Erkmen G. Aslim
, Wei Fu (UPenn), Chia-Lun Liu (UPenn), and Erdal Tekin (American University) "Vaccination Policy, Delayed Care, and Health Expenditures", NBER Working Paper 30139.
Abstract
The COVID-19 pandemic has profoundly affected the United States healthcare system, resulting in major disruptions in the delivery of essential care and causing crippling financial losses that threaten the viability of millions of medical practices. There is little empirical evidence on the types of policies or innovations that are effective in shaping healthcare seeking behavior during a public health crisis. This paper evaluates the effect of COVID-19 vaccination on the individual propensity to delay or skip medical care. Our research design exploits the arguably exogenous variation in age-specific vaccine eligibility rollout across states and over time as an instrument for individual vaccination status. We find that receiving a COVID-19 vaccine reduces the likelihood of delaying care for any medical condition by 37 percent. Furthermore, our analysis reveals that children are significantly less likely to delay or skip healthcare delayed as a result of the availability of vaccines for their parents, indicating the presence of a positive health spillover within households that extends beyond protection against infection. We also find evidence to indicate that vaccination affects healthcare seeking behavior by easing concerns about contracting or spreading COVID-19. In supplementary analysis, we use novel data on debit and credit card spending to demonstrate that increased vaccine uptake has a positive, albeit statistically insignificant, effect on consumer healthcare spending in the short run. Our results highlight the important role that vaccines play in, not only protecting against coronavirus, but also safeguarding against the worsening of health due to delayed or foregone medical care. The decline in delayed or foregone care caused by vaccination is particularly strong among minorities and those with a low socioeconomic background, revealing an important role that vaccination efforts can play in narrowing inequities in health and healthcare. More broadly, our findings imply that advancements in vaccine development coupled with a regulatory process that accelerates the availability of vaccines to public in a safe manner can have the additional benefit of tackling unmet healthcare needs during a public health crisis.
JEL codes
I1, I12, I18
Keywords
Erkmen G. Aslim
, Murat C. Mungan (George Mason), and Han Yu (UMemphis) "A Welfare
Analysis of Medicaid and Crime.", George Mason Law & Economics Research Paper Series.
Abstract
We calculate conservative estimates for the marginal value of public funds (MVPF) associated with providing Medicaid to inmates exiting prison. Our MVPF estimates, which measure the ratio between the benefits associated with the policy (measured in terms of willingness to pay) and its costs net of fiscal externalities, range between 3.44 and 10.61. A large proportion of the benefits that we account for are related to the reduced future criminal involvement of exiting inmates who receive Medicaid. Using a difference-in-differences approach, we find that Medicaid expansions reduce the average number of times a released inmate is reimprisoned within a year by about 11.5%. We use this estimate along with key values reported elsewhere (e.g., victimization costs, data on victimization and incarceration) to calculate specific benefits from the policy. These include reduced criminal harm due to reductions in reoffenses; direct benefits to former inmates from receiving Medicaid; increased employment; and reduced loss of liberty due to fewer future reimprisonments. Net-costs consist of the cost of providing Medicaid net of changes in the governmental cost of imprisonment; changes in the tax revenue due to increased employment; and changes in spending on other public assistance programs. We interpret our estimates as being conservative, because we err on the side of under-estimating benefits and over-estimating costs when data on specific items are imprecise or incomplete. Our findings are largely consistent with others in the sparse literature investigating the crime-related welfare impacts of Medicaid access, and suggest that public health insurance programs can deliver sizeable indirect benefits from reduced crime in addition to their direct health-related benefits.
JEL codes
C32,E32,I11,J22,J23
Keywords
Medicaid, Crime, Affordable Care Act, MVPF
Erkmen G. Aslim
, Shin-Yi Chou (Lehigh), and Kuhelika De (GVSU) "Business Cycles and Healthcare Employment", Under Review, Feb 2022, NBER Working Paper 29799.
Abstract
Is healthcare employment recession proof? We examine the hypothesis that healthcare
employment is stable across the business cycle. We explicitly distinguish between negative
aggregate demand and supply shocks in studying how healthcare employment responds to
recessions, and show that this response depends largely on the type of the exogenous shock
triggering the recession. We find that healthcare employment responds procyclically to demandinduced recessions; and the reduction is driven by layoffs and discharges rather than voluntary
quits. In evaluating additional mechanisms, we find evidence of a reduction in real personal
healthcare expenditures resulting from an adverse demand shock. By contrast, we find that
healthcare employment is fairly stable and even responds countercyclically to supply-induced
recessions, suggesting compositional changes such as downskilling particularly in nursing
sectors. Our findings establish that employment responses during economic downturns are
heterogeneous across healthcare sub-sectors. More generally, by isolating the impact of the
structural demand shock from supply shock on healthcare employment, we provide new empirical
evidence that healthcare employment is not recession proof.
JEL codes
I13, K42
Keywords
