad del Rosarioreponame:Repositorio Institucional EdocURspahttp://creativecommons.org/licenses/by-nc-nd/4.0/http://purl.org/coar/access_right/c_abf2Buitrago, GiancarloRodríguez Lesmes, Paul AndrésSerna, NataliaVera-Hernández, Marcosoai:repository.urosario.edu.co:10336/417452024-04-08T14:26:32Z

The Role of Hospital Networks in Individual Mortality

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