{"type":"script","doc_desc":{"producers":[{"abbr":"CK","name":"Krestel","affiliation":"World Bank"}],"prod_date":"2023-07-04","version":"1"},"project_desc":{"authoring_entity":[{"name":"Timothy J. Layton","email":"layton@hcp.med.harvard.edu","affiliation":"Harvard University and NBER"},{"name":"Nicole Maestas","email":"maestas@hcp.med.harvard.edu","author_id":[{"type":"ORCID","id":"0000-0001-5819-0108"}],"affiliation":"Harvard University and NBER"},{"name":"Daniel Prinz","affiliation":"World Bank and Institute for Fiscal Studies","email":"dprinz@worldbank.org"},{"name":"Boris Vabson","email":"vabson@hcp.med.harvard.edu","affiliation":"Harvard University"}],"output":[{"type":"Published Paper","doi":"https:\/\/doi.org\/10.1257\/pol.20190628","title":"Health Care Rationing in Public Insurance Programs: Evidence from Medicaid","authors":"Timothy J. Layton, Nicole Maestas, Daniel Prinz, Boris Vabson","uri":"https:\/\/www.aeaweb.org\/articles?id=10.1257\/pol.20190628"}],"software":[{"name":"Stata","version":"15"}],"title_statement":{"idno":"PP_USA_2022_EXT-4_v01","title":"Reproducibility package for Health Care Rationing in Public Insurance Programs: Evidence from Medicaid","identifiers":[{"type":"doi","identifier":"https:\/\/doi.org\/10.3886\/E134661V1"}]},"contributors":[{"name":"Francoise Becker ","affiliation":"Social Security Administration (SSA)","role":"Data assistance"},{"name":"Julia Yates ","role":"RA"}],"sponsors":[{"name":"Laura and John Arnold Foundation"},{"name":"Social Security Administration ","grant_no":"#5 DRC12000002-06","abbr":"SSA"},{"name":"National Bureau of Economic Research as part of the SSA Disability Research Consortium","abbr":"NBER"},{"name":"National Institute on Aging ","grant_no":"P30-AG012810"},{"name":"Agency for Health Care Research and Quality","grant_no":"K01-HS25786-01"}],"acknowledgment_statement":"We thank Kate Bundorf, Heinrich K\u00f6gel, Jessica Van Parys, and Matt Rutledge for serving as discussants for the paper as well as seminar participants at Harvard Medical School, the Leonard Davis Institute of Health Economics at the University of Pennsylvania, the NBER Spring Aging Meeting, ASHEcon, the American-European Health Economics Study Group, the Disability Research Consortium Annual Meeting, the University of Minnesota, the Schaeffer Center at the University of Southern California, the Institute on Health Economics, Health Behaviors, and Disparities at Cornell University, Harvard University, the APPAM Annual Fall Research Conference, Yale School of Public Health, and RAND for useful comments. We thank Mike Geruso, Jon Kolstad, Jenn Kowalski, Chris Ody, Bastian Ravesteijn, Mark Shepard, Amanda Starc, and Jacob Wallace for helpful conversations about earlier drafts of this paper. ","production_date":"2022-11","abstract":"We study two mechanisms used by public health insurance programs for rationing health care: outsourcing to private managed care plans and quantity limits for prescription drugs. Leveraging a natural experiment in Texas\u2019s Medicaid program, we find that the shift to managed care and the relaxation of a strict drug cap increased access to high-value drugs and outpatient services and reduced avoidable hospitalizations. Program costs increased significantly, indicating a trade-off between cost and quality. We provide suggestive evidence attributing the reduction in hospitalizations to the relaxation of the drug cap and much of the spending increase to the shift to managed care.","geographic_units":[{"name":"United States of America","code":"USA","type":"cty"}],"methods":[{"name":"Natural Experiment"},{"name":"Difference-in-Difference in event study form"},{"name":"Instrumental variables"},{"name":"OLS with fixed effects"},{"name":"OLS"}],"topics":[{"vocabulary":"JEL Classifications","uri":"https:\/\/www.aeaweb.org\/econlit\/jelCodes.php","id":"G22","name":"Insurance \u2022 Insurance Companies \u2022 Actuarial Studies"},{"vocabulary":"JEL Classifications","uri":"https:\/\/www.aeaweb.org\/econlit\/jelCodes.php","id":"H75","name":"State and Local Government: Health \u2022 Education \u2022 Welfare \u2022 Public Pensions"},{"vocabulary":"JEL Classifications","uri":"https:\/\/www.aeaweb.org\/econlit\/jelCodes.php","id":"I13","name":"Health Insurance, Public and Private"},{"vocabulary":"JEL Classifications","uri":"https:\/\/www.aeaweb.org\/econlit\/jelCodes.php","id":"I18","name":"Government Policy \u2022 Regulation \u2022 Public Health"},{"vocabulary":"JEL Classifications","uri":"https:\/\/www.aeaweb.org\/econlit\/jelCodes.php","id":"I38","name":"Government Policy \u2022 Provision and Effects of Welfare Programs"}],"language":[{"name":"English","code":"EN"}],"data_statement":"We obtained the Medicaid Analytic eXtract (MAX) through Data Use Agreement (DUA) 25543 from the Centers for Medicare and Medicaid Services (CMS) through the National Bureau of Economic Research (NBER). The data are confidential, but may be obtained with Data Use Agreements with the Centers of Medicaid and Medicare Services (CMS). The Clinical Classifications Software (CCS) is included in the replication package. The RED BOOK classifications associated with Truven Health\u2019s MartketScan data are proprietary and confidential. We used geographic data on counties in our analysis that can be found under \/raw\/counties\/data\/ and we used geographic data on zipcodes in our analysis that can be found under \/raw\/zipcodes\/data\/ in the replication package. The Medicaid State Drug Utilization Data is freely available online from https:\/\/www.medicaid.gov\/ medicaid\/prescription-drugs\/state-drug-utilization-data\/index.html. The data must be loaded under \/raw\/state_drug_utilization_data\/data\/.","technology_environment":"Cluster size: 300 G and Equivalent RAM\nDisk Size: 1,000 G\nMemory Size: 200 G","technology_requirements":"Time requirement: 4 days","reproduction_instructions":"A readme file with detailed instructions is part of the (external) reproducibility package.","confidentiality":"Yes, please refer to the data statement and the readme file.","contacts":[{"name":"Daniel Prinz","role":"Author","affiliation":"World Bank and Institute for Fiscal Studies","email":"dprinz@worldbank.org"},{"name":"Reproducibility WBG","email":"reproducibility@worldbank.org","uri":"reproducibility.worldbank.org"}],"scripts":[{"dependencies":"reghdfe, coefplot, estout, espmap, elixhauser","file_name":"PP_USA_2022_EXT-4_prg_v01.zip","zip_package":"PP_USA_2022_EXT-4_prg_v01.zip","title":"Reproducibility package (code) for  Health Care Rationing in Public Insurance Programs","date":"2022-11","software":"Stata","instructions":"See readme in the reproducibility package","source_code_repo":"AEA data and code repository (ICPSR)","license":[{"name":"Creative Commons Attribution 4.0 International (CC BY 4.0) License","uri":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"notes":"Could not be checked externally due to the confidentiality of the data."}],"repository_uri":[{"name":"AEA Data and Code Repository","uri":"https:\/\/www.openicpsr.org\/openicpsr\/aea"}],"license":[{"name":"Creative Commons Attribution 4.0 International (CC BY 4.0) License","uri":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"disclaimer":"The materials in the reproducibility packages are distributed as they were prepared by the staff of the International Bank for Reconstruction and Development\/the World Bank. The findings, interpretations, and conclusions expressed in this event do not necessarily reflect the views of the World Bank, the Executive Directors of the World Bank, or the governments they represent. The World Bank does not guarantee the accuracy of the materials included in the reproducibility package.","reproducibility_status":{"type":"Partial access","note":"Some elements of the code or data are confidential and are not included in the reproducibility package. The readme specifies what elements can be reproduced."}},"tags":[{"tag":"Partially Reproducible"},{"tag":"Published Paper"}],"schematype":"script"}