Does Obamacare Care? A Fuzzy Difference-in-Discontinuities Approach

49 Pages Posted: 2 Jan 2019

See all articles by Hector Galindo-Silva

Hector Galindo-Silva

Pontifical Xavierian University

Nibene Habib Somé

University of Western Ontario - Department of Epidemiology and Biostatistics

Guy Tchuente

University of Kent

Date Written: November 2018

Abstract

This paper explores the use of fuzzy regression-discontinuity design in the context where multiple treatments are applied at the threshold. The identification result shows that, under a very strong assumption of equality of treatment probability changes at the cutoff point, a difference in fuzzy discontinuity identify a treatment effect of interest. Using the data from the National Health Interview Survey (NHIS), we apply this identification strategy to evaluate the causal effect of the Affordable Care Act (ACA) on health care access and utilization of old Americans. We find results suggesting that the implementation of the Affordable Care Act has led to an increase in the hospitalization rate of elderly American -- 5% more hospitalization. It has caused a minor increase of cost-related direct barrier to access to care -- 3.6% increase in the probability of delaying care for cost reasons. The ACA has also exacerbated cost-related barriers to follow-up and continuity care -- 7% more elderly couldn't afford prescriptions, 7% more couldn't see a specialist and, 5.5% more couldn't afford a follow-up visit - as result of ACA.

Keywords: Fuzzy Difference-in-Discontinuities, Identification, Affordable Care Act

JEL Classification: C13, C33, I13

Suggested Citation

Galindo Silva, Hector and Somé, Nibene Habib and Tchuente, Guy, Does Obamacare Care? A Fuzzy Difference-in-Discontinuities Approach (November 2018). Available at SSRN: https://ssrn.com/abstract=3301047 or http://dx.doi.org/10.2139/ssrn.3301047

Hector Galindo Silva

Pontifical Xavierian University ( email )

Colombia

Nibene Habib Somé

University of Western Ontario - Department of Epidemiology and Biostatistics ( email )

1151 Richmond Street
Suite 2
London, Ontario N6A 5B8
Canada

Guy Tchuente (Contact Author)

University of Kent ( email )

Keynes College, University of Kent
Canterbury, Kent CT2 7NP
United Kingdom

HOME PAGE: http://https://www.kent.ac.uk/economics/staff/profiles/guy-tchuente.html

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