CAREER: Public Health Insurance, Medical Expenditures, and Labor Market Outcomes

CAREER项目摘要：扩大医疗保险覆盖范围的影响虽然扩大医疗保险覆盖范围的影响一直是经济学家感兴趣的，但2006年马萨诸塞州医疗改革和2010年平价医疗法案（ACA）的通过使医疗改革成为公众讨论的前沿。医疗支出在美国经济中所占的比例越来越大，接近GDP的18%。与此同时，数百万美国人缺乏医疗保险。这两个现实激发了对三个相关项目的兴趣。第一个项目的目标是描述非老年人医疗支出的演变，以告知保险设计;第二个项目的目标是研究医疗补助对健康和劳动力市场结果的长期影响;第三个项目的目标是使用医生之间的差异来衡量密集型医疗保险支出的回报。智力优势：每个项目都通过使用不同的数据源来推进知识的前沿，这些数据源提供了罕见的细节水平。 使用这些数据的部分智力价值在于数据准备-开发访问数据的过程，清理数据，并从中得出程式化的事实。进一步的智力价值在于发展和执行简单的理论和计量经济学方法，这些方法不会掩盖数据的丰富性。 项目1使用了1982年至2009年纽约州几乎所有与死亡率记录相关的医院就诊数据。 这些数据包括纵向患者标识符，允许详细描述非老年人的医疗支出演变，特别是那些高支出，死亡率和保险拒绝的可能性。 项目2使用了1996年至2009年提交的所有联邦纳税申报表的数据。 这些数据允许分析医疗补助资格对就业，收入和教育的长期影响。 项目3使用了1991年至2010年间100%的住院医疗保险索赔数据，这些数据与美国医学协会关于医生的数据相关联。 这些数据可用于评估所有治疗Medicare患者的医生的治疗和结果。更广泛的影响：建立在广泛的数据基础上，研究项目和教育计划将有助于更好地了解健康保险市场的复杂性及其在社会中的价值。该研究议程的目标是通过为关键政策问题找到实证答案来推进卫生经济学领域。 一个平等的优先事项将使这些答案提供给其他研究人员，学生和卫生政策界。

CAREER Project Abstract: The Impact of Expanded Health Insurance CoverageWhile the impact of expanded health insurance coverage has long been of interest to economists, the passage of the Massachusetts health reform in 2006 and the Affordable Care Act (ACA) in 2010 has brought health reform to the forefront of public discourse. Health spending comprises a growing portion of the U.S. economy, approaching 18% of GDP. At the same time, millions of Americans lack health insurance. These two realities motivate interest in three related projects. The goal of the first project is to characterize the evolution of nonelderly medical expenditures to inform insurance design; the goal of the second project is to examine the long term impact of Medicaid on health and labor market outcomes; and the goal of the third project is to measure the returns to intensive Medicare spending using variation across physicians. Intellectual Merit: Each project advances the frontier of knowledge by using a different data source that provides a rare level of detail. Part of the intellectual merit in the use of these data lies in data preparation -- developing processes to access the data, cleaning them, and deriving stylized facts from them. Further intellectual merit lies in the development and execution of simple theory and econometric methods that do not obscure the richness of the data. Project 1 uses data on almost all hospital visits in the state of New York from 1982 to 2009 linked to mortality records. These data include longitudinal patient identifiers, allowing detailed characterization of the evolution of medical expenditures for nonelderly individuals, especially those with high expenditures, mortality, and likelihood of insurance denial. Project 2 uses data on all federal tax returns filed from 1996 to 2009. These data permit analysis of the long term impact of Medicaid eligibility on employment, earnings, and education. Project 3 uses data on 100% of hospital inpatient Medicare claims between 1991 and 2010 linked to American Medical Association data on physicians. These data can be used to evaluate treatment and outcomes for all doctors who treat Medicare patients.Broader Impact: Building on a wide range of data, the research projects and education plan will aid in a greater understanding of the complexities of the health insurance market and its value in society. The objective of this research agenda is to advance the field of health economics by finding empirical answers to key policy questions. An equal priority will be making these answers accessible to other researchers, students, and the health policy community.