Publications by James Reschovsky for Health Policy Center

Back to Browse by Author

Jack Hadley and James Reschovsky used physician survey data linked to Medicare claims data to analyze how fee levels, market factors, and financial incentives affect physicians' fee-for-service Medicare service volume. They found that Medicare fees are positively related to both the number of beneficiaries treated and the intensity of services provided. The results also suggest that physicians may manipulate the mix of services to increase the effective Medicare fee. Several market factors also influence the quantity of Medicare services physicians render. Results highlight limitations of the present system for compensating physicians in Medicare's fee-for-service program. (International Journal of Health Care Finance and Economics 6, pp 131-150, June 2006.)

This study compared out-of-pocket spending for health care by lower-income uninsured people with their net spending on insurance and health care if they took up each of three hypothetical tax credits. Because of nongroup policies' high cost and low benefits, nearly all would spend more, often much more, under a tax credit similar to that proposed by the Bush administration. When viewed in the context of other research on low-income people's demand for health insurance, the results suggest that sizable reductions in the number of uninsured will require more generous tax credits than those in current proposals. (Health Affairs Web Exclusive, February 25, 2004.)

This analysis estimates a selection-adjusted model of the premium for nongroup insurance to measure the effect of health status on the cost of nongroup insurance. Using data from two recent national surveys, the probability of buying nongroup insurance is about 50 percent lower for people in fair or poor health compared to similar people in excellent health. Correcting for selection, premiums are 13 to 16 percent higher for people with modest health problems and 43 to 50 percent higher for people with major health problems compared to someone in excellent health. We use the selection-corrected premiums to simulate the effects on the price and affordability of nongroup insurance for the uninsured under two recent tax credit proposals. (Inquiry 40(3): 235–53, Fall 2003.)

The State Children’s Health Insurance Program (SCHIP) was designed to increase the number of children with health insurance coverage without resulting in large numbers of children substituting public coverage for private coverage. This study uses data from the Community Tracking Study collected before and after SCHIP implementation to examine effects of increases in eligibility for public coverage on children’s health insurance coverage. Using a regression-based difference-in-differences approach, we find that increases in eligibility for public coverage did increase the likelihood of having Medicaid or other state coverage versus being uninsured for the primary SCHIP target population – children in families with incomes between 100 and 200 percent of the federal poverty level. However, eligibility increases also increases the likelihood of having public coverage versus private insurance for this income group, indicating that SCHIP expansions resulted in substitution of public for private insurance. In fact, simulation results indicate that the initial impact of SCHIP on private insurance coverage has been far greater than on uninsurance rates. These results reflect the early stages of SCHIP implementation, however, and are subject to change as the SCHIP program matures. (Medical Care Research and Review 2002 December; 59(4): 359-383).

This paper explores the decisions by small business establishments (less than 100 workers) to offer health insurance. We estimate a theoretically derived model of establishments’ demand for insurance using nationally representative data from the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey and other sources. Findings show that premiums have a moderate effect on offer decisions (elasticity = -.54), though very small establishments and those employing low-wage workers are more responsive. This suggests that premium subsidies to employers would be an inefficient means of increasing insurance coverage. Greater availability of public insurance and safety net care has a small negative effect on offer decisions. (Inquiry 2002 Summer; 39: 118-137)

Return to list of authors.