Rebecca Myerson is an Assistant Professor in the Department of Population Health Sciences at the University of Wisconsin’s School of Medicine and Public Health. Her research aims to quantify how public policies can improve outcomes for vulnerable patients, including impacts on insurance coverage and incidence, diagnosis, and treatment of chronic conditions. Specific projects have analyzed the impacts of trans fat bans, health insurance expansions, supplemental income programs, and policies targeted for patients with low health insurance literacy or low English proficiency. Myerson holds a doctorate in public policy from the University of Chicago with a concentration in applied econometrics, as well as a master in public health from the University of Washington and a bachelor’s in psychology from Harvard. Prior to coming to Wisconsin, she was an Assistant Professor at the University of Southern California. Myerson’s policy research has been honored with the 2018 ISPOR Award for Excellence in Application of Pharmacoeconomics and Health Outcomes Research, funded by a Fulbright scholarship and the Agency for Healthcare Research and Quality, and cited by the New York Times, Washington Post, NBC Nightly News, and the Congressional Budget Office.
Introduction: Numerous bans on the use of trans fatty acids (TF)s in eateries are in effect acros... more Introduction: Numerous bans on the use of trans fatty acids (TF)s in eateries are in effect across the United States. No studies have examined cardiovascular event rates after the bans were enacted. Hypothesis: The July 1, 2007 ban on TFs in restaurants and food trucks in New York City (NYC) was associated with an accelerated decline in MI and stroke. Methods: We used the 2002-2013 New York Department of Health Statewide Planning and Research Cooperative System (SPARCS) data to calculate hospital admission rates for incident of MI and stroke in NYC residents (using county of residence). Diagnosis was established using primary discharge ICD-9-CM codes 410.00-410.99 for MI and 430.00-438.99 for stroke. Rates were calculated using Census 2000 and 2010 data and intercensal estimates. Incidence rates of MI and stroke declined between 2002 and 2007. To analyze whether there was additional decline from these prior trends after implementation of the NYC TF ban, we used negative binomial reg...
We use three biomarker datasets to study the consequences of removing the barriers to acquiring i... more We use three biomarker datasets to study the consequences of removing the barriers to acquiring information about asymptomatic conditions. We focus on screening for diabetes, hypertension, and high cholesterol, three common conditions that are often undiagnosed. We demonstrate that the impact of reducing the cost of screening on treatment can be undermined by patient composition effects: reducing the cost of screening increases the fraction of diagnosed patients with low uptake of ex-post medical treatment. These findings can be reconciled by a model in which patients with lower net benefits to medical treatment have lower demand for ex-ante information acquisition. We further show that this change in the composition of diagnosed patients can produce misleading conclusions during policy analysis, such as false reductions in measured health system performance after barriers to screening are removed.
This paper investigates the consequences of removing barriers to information by studying screenin... more This paper investigates the consequences of removing barriers to information by studying screenings that enable medical treatment of asymptomatic health conditions. We consider two unintended consequences of reducing out-of-pocket costs of screening, as is done in the Affordable Care Act. First, lower-cost screenings attract patients with lower demand for information, who may also have lower demand for treatment. Second, expanding screening could increase adverse selection and reduce the stability of health insurance markets. Using data from three biomarker studies reflecting different populations affected by the Affordable Care Act, we find evidence for the former prediction
This chapter summarizes recent evidence on insurance policy as a tool to improve prevention, diag... more This chapter summarizes recent evidence on insurance policy as a tool to improve prevention, diagnosis, and treatment of diabetes. We note several key findings. First, recent availability of insurance coverage for diabetes prevention programs could have a significant impact on the diabetes epidemic, if coverage leads to adoption of these effective programs. Second, expansions in insurance coverage for low-income adults appear to accelerate diabetes diagnosis; in turn, diagnosis increases doctor visits for diabetes management. Third, expansions in insurance coverage and reduction of co-pays for essential diabetes medicines are associated with increased treatment of diabetes; these patterns have been found across studies of Medicare Part D, Medicaid, and private insurance and, if the effects persist, could improve diabetes outcomes. Finally, provider-side financial incentives to improve diabetes care for insured patients have not been shown to consistently improve diabetes management,...
Supplemental Digital Content is available in the text. Background: Annual lung cancer screening v... more Supplemental Digital Content is available in the text. Background: Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening. Objective: The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening. Research Design: A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk. Subjects: A total of 11,163 individuals at high risk for lung cancer just above and below age 65. Measure: Self-reported use of low-dose computed tomography to screen for lung cancer in the past 12 months. Results: A total of 10,951 people at high lung cancer risk (45.7% women, response rate=98.1%) reported lung cancer screening information. Nearly universal access to Medicare increased lung cancer screening by 16.2 percentage points among men (95% confidence interval: 2.4%–30.0%, P=0.02), compared with a baseline screening rate of 11.1% just younger than age 65. Women had a baseline screening rate of 18.2% and experienced no statistically significant change in screening (1.6 percentage point increase, 95% confidence interval: −19.8% to 23.0%, P=0.88). Conclusions: Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening.
IntroductionCancer is a leading cause of death in China. Rural-to-urban migrants are a group of o... more IntroductionCancer is a leading cause of death in China. Rural-to-urban migrants are a group of over 260 million people in China sometimes termed the ‘floating’ population. This study assessed the prevalence of cancer diagnosis and access to needed healthcare by residence and migration status in China.MethodsWe used data from the China Health and Retirement Longitudinal Survey, a nationally representative population-based random sample of adults age 45 years and older and their spouses in China. We used multivariable logistic regressions to compare outcomes among rural-to-urban migrants, local urban residents and local rural residents after adjusting for province of residence, socioeconomic status and demographic characteristics.ResultsThe sample included 7335 urban residents, 9286 rural residents and 3255 rural-to-urban migrants. Prevalence of cancer diagnosis was 9.9 per 1000 population among rural-to-urban migrants (95% CI 6.5 to 15.1 per 1000 population). Rural-to-urban migrants...
Diabetes is a top contributor to the avoidable burden of disease. Costly diabetes medications, in... more Diabetes is a top contributor to the avoidable burden of disease. Costly diabetes medications, including insulin and drugs from newer medication classes, can be inaccessible to people who lack insurance coverage. In 2014 and 2015 twenty-nine states and the District of Columbia expanded eligibility for Medicaid among low-income adults. To examine the impacts of Medicaid expansion on access to diabetes medications, we analyzed data on over ninety-six million prescription fills using Medicaid insurance in the period January 2008-December 2015. Medicaid eligibility expansions were associated with thirty additional Medicaid diabetes prescriptions filled per 1,000 population in 2014-15, relative to states that did not expand Medicaid eligibility. Age groups with higher prevalence of diabetes exhibited larger increases. The increase in prescription fills grew significantly over time. Overall, fills for insulin and for newer medications increased by 40 percent and 39 percent, respectively. ...
To determine whether identification of previously undiagnosed high cholesterol, hypertension, and... more To determine whether identification of previously undiagnosed high cholesterol, hypertension, and/or diabetes during an in-home assessment impacts care seeking among Medicare beneficiaries. Data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, which recruited African American and white participants across the continental United States from 2003-2007, were linked to Medicare claims. We used panel data models to analyze changes in doctor visits for evaluation and management of conditions after participants were assessed, utilizing the study's rolling recruitment to control for secular trends. We extracted Medicare claims for the 24 months before through 24 months after assessment via REGARDS for 5,884 participants. Semi-annual doctor visits for previously undiagnosed conditions increased by 22 percentage points (95 percent confidence interval: 16-28) 2 years following assessment. The effect was similar by gender, race, region, and Medicaid, but it ...
Objective The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount ... more Objective The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount and potentially generate profit if they are reimbursed at rates that exceed 340B acquisition prices. Disproportionate share hospitals (DSH) are eligible to participate in 340B if their DSH adjustment–a measure that identifies hospitals that treat a disproportionate share of low income Medicare or Medicaid patients–is above 11.75%. To assess whether hospitals behave strategically to gain access to the program, we examined data on the number of hospitals just above versus below the DSH adjustment threshold for 340B eligibility and conducted McCrary density tests to assess statistical significance. Results In 2014–2016, the number of hospitals increases by 41% just above the 340B eligibility threshold. McCrary density tests found this increase to be statistically significant across a range of bandwidths in 2014–2016 (p < 0.01). From 2011–2013, the findings are sensitive to the bandwidth ...
Background: Annual lung cancer screening via low-dose computed tomography can reduce lung cancer ... more Background: Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening. Objective: The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening. Research Design: A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk.
Objective: The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount... more Objective: The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount and potentially generate profit if they are reimbursed at rates that exceed 340B acquisition prices. Disproportionate share hospitals (DSH) are eligible to participate in 340B if their DSH adjustment-a measure that identifies hospitals that treat a disproportionate share of low income Medicare or Medicaid patients-is above 11.75%. To assess whether hospitals behave strategically to gain access to the program, we examined data on the number of hospitals just above versus below the DSH adjustment threshold for 340B eligibility and conducted McCrary density tests to assess statistical significance. Results: In 2014-2016, the number of hospitals increases by 41% just above the 340B eligibility threshold. McCrary density tests found this increase to be statistically significant across a range of bandwidths in 2014-2016 (p < 0.01). From 2011-2013, the findings are sensitive to the bandwidth around the threshold, but insignificant in 2008-2010. We found no comparable change among hospitals ineligible for the 340B program. These data are consistent with the hypothesis that some hospitals adjust their DSH to gain 340B eligibility. Our findings support recent calls from the Government Accountability Office to improve oversight of the 340B program.
Trans-fatty acids (TFAs) have deleterious cardiovascular effects. Restrictions on their use were ... more Trans-fatty acids (TFAs) have deleterious cardiovascular effects. Restrictions on their use were initiated in 11 New York State (NYS) counties between 2007 and 2011. The US Food and Drug Administration plans a nationwide restriction in 2018. Public health implications of TFA restrictions are not well understood. To determine whether TFA restrictions in NYS counties were associated with fewer hospital admissions for myocardial infarction (MI) and stroke compared with NYS counties without restrictions. We conducted a retrospective observational pre-post study of residents in counties with TFA restrictions vs counties without restrictions from 2002 to 2013 using NYS Department of Health's Statewide Planning and Research Cooperative System and census population estimates. In this natural experiment, we included those residents who were hospitalized for MI or stroke. The data analysis was conducted from December 2014 through July 2016. Residing in a county where TFAs were restricted....
Introduction: Numerous bans on the use of trans fatty acids (TF)s in eateries are in effect acros... more Introduction: Numerous bans on the use of trans fatty acids (TF)s in eateries are in effect across the United States. No studies have examined cardiovascular event rates after the bans were enacted. Hypothesis: The July 1, 2007 ban on TFs in restaurants and food trucks in New York City (NYC) was associated with an accelerated decline in MI and stroke. Methods: We used the 2002-2013 New York Department of Health Statewide Planning and Research Cooperative System (SPARCS) data to calculate hospital admission rates for incident of MI and stroke in NYC residents (using county of residence). Diagnosis was established using primary discharge ICD-9-CM codes 410.00-410.99 for MI and 430.00-438.99 for stroke. Rates were calculated using Census 2000 and 2010 data and intercensal estimates. Incidence rates of MI and stroke declined between 2002 and 2007. To analyze whether there was additional decline from these prior trends after implementation of the NYC TF ban, we used negative binomial reg...
We use three biomarker datasets to study the consequences of removing the barriers to acquiring i... more We use three biomarker datasets to study the consequences of removing the barriers to acquiring information about asymptomatic conditions. We focus on screening for diabetes, hypertension, and high cholesterol, three common conditions that are often undiagnosed. We demonstrate that the impact of reducing the cost of screening on treatment can be undermined by patient composition effects: reducing the cost of screening increases the fraction of diagnosed patients with low uptake of ex-post medical treatment. These findings can be reconciled by a model in which patients with lower net benefits to medical treatment have lower demand for ex-ante information acquisition. We further show that this change in the composition of diagnosed patients can produce misleading conclusions during policy analysis, such as false reductions in measured health system performance after barriers to screening are removed.
This paper investigates the consequences of removing barriers to information by studying screenin... more This paper investigates the consequences of removing barriers to information by studying screenings that enable medical treatment of asymptomatic health conditions. We consider two unintended consequences of reducing out-of-pocket costs of screening, as is done in the Affordable Care Act. First, lower-cost screenings attract patients with lower demand for information, who may also have lower demand for treatment. Second, expanding screening could increase adverse selection and reduce the stability of health insurance markets. Using data from three biomarker studies reflecting different populations affected by the Affordable Care Act, we find evidence for the former prediction
This chapter summarizes recent evidence on insurance policy as a tool to improve prevention, diag... more This chapter summarizes recent evidence on insurance policy as a tool to improve prevention, diagnosis, and treatment of diabetes. We note several key findings. First, recent availability of insurance coverage for diabetes prevention programs could have a significant impact on the diabetes epidemic, if coverage leads to adoption of these effective programs. Second, expansions in insurance coverage for low-income adults appear to accelerate diabetes diagnosis; in turn, diagnosis increases doctor visits for diabetes management. Third, expansions in insurance coverage and reduction of co-pays for essential diabetes medicines are associated with increased treatment of diabetes; these patterns have been found across studies of Medicare Part D, Medicaid, and private insurance and, if the effects persist, could improve diabetes outcomes. Finally, provider-side financial incentives to improve diabetes care for insured patients have not been shown to consistently improve diabetes management,...
Supplemental Digital Content is available in the text. Background: Annual lung cancer screening v... more Supplemental Digital Content is available in the text. Background: Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening. Objective: The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening. Research Design: A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk. Subjects: A total of 11,163 individuals at high risk for lung cancer just above and below age 65. Measure: Self-reported use of low-dose computed tomography to screen for lung cancer in the past 12 months. Results: A total of 10,951 people at high lung cancer risk (45.7% women, response rate=98.1%) reported lung cancer screening information. Nearly universal access to Medicare increased lung cancer screening by 16.2 percentage points among men (95% confidence interval: 2.4%–30.0%, P=0.02), compared with a baseline screening rate of 11.1% just younger than age 65. Women had a baseline screening rate of 18.2% and experienced no statistically significant change in screening (1.6 percentage point increase, 95% confidence interval: −19.8% to 23.0%, P=0.88). Conclusions: Gaining Medicare coverage at age 65 increased lung cancer screening take-up among men at high lung cancer risk. Lack of insurance or inadequate access to care hinders screening.
IntroductionCancer is a leading cause of death in China. Rural-to-urban migrants are a group of o... more IntroductionCancer is a leading cause of death in China. Rural-to-urban migrants are a group of over 260 million people in China sometimes termed the ‘floating’ population. This study assessed the prevalence of cancer diagnosis and access to needed healthcare by residence and migration status in China.MethodsWe used data from the China Health and Retirement Longitudinal Survey, a nationally representative population-based random sample of adults age 45 years and older and their spouses in China. We used multivariable logistic regressions to compare outcomes among rural-to-urban migrants, local urban residents and local rural residents after adjusting for province of residence, socioeconomic status and demographic characteristics.ResultsThe sample included 7335 urban residents, 9286 rural residents and 3255 rural-to-urban migrants. Prevalence of cancer diagnosis was 9.9 per 1000 population among rural-to-urban migrants (95% CI 6.5 to 15.1 per 1000 population). Rural-to-urban migrants...
Diabetes is a top contributor to the avoidable burden of disease. Costly diabetes medications, in... more Diabetes is a top contributor to the avoidable burden of disease. Costly diabetes medications, including insulin and drugs from newer medication classes, can be inaccessible to people who lack insurance coverage. In 2014 and 2015 twenty-nine states and the District of Columbia expanded eligibility for Medicaid among low-income adults. To examine the impacts of Medicaid expansion on access to diabetes medications, we analyzed data on over ninety-six million prescription fills using Medicaid insurance in the period January 2008-December 2015. Medicaid eligibility expansions were associated with thirty additional Medicaid diabetes prescriptions filled per 1,000 population in 2014-15, relative to states that did not expand Medicaid eligibility. Age groups with higher prevalence of diabetes exhibited larger increases. The increase in prescription fills grew significantly over time. Overall, fills for insulin and for newer medications increased by 40 percent and 39 percent, respectively. ...
To determine whether identification of previously undiagnosed high cholesterol, hypertension, and... more To determine whether identification of previously undiagnosed high cholesterol, hypertension, and/or diabetes during an in-home assessment impacts care seeking among Medicare beneficiaries. Data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, which recruited African American and white participants across the continental United States from 2003-2007, were linked to Medicare claims. We used panel data models to analyze changes in doctor visits for evaluation and management of conditions after participants were assessed, utilizing the study's rolling recruitment to control for secular trends. We extracted Medicare claims for the 24 months before through 24 months after assessment via REGARDS for 5,884 participants. Semi-annual doctor visits for previously undiagnosed conditions increased by 22 percentage points (95 percent confidence interval: 16-28) 2 years following assessment. The effect was similar by gender, race, region, and Medicaid, but it ...
Objective The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount ... more Objective The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount and potentially generate profit if they are reimbursed at rates that exceed 340B acquisition prices. Disproportionate share hospitals (DSH) are eligible to participate in 340B if their DSH adjustment–a measure that identifies hospitals that treat a disproportionate share of low income Medicare or Medicaid patients–is above 11.75%. To assess whether hospitals behave strategically to gain access to the program, we examined data on the number of hospitals just above versus below the DSH adjustment threshold for 340B eligibility and conducted McCrary density tests to assess statistical significance. Results In 2014–2016, the number of hospitals increases by 41% just above the 340B eligibility threshold. McCrary density tests found this increase to be statistically significant across a range of bandwidths in 2014–2016 (p < 0.01). From 2011–2013, the findings are sensitive to the bandwidth ...
Background: Annual lung cancer screening via low-dose computed tomography can reduce lung cancer ... more Background: Annual lung cancer screening via low-dose computed tomography can reduce lung cancer mortality among high-risk adults by 20%; however, screening take-up remains low. Inadequate insurance coverage or access to care may be a barrier to screening. Objective: The objective of this study was to estimate the effect of nearly universal access to Medicare coverage on annual lung cancer screening. Research Design: A regression discontinuity design was used to estimate the causal effect of nearly universal access to Medicare at age 65. Data come from the 2017 to 2019 Behavioral Risk Factor Surveillance System in 28 states that adopted the optional module on lung cancer screening and lung cancer risk.
Objective: The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount... more Objective: The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount and potentially generate profit if they are reimbursed at rates that exceed 340B acquisition prices. Disproportionate share hospitals (DSH) are eligible to participate in 340B if their DSH adjustment-a measure that identifies hospitals that treat a disproportionate share of low income Medicare or Medicaid patients-is above 11.75%. To assess whether hospitals behave strategically to gain access to the program, we examined data on the number of hospitals just above versus below the DSH adjustment threshold for 340B eligibility and conducted McCrary density tests to assess statistical significance. Results: In 2014-2016, the number of hospitals increases by 41% just above the 340B eligibility threshold. McCrary density tests found this increase to be statistically significant across a range of bandwidths in 2014-2016 (p < 0.01). From 2011-2013, the findings are sensitive to the bandwidth around the threshold, but insignificant in 2008-2010. We found no comparable change among hospitals ineligible for the 340B program. These data are consistent with the hypothesis that some hospitals adjust their DSH to gain 340B eligibility. Our findings support recent calls from the Government Accountability Office to improve oversight of the 340B program.
Trans-fatty acids (TFAs) have deleterious cardiovascular effects. Restrictions on their use were ... more Trans-fatty acids (TFAs) have deleterious cardiovascular effects. Restrictions on their use were initiated in 11 New York State (NYS) counties between 2007 and 2011. The US Food and Drug Administration plans a nationwide restriction in 2018. Public health implications of TFA restrictions are not well understood. To determine whether TFA restrictions in NYS counties were associated with fewer hospital admissions for myocardial infarction (MI) and stroke compared with NYS counties without restrictions. We conducted a retrospective observational pre-post study of residents in counties with TFA restrictions vs counties without restrictions from 2002 to 2013 using NYS Department of Health's Statewide Planning and Research Cooperative System and census population estimates. In this natural experiment, we included those residents who were hospitalized for MI or stroke. The data analysis was conducted from December 2014 through July 2016. Residing in a county where TFAs were restricted....
Screening interventions can produce very different treatment and health outcomes, depending on th... more Screening interventions can produce very different treatment and health outcomes, depending on the reasons why patients went unscreened in the first place. Economists have paid scant attention to the complexities of evaluating screening interventions. In this paper, we propose a simple economic framework to guide policy-makers and analysts in designing and evaluating the impact of screening interventions on uptake of relevant treatment. We then apply these insights to several salient empirical examples that illustrate the different kinds of effects screening programs might produce. Our empirical examples focus on contexts relevant to the top cause of death in the United States, heart disease.
61 million children in rural China live apart from one or more migrant parents. This paper addres... more 61 million children in rural China live apart from one or more migrant parents. This paper addresses a puzzle in the empirical literature about the effects on children. Using a model of parental decision making, I identify conditions under which the net effect on children is clearly harmful. In particular, if government spending is a substitute for parental spending and parent time with the child is weakly complementary to spending on the child, then a child’s welfare decreases when a parent migrates for work. The proofs exploit the fact that before migrating without their child, parents cross a margin of indifference. Therefore, if government programs designed to help rural children push some parents across this margin - I demonstrate that recent funding for health insurance in rural China was indeed associated with an increase in the number of left-behind children - this could undermine the benefits of such programs. More broadly, the analysis demonstrates how focusing on marginal treatment effects can facilitate signing otherwise difficult-to-sign comparative statics.
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