Market Competition and Healthcare Policy



Health Insurance Coverage—Is Broader Always Better?

Insurance exists to protect enrollees against their financial exposure to catastrophically high-cost low-probability events. Indeed, health insurance began as sickness funds, where workers made weekly contributions to a fund that would temporarily provide a reduced wage to those too ill to work.
Research Project

2024 Pilot Grants

HBHI is pleased to announce our five pilot grant awardees for our 2024 cohort.

Hospital Prices in Medicaid Managed Care

As of 2020, 70% of Medicaid beneficiaries (57 million) were insured through Medicaid managed care (MMC), in which a private insurer covers a beneficiary’s medical care in exchange for fixed payments from state Medicaid agencies.1 A key role of MMC insurers is to negotiate prices with hospitals. MMC prices have important implications for government health expenditures and access to care for Medicaid beneficiaries. However, little is known about MMC prices.2 We used hospitals’ self-disclosed pricing information to characterize MMC hospital prices.

Impact of Direct-to-Consumer Advertising on Outpatient Care Utilization

There is much debate about the effects of pharmaceutical direct to consumer advertising (DTCA) on health care use. In this paper, we inform this debate by examining the effects of DTCA on office visits, as well as treatment courses resulting from those visits, for five common chronic conditions (hypertension, hyperlipidemia, diabetes, depression, and osteoporosis). In particular, we examine whether office visits result in use of drug therapy and/or continued office visits over time.

Workforce Composition In Private Equity–Acquired Versus Non–Private Equity–Acquired Physician Practices

Despite growth in private equity (PE) acquisitions of physician practices in the US, little is known about how changes in ownership influence workforce composition. Using clinician-level data linked to practice acquisition information, we estimated changes in clinician workforce composition in PE-acquired practice sites relative to non-PE-acquired independent practice sites for dermatology, ophthalmology, and gastroenterology specialties.

Estimating Savings Opportunities From Therapeutic Substitutions of High-Cost Generic Medications

In this cross-sectional analysis of the top 1000 generics in Colorado’s all-payer claims database in 2019, 45 high-cost generics that had lower-cost therapeutic alternatives of same clinical value were identified. Overall, high-cost generics were 15.6 times more expensive than their therapeutic alternatives (median values); if the lower-cost alternatives had been used, total spending would have been reduced by 88.3%.

Customized Care for Complex Conditions in Medicare Advantage

Medicare beneficiaries frequently select suboptimal Medicare Advantage plan products or elect traditional fee-for-service Medicare due to choice paralysis, cognitive impairments, and consumer health insurance illiteracy. Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs) offer an opportunity to tie disease to both plan design and marketing, simplifying consumer choice architecture.

HBHI 2020 Pilot Grant on Social Support for Markets Yields Working Paper

Mario Macis, PhD of Carey Business School and member of HBHI’s Leadership Committee won a 2020 HBHI pilot grant on “Social Support for Markets in Health and Healthcare: Insights from the COVID-19 Pandemic.” His efforts produced a working paper which was disseminated in April 2022 by the National Bureau of Economic Research (NBER) as well as two research networks in Germany.

Is the Price Right? The Role of Morals, Ideology, and Tradeoff Thinking in Explaining Reactions to Price Surges

Price surges often generate social disapproval and requests for regulation and price controls, but these interventions may cause inefficiencies and shortages. To study how individuals perceive and reason about sudden price increases for different products under different policy regimes, we conduct a survey experiment with Canadian and U.S. residents.