Essays on the economic burden of diabetes and the effect of SCHIP expansion on insurance coverage in Hawaiʻi

Abstract

Chapter 1 uses the 2004 to 2008 Medical Expenditure Panel Survey to estimate the difference in annual medical expenditures between diabetics and non-diabetics. Various propensity score matching methods demonstrate that an adult diagnosed with diabetes incurs annual expenditures $2,900 higher than an otherwise identical non-diabetic. By splitting the diabetic sample into 8 treatment groups by diabetes comorbidity combination, it is clear that heart disease causes the largest increase in expenditures of diabetics compared to other comorbidities. Chapter 2 analyzes the diabetes expenditure differential over progression of the disease. Using propensity score matching, diabetes progression is defined both by disease duration and severity, as measured by treatment regimen. A persistent, statistically significant increase in the expenditure differential is estimated over diabetes duration quartile, with prescription drug, hospital and office-based provider expenditures of diabetics all increasing relative to those of non-diabetics. While diabetics treated with insulin incur the highest expenditures relative to non-diabetics, those treated with a diet modification alone are estimated to incur higher expenditures relative to non-diabetics than diabetics on a regimen of oral medication. Chapter 3 evaluates the effect of State Children's Health Insurance Program (SCHIP) expansion on insurance coverage in Hawaii using the 1998 to 2008 Current Population Survey. A model-based difference-in-differences approach compares changes in insurance coverage between the group of SCHIP-targeted children and a control group consisting of children for whom eligibility remained constant over the period of analysis. We estimate a 20 percent take-up rate of SCHIP and an 87 percent crowd-out rate of private insurance among newly-eligible children.