Essays in health economics and industrial organization [electronic resource]

This dissertation presents three essays in health economics and industrial organization. In the first essay, titled "Entry and Long-Run Market Structure in Nongroup Health Insurance, " I examine why there are many highly concentrated markets for nongroup (individual) health insurance in the United States. I do this by estimating a static model of entry, with which I show two results. First, incumbent insurers attract disproportionately high market share but do not get a disproportionate share of the most profitable consumers via underwriting (screening). Due to their high market share, they partially deter entry by other more marginal insurers, contributing to high market concentration. Second, rural areas have low population, unprofitable demographics (low-income, high disease incidence), and higher fixed costs of entry (isolated, few physicians). All three confluent factors at once cause rural areas to face significantly more market concentration than others. I use the estimated model to simulate the long-run changes in market concentration under the Affordable Care Act. Most urban areas face a decline in market concentration, but most rural areas - which were already highly concentrated - face an increase in market concentration. In the second essay, titled "Competition and Innovation: Did Monsanto's Entry Encourage Innovation in GMO Crops?, " I examine the relationship between competition and innovation using Monsanto's entry into agricultural biotechnology. In 1996, Monsanto - then a chemical firm - bought a plant breeder that had developed a new corn hybrid, which could withstand Monsanto's powerful herbicide Roundup. Due to the pre-existing structure of the US plant-breeding industry, this acquisition and Monsanto's acquisition of five other corn breeders meant that Monsanto had also entered soy breeding, in addition to corn. As a result, the market structure of soy breeding shifted from a quasi monopoly (by Pioneer Hi-Bred) to a duopoly with a competitive fringe. At the same time, Monsanto's acquisitions created no significant change in the market structure for other crops, such as wheat or cotton. Using new data on field trials, I study the effects of these changes on innovation. These data indicate that Pioneer and the competitive fringe innovated less in response to Monsanto's entry. Data on patent applications, however, indicate that Pioneer and the competitive fringe patented more after Monsanto entered. In the third essay, titled "Studying State-Level Variation in Nongroup Health Insurance Regulation: Insurers' Incentives to Screen Consumers, " I compare different state-level regulations for nongroup (individual) health insurance, and I use the comparison to show how regulation may affect insurers' incentives to screen and reject high-cost consumers. The study is possible because of historical variation in regulation - various states instituted high-risk pool (HRP), community rating (CR), and guaranteed issue (GI) regulation in the 1990s. I compare rejections of individual insurance applications across the different regulatory regimes. Rejections do not decline under HRP regulation. Historically, HRPs have generated little change to demand for private nongroup insurance among high-cost consumers, leaving underwriting (i.e. screening) unchanged. CR by itself (without GI) increases rejections. Insurers have a stronger incentive to underwrite when it is allowed but pricing is restricted. GI (with CR) decreases rejections, but they are not fully eliminated - a non-zero fraction of consumers are still rejected. Insurers face substantial incentive to screen consumers, which may outweigh the implicit cost of screening that regulation imposes. In light of insurers' behavior under these three regulations, future policy should decrease insurers' incentives to screen consumers. This reduces wasted resources devoted to underwriting.

Keywords: Economics.
Advisor: Bresnahan Timothy F. primary advisor. Thesis advisor
Dickstein Michael J.
Einav Liran advisor. Thesis advisor
Moser Petra advisor. Thesis advisor