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Scholarly Research

The Schroeder Center for Health Policy supports the scholarly research of William and Mary faculty. Center-supported research has been published in books and peer- reviewed academic journals and is distributed as working papers.

 

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"Recessions and Seniors’ Health; Health Behaviors; and Healthcare Use: Analysis of the Medicare Current Beneficiary Survey," by Melissa McInerney and Jennifer M. Mellor. Forthcoming in the Journal of Health Economics, 2012.

A number of studies report that U.S. state mortality rates, particularly for the elderly, decline during economic downturns. Further, several prior studies use microdata to show that as state unemployment rates rise, physical health improves, unhealthy behaviors decrease, and medical care use declines. We use data on elderly mortality rates and data from the Medicare Current Beneficiary Survey from a time period that encompasses the start of the Great Recession. We find that elderly mortality is countercyclical during most of the 1994 to 2008 period. Further, as unemployment rates rise, seniors report worse mental health and are no more likely to engage in healthier behaviors. We find suggestive evidence that inpatient utilization increases perhaps because of an increased physician willingness to accept Medicare patients. Our findings suggest that either elderly individuals respond differently to recessions than do working age adults, or that the relationship between unemployment and health has changed.   

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McInerney and Mellor are faculty memebers in the Department of Economics at the College of William and Mary. 

 

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Hospital Volume Responses to Medicare's Outpatient Prospective Payment System: Evidence from Florida," by Daifeng He and Jennifer M. Mellor. Forthcoming in the Journal of Health Economics, 2012.  

Effective in 2000, Medicare's Outpatient Prospective Payment System (OPPS) sets pre-determined reimbursement rates for hospital outpatient services, replacing the prior cost-based methods of reimbursement. Using Florida outpatient discharge data, we study the effect of OPPS on hospital outpatient volume. We find that on average Medicare rate cuts either decreased or had no significant effect on Medicare volume, but increased private fee-for-service (FFS) volume. We also find that responses vary with the hospital's “exposure” to Medicare payment changes, where exposure is measured as the baseline Medicare patient share. Compared to less exposed hospitals, highly exposed hospitals responded with larger increases in private FFS volume and with smaller decreases (in some cases, even increases) in Medicare volume when payment rates fell. Our results are consistent with provider demand inducement.   

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He and Mellor are faculty members in the Department of Economics at the College of William and Mary.

 

International Journal of Pediatric Obesity
"Child Body Mass Index, Obesity, and Proximity to Fast Food Restaurants," by Jennifer M. Mellor, Carrie B. Dolan, and Ronald Rapoport. International Journal of Pediatric Obesity, 6 (1): 60-68, February 2011.

Using a sample of elementary and middle school students, the authors examined the associations between body mass index (BMI), obesity, and measures of the proximity of fast food and full service restaurants to students ' residences. Socioeconomic status was controlled for using a novel proxy measure based on housing values. The authors found that students residing in homes with higher assessment values were significantly less likely to be obese, and had significantly lower BMIs. Upon controlling for socioeconomic status and other characteristics, the associations of BMI and obesity with proximity to food service establishments were reduced. Nonetheless, students who resided within one-tenth or one-quarter of a mile from a fast food restaurant had significantly higher values of BMI. The proximity of full service restaurants to residences did not have a significant positive association with either BMI or overweight. Therefore, public health efforts to limit access to fast food among nearby residents could have beneficial effects on child obesity. Public data on property value assessments may serve as useful approximations for socioeconomic status when address data are available.

Mellor and Rapoport are faculty members in the Department of Economics and Department of Government, respectively, at the College of William and Mary.  Dolan is a research analyst and epidemiologist in the Office of Institutional Analysis & Effectiveness at the College of William and Mary.

  

Health Economics
"Do Cigarette Taxes Affect Children's Body Mass Index? The Effect of Houshold Environment on Health," by Jennifer M. Mellor. Health Economics, 20 (4): 417-431, April 2011.

Several recent studies demonstrate a positive effect of cigarette prices and taxes on obesity among adults, especially those who smoke. If higher cigarette costs affect smokers' weights by increasing calories consumed or increasing food expenditures, then cigarette taxes and prices may also affect obesity in children of smokers. This study examines the link between child body mass index (BMI) and obesity status and cigarette costs using data from the National Longitudinal Survey of Youth-79 (NLSY79). Controlling for various child, mother, and household characteristics as well as child-fixed effects, the authors find that cigarette taxes and prices increase BMI in the children of smoking mothers. Interestingly, and unlike previous research findings for adults, higher cigarette taxes do not increase the likelihood of obesity in children. These findings are consistent with a causal mechanism in which higher cigarette costs reduce smoking and increase food expenditures and consumption in the household.   

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Mellor is a Professor of Economics at the College of William and Mary. 
 

Health Economics
"Religious Participation and Risky Behaviors among Adolescents," by Jennifer M. Mellor and Beth A. Freeborn. Health Economics, 20(10): 1226-1240, October 2010.

Previous studies have shown that adolescent religious participation is negatively associated with risky health behaviors like cigarette smoking, alcohol consumption, and illicit drug use. But does religion directly reduce risky behaviors, or are both religious participation and risky health behaviors driven by some common unobserved individual trait? This study uses data from the National Longitudinal Study of Adolescent Health and implements an instrumental variables approach to identify the effect of religious participation on smoking, binge drinking and marijuana use.  

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Mellor and Freeborn are faculty members in the Department of Economics at the College of William and Mary.

 

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"Predicting Health Behaviors with an Experimental Measure of Risk Preference," by Lisa R. Anderson and Jennifer M. Mellor. Journal of Health Economics, 27 (5): 1260-1274, September 2008.

Despite the importance of individual-specific risk preference in decision-making, there is no consensus on how best to measure it in order to control for its contribution to economic and health behaviors. This study reports on a large-scale economics experiment paired with a survey. The authors examine the association between an experimental measure of individual risk preference and health-related behaviors among adults aged 18 to 87 years. Controlling for subject demographic and economic characteristics, the experimental measure of risk aversion is negatively and significantly associated with cigarette smoking, heavy drinking, being overweight or obese, and seat belt non-use.

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Anderson and Mellor are faculty members in the Department of Economics at the College of William and Mary.

 

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 Magnetic Appeal: MRI and the Myth of Transparency, by Kelly A. Joyce, Cornell University Press, 2008.

This book investigates popular perceptions of MRI and the technology's use in clinical medicine. Building on a co-production framework, Joyce shows how ideas about mechanically-produced pictures, fee-for-service insurance reimbursements, definitions of evidence, advertising, concerns about litigation, and decreasing clinical exam times all help make MRI the right tool for diagnostic work.

Joyce is an Associate Professor of Sociology at the College of William and Mary.

 

 

 

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 "The Role of Medicaid" by Alan R. Weil and Louis F. Rossiter, in Restoring Fiscal Sanity 2007: The Health Spending Challenge. Alice M. Rivlin and Joseph R. Antos, eds., The Brookings Institution Press, 2007.

Any serious efforts to control the federal budget must include Medicaid. While much Medicaid spending is driven by the same factors that are increasing overall healthcare spending, namely advances in medical technology and increasing needs of the population, some cost pressures are unique. This study examines these unique forces that contribute to Medicaid's spending growth, and what might be done about them.

Rossiter is a Research Professor of Public Policy at the College of William and Mary.

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