Boston University, Department of Economics, United States.
Harvard Medical School, Department of Health Care Policy, United States.
J Health Econ. 2017 Sep;55:232-243. doi: 10.1016/j.jhealeco.2017.07.007. Epub 2017 Jul 29.
We estimate within-year price elasticities of demand for detailed health care services using an instrumental variable strategy, in which individual monthly cost shares are instrumented by employer-year-plan-month average cost shares. A specification using backward myopic prices gives more plausible and stable results than using forward myopic prices. Using 171 million person-months spanning 73 employers from 2008 to 2014, we estimate that the overall demand elasticity by backward myopic consumers is -0.44, with higher elasticities of demand for pharmaceuticals (-0.44), specialists visits (-0.32), MRIs (-0.29) and mental health/substance abuse (-0.26), and lower elasticities for prevention visits (-0.02) and emergency rooms (-0.04). Demand response is lower for children, in larger firms, among hourly waged employees, and for sicker people. Overall the method appears promising for estimating elasticities for highly disaggregated services although the approach does not work well on services that are very expensive or persistent.
我们使用工具变量策略估计了详细医疗服务的年内需求价格弹性，其中个体每月成本份额由雇主年度计划月份平均成本份额来衡量。使用后向短视价格的规范比使用前向短视价格的规范更合理、更稳定。使用 2008 年至 2014 年间 73 家雇主的 1.71 亿个人月数据，我们估计后向短视消费者的总体需求弹性为-0.44，对药品（-0.44）、专科医生就诊（-0.32）、磁共振成像（MRI）（-0.29）和精神健康/药物滥用（-0.26）的需求弹性较高，对预防就诊（-0.02）和急诊室就诊（-0.04）的需求弹性较低。儿童、大公司、小时工和病情较重的人对需求的反应较低。总的来说，该方法似乎很有希望用于估计高度细分服务的弹性，尽管该方法不适用于非常昂贵或持续的服务。
