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Herring B, Trish E. Quantifying Overinsurance Tied to the Tax Exclusion for Employment-Based Health Insurance and Its Variation by Health Status. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019893857. [PMID: 31823664 PMCID: PMC6906432 DOI: 10.1177/0046958019893857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The exclusion of employment-based health insurance from income and payroll taxes
is thought to increase the generosity of insurance coverage and, in turn,
increase the overutilization of low-value health care services. We examine this
inefficiency of overinsurance by quantifying the change in expected utility
across 4 benchmark plans varying in actuarial value (AV) and focus on the
distribution of each of these estimates across different groups of people
varying in health status. Specifically, we quantify the changes in health care
spending due to moral hazard and the changes in uncertainty tied to risk
aversion using data from the nationally representative sample of adults with
employment-based coverage from the 2007-2016 Medical Expenditure Panel Survey,
and produce estimates of expected utility for 24 groups of people based on their
age, gender, and preexisting conditions. Our model suggests an average preferred
AV of 78% without the tax exclusion, with 29.0% of the population preferring a
60% AV, 6.5% preferring a 70% AV, 18.1% preferring an 80% AV, and 46.4%
preferring a 90% AV. When incorporating the distortionary effect of the
employment-based tax exclusion, the preferred plan increases to an 83% AV for
low-income people (with 71.0% of the population preferring a 90% AV) and an 84%
AV for high-income people (with 76.0% of the population preferring a 90% AV). We
estimate that policy changes to make subsidies independent of a plan’s AV could
result in increases in utility equal to about 2.7% of total health care
spending, but with those net gains concentrated among the healthy.
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Affiliation(s)
- Bradley Herring
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin Trish
- University of Southern California, Los Angeles, USA
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Lissenden B, Amin K, Drury K, Pope GC, Kautter J, Sutton E, Peele Y. A Comparison of Health Risk and Costs Across Private Insurance Markets. Med Care 2019; 58:146-153. [PMID: 31688571 DOI: 10.1097/mlr.0000000000001239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Patient Protection and Affordable Care Act (PPACA) established new parameters for the individual and small group health insurance markets starting in 2014. We study these 2 reformed markets by comparing health risk and costs to the more mature large employer market. STUDY DATA For 2017, claims data for all enrollees in PPACA-compliant individual and small group market plans as well as claims data from a sample of large employer market enrollees. VARIABLES AND METHODOLOGY Risk scores and total (unadjusted and risk-adjusted) per-member-per-month (PMPM) allowed charges. Differences across markets in enrollment duration, age, and geographic distribution are addressed. The analysis is descriptive. RESULTS Compared with large employer market enrollees, health risk was 3% lower among PPACA small group market enrollees and 20% higher among PPACA individual market enrollees. After adjusting for differences in health risk, enrollees in the PPACA individual market had 27% lower PMPM allowed charges than enrollees in the large employer market and enrollees in the PPACA small group market had 12% lower PMPM allowed charges than enrollees in the large employer market. CONCLUSIONS On average, the PPACA individual market enrolls sicker individuals than the 2 group markets. But this does not translate to higher health costs; in fact, enrollees in the PPACA individual market accumulate lower allowed charges than enrollees in the large employer market. Lower-income enrollees particularly accumulate lower allowed charges. Narrower networks and increased enrollee cost-sharing among individual market plans, though they may reduce the value of coverage, likely significantly reduce allowed charges.
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Affiliation(s)
| | - Krutika Amin
- Centers for Medicare and Medicaid Services, CCIIO, Baltimore, MD
| | - Kelly Drury
- Centers for Medicare and Medicaid Services, CCIIO, Baltimore, MD
| | | | | | - Erin Sutton
- Centers for Medicare and Medicaid Services, CCIIO, Baltimore, MD
| | - Yolanda Peele
- Centers for Medicare and Medicaid Services, CCIIO, Baltimore, MD
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Trish E, Herring B. Does Limiting Allowable Rating Variation in the Small Group Health Insurance Market Affect Employer Self-Insurance? THE JOURNAL OF RISK AND INSURANCE 2018; 85:607-633. [PMID: 30100626 PMCID: PMC6082633 DOI: 10.1111/jori.12184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Affordable Care Act (ACA) imposes adjusted community rating in the small group market, which employers can avoid by self-insuring, raising concerns about adverse selection. We evaluate the impact of limiting allowable rating variation on employer self-insurance across industries with varied health risk, using cross-state variation in pre-ACA rating regulations, the nationally-representative 2008-2013 KFF/HRET Employer Health Benefits survey, and a triple-difference regression approach. We find that lower-risk employers subject to laws limiting allowable premium rating variation have a predicted probability of self-insurance that is about 18 percentage points higher than otherwise-similar higher-risk employers, suggesting that these selection concerns are warranted.
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Affiliation(s)
- Erin Trish
- Assistant Research Professor, University of Southern California Price School of Public Policy, Schaeffer Center for Health Policy and Economics, Verna and Peter Dauterive Hall 412G, 635 Downey Way | Los Angeles, CA 90089, 213-821-6178
| | - Bradley Herring
- Associate Professor of Health Economics, Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 North Broadway, Room 408 | Baltimore, MD 21205, 410-614-5967
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Economics and obesity policy. Int J Obes (Lond) 2017; 41:831-834. [PMID: 28077861 DOI: 10.1038/ijo.2017.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/27/2016] [Accepted: 12/13/2016] [Indexed: 11/08/2022]
Abstract
This paper elucidates the challenges surrounding the economics of some popular obesity-related policy proposals. Solid economic justifications for anti-obesity policies are often lacking, and evidence suggests policies like fat and soda taxes or restrictions on food stamp spending are unlikely to substantively affect obesity prevalence. In short, many of the same factors that make obesity such a complicated and multifaceted issue extend to the economic analysis of public health policies.
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Cantor JC, Monheit AC. Reform of the Individual Insurance Market in New Jersey: Lessons for the Affordable Care Act. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2016; 41:781-801. [PMID: 27127253 DOI: 10.1215/03616878-3620941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The individual health insurance market has played a small but important role in providing coverage to those without access to group insurance or public programs. With implementation of the Affordable Care Act (ACA), the individual market has attained a more prominent role. However, achieving accessible and affordable coverage in this market is a long-standing challenge, in large part due to the threat of adverse risk selection. New Jersey pursued comprehensive reforms beginning in the 1990s to achieve a stable, accessible, and affordable individual market. We review how adverse risk selection can pose a challenge to achieving such objectives in the individual health insurance market. We follow this discussion by describing the experience of New Jersey through three rounds of legislative reform and through the first year of the implementation of the ACA coverage provisions. While the New Jersey reforms did not require individuals to purchase coverage, its experiences with direct and indirect market subsidies and regulations guiding plan design, issuance, and rating have important implications for how the ACA may achieve its coverage goals in the absence of the controversial individual purchase mandate.
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Abstract
BACKGROUND We sought to determine how health care-related financial burden, childhood activity limitations, health insurance, and other access-related factors predict delayed or forgone care for families with children, using a nationally representative, population-based sample. METHODS Our sample included families with children aged 0 to 17 years whose family was interviewed about their health care expenditures in 1 of 7 panels of the 2001 to 2008 Medial Expenditure Panel Survey (N = 14 138). Financial burden was defined as (1) the sum of out-of-pocket health service expenditures during the first survey year and (2) that sum divided by adjusted family income. Delayed or forgone care was defined as self-report of delayed or forgone medical care or prescription medications for the reference parent or child during the second survey year. RESULTS Financial burden, discordant insurance, and having a child with an activity limitation were some of the strongest predictors of delayed or forgone care. Additionally, significant health insurance and income-related disparities exist in the experience of delayed or forgone care. CONCLUSIONS Children and their families are delaying or forgoing needed care due to health care-related financial burden. Policies are needed to effectively reduce financial burden and improve the concordance of insurance between parents and children because this may reduce the frequency of unmet need among families. Moreover, reducing the occurrence of delayed or forgone care may improve health outcomes by increasing the opportunity to receive timely and preventive care.
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Affiliation(s)
- Lauren E. Wisk
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Whitney P. Witt
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
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Hill SC. Individual insurance benefits to be available under health reform would have cut out-of-pocket spending in 2001-08. Health Aff (Millwood) 2012; 31:1349-56. [PMID: 22591659 DOI: 10.1377/hlthaff.2011.1206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Under the Affordable Care Act, individual health insurance will probably become more generous and more like employment-related insurance. Currently, individual insurance typically has less generous benefits than employment-related insurance. This study compared out-of-pocket spending on health care between individual and employment-related insurance, controlling for numerous characteristics such as health status. Then it simulated the impact of full implementation of provisions of the Affordable Care Act on adults who currently have individual insurance, including important subgroups-adults with chronic conditions, the near-elderly (ages 55-64), and low-income populations. If adults who had individual insurance during 2001-08 had instead had benefits similar to those under the Affordable Care Act, their average annual out-of-pocket spending on medical care and drugs might have been $280 less. The near-elderly and people with low incomes might have saved $589 and $535, respectively. An important improvement would have been the reduced probability of incurring very high out-of-pocket spending. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many.
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Affiliation(s)
- Steven C Hill
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland, USA.
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Nichols LM. Government intervention in health care markets is practical, necessary, and morally sound. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2012; 40:547-557. [PMID: 23061583 DOI: 10.1111/j.1748-720x.2012.00688.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This essay makes the affirmative case for health reform by expounding on three fundamental points: (1) one moral case for expanding access to coverage and care to all is grounded in scriptural concepts of community and mutual obligation which continue to inform the American pursuit of justice; (2) the structure of PPACA springs from an appreciation of and approach to channeling market forces that was developed and proposed by a coalition of moderate and conservative Republican U.S. senators almost 20 years ago; (3) the most humane path to a better and more sustainable health system lies in implementing (and amending where appropriate) PPACA as fast and fully as we can. The purpose of this essay is to articulate why it is not possible to make our health system better, sustainable and serve us all without government playing specific and limited but absolutely crucial catalytic roles.
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Kifmann M, Roeder K. Premium subsidies and social health insurance: substitutes or complements? JOURNAL OF HEALTH ECONOMICS 2011; 30:1207-1218. [PMID: 21958945 DOI: 10.1016/j.jhealeco.2011.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 08/01/2011] [Accepted: 08/18/2011] [Indexed: 05/31/2023]
Abstract
Premium subsidies have been advocated as an alternative to social health insurance. These subsidies are paid if expenditure on health insurance exceeds a given share of income. In this paper, we examine whether this approach is superior to social health insurance from a welfare perspective. We show that the results crucially depend on the correlation of health and productivity. For a positive correlation, we find that combining premium subsidies with social health insurance is the optimal policy.
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Affiliation(s)
- Mathias Kifmann
- Universität Hamburg, Fachbereich Sozialökonomie, Von-Melle-Park 5, 20146 Hamburg, Germany.
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Sheils JF, Haught R. Without the individual mandate, the Affordable Care Act would still cover 23 million; premiums would rise less than predicted. Health Aff (Millwood) 2011; 30:2177-85. [PMID: 22031718 DOI: 10.1377/hlthaff.2011.0708] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Many policy analysts fear that eliminating the individual health insurance mandate and penalty from the Affordable Care Act of 2010 would lead to a "premium spiral," in which healthy people would drop coverage, premiums would soar, and the number of people with coverage would plummet. However, there are other provisions of the law that would greatly mitigate this effect. For example, the subsidies provided in the law to help people purchase coverage through health insurance exchanges would restrain a premium spiral by absorbing much of the impact of premium increases. We estimate that if the mandate were lifted, premiums in the individual market would increase by 12.6 percent-somewhat less than other estimates-with 7.8 million people losing coverage, versus other estimates for coverage loss of 16-24 million people. In sum, the Affordable Care Act would still cover 23 million people who would have been uninsured without the law. Our study suggests that although the mandate would have important effects on premiums and coverage, it might not be essential to the act's successful implementation.
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Affiliation(s)
- Bradley Herring
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Bhattacharya J, Sood N. Who pays for obesity? THE JOURNAL OF ECONOMIC PERSPECTIVES : A JOURNAL OF THE AMERICAN ECONOMIC ASSOCIATION 2011; 25:139-58. [PMID: 21598459 PMCID: PMC6415902 DOI: 10.1257/jep.25.1.139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Adult obesity is a growing problem. From 1962 to 2006, obesity prevalence nearly tripled to 35.1 percent of adults. The rising prevalence of obesity is not limited to a particular socioeconomic group and is not unique to the United States. Should this widespread obesity epidemic be a cause for alarm? From a personal health perspective, the answer is an emphatic "yes." But when it comes to justifications of public policy for reducing obesity, the analysis becomes more complex. A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population—a statement which is then taken to justify public policy interventions. But the question of who pays for obesity is an empirical one, and it involves analysis of how obese people fare in labor markets and health insurance markets. We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity. In the conclusion, we offer a few thoughts about some complexities of such a justification.
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Affiliation(s)
- Jay Bhattacharya
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, USA
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13
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Breyer F, Bundorf MK, Pauly MV. Health Care Spending Risk, Health Insurance, and Payment to Health Plans. HANDBOOK OF HEALTH ECONOMICS 2011. [DOI: 10.1016/b978-0-444-53592-4.00011-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Doonan MT, Tull KR. Health care reform in Massachusetts: implementation of coverage expansions and a health insurance mandate. Milbank Q 2010; 88:54-80. [PMID: 20377758 DOI: 10.1111/j.1468-0009.2010.00589.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Much can be learned from Massachusetts's experience implementing health insurance coverage expansions and an individual health insurance mandate. While achieving political consensus on reform is difficult, implementation can be equally or even more challenging. METHODS The data in this article are based on a case study of Massachusetts, including interviews with key stakeholders, state government, and Commonwealth Health Insurance Connector Authority officials during the first three years of the program and a detailed analysis of primary and secondary documents. FINDINGS Coverage expansion and an individual mandate led Massachusetts to define affordability standards, establish a minimum level of insurance coverage, adopt insurance market reforms, and institute incentives and penalties to encourage coverage. Implementation entailed trade-offs between the comprehensiveness of benefits and premium costs, the subsidy levels and affordability, and among the level of mandate penalties, public support, and coverage gains. CONCLUSIONS National lessons from the Massachusetts experience come not only from the specific decisions made but also from the process of decision making, the need to keep stakeholders engaged, the relationship of decisions to existing programs and regulations, and the interactions among program components.
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Affiliation(s)
- Michael T Doonan
- Heller School for Social Policy and Management, Brandeis University, 415 South St., Waltham, MA 02454-9110, USA.
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15
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Affiliation(s)
- Mark V Pauly
- Health Care Management Department, the Wharton School, University of Pennsylvania, Philadelphia, USA
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16
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Hoffman AK. Oil and water: mixing individual mandates, fragmented markets, and health reform. AMERICAN JOURNAL OF LAW & MEDICINE 2010; 36:7-77. [PMID: 20481402 DOI: 10.1177/009885881003600101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The 2010 federal health insurance reform act includes an individual mandate that will require Americans to carry health insurance. This article argues that even if the mandate were to catalyze universal health insurance coverage, it will fall short on some of the policy objectives many hope to achieve through a mandate if implemented in a fragmented insurance market. To uncover this problem, this article sets forth a novel framework that disentangles three different policy objectives the individual mandate can serve. Namely, supporters of the mandate might hope for it to: (1) facilitate greater health and financial security for the uninsured ("paternalism"); (2) eliminate inefficiencies in health care delivery and financing ("efficiency"); and/or (3) require the healthy to buy insurance to help fund medical care for the sick ("health redistribution"). Health redistribution--the primary focus of this article--is a shifting of wealth from the healthy to the sick through the mechanism of risk pooling. Many see health redistribution as a means to enable all Americans to more equitably access medical care on the basis of need, rather than on the basis of ability or willingness to pay. Drawing on evidence from the implementation of an individual mandate in Massachusetts's health reform in 2006, this article reveals that the fragmented American health insurance market will thwart the mandate's ability to achieve these objectives- in particular the goal of health redistribution. Fragmentation is an atomization of the insurance market into numerous risk pools that has been driven by market competition and regulation. It prevents Americans from sharing broadly in the risk of poor health and, in doing so, entrenches a system where access to medical care remains tied to ability to pay and individualized characteristics. The final section of this article examines how various policies, including some in the new law (e.g., insurance regulation and exchanges) and others not (e.g., expanded public insurance), can reduce fragmentation so that the mandate can successfully serve all desired objectives and in the process gain greater legitimacy over time.
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Affiliation(s)
- Allison K Hoffman
- Harvard Law School, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, USA
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17
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Baicker K, Dow WH. Risk selection and risk adjustment: improving insurance in the individual and small group markets. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2009; 46:215-28. [PMID: 19694394 DOI: 10.5034/inquiryjrnl_46.2.215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Insurance market reforms face the key challenge of addressing the threat that risk selection poses to the availability, of stable, high-value insurance policies that provide long-term risk protection. Many of the strategies in use today fail to address this breakdown in risk pooling, and some even exacerbate it. Flexible risk adjustment schemes are a promising avenue for promoting market stability and limiting insurer cream-skimming, potentially providing greater benefits at lower cost. Reforms intended to increase insurance coverage and the value of care delivered will be much more effective if implemented in conjunction with policies that address these fundamental selection issues.
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Affiliation(s)
- Katherine Baicker
- Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA.
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Paolucci F, Prinsze F, Stam PJA, van de Ven WPMM. The potential premium range of risk-rating in competitive markets for supplementary health insurance. INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE AND ECONOMICS 2009; 9:243-58. [PMID: 19125326 DOI: 10.1007/s10754-008-9049-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 12/07/2008] [Indexed: 11/28/2022]
Abstract
In this paper, we simulate several scenarios of the potential premium range for voluntary (supplementary) health insurance, covering benefits which might be excluded from mandatory health insurance (MI). Our findings show that, by adding risk-factors, the minimum premium decreases and the maximum increases. The magnitude of the premium range is especially substantial for benefits such as medical devices and drugs. When removing benefits from MI policymakers should be aware of the implications for the potential reduction of affordability of voluntary health insurance coverage in a competitive market.
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Affiliation(s)
- Francesco Paolucci
- Australian Centre for Economic Research on Health, The Australian National University, Canberra, ACT, 0200, Australia.
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Abstract
Several myths about health insurance interfere with the diagnosis of problems in the current system and impede the development of productive reforms. Although many are built on a kernel of truth, complicated issues are often simplified to the point of being false or misleading. Several stem from the conflation of health, health care, and health insurance, while others attempt to use economic arguments to justify normative preferences. We apply a combination of economic principles and lessons from empirical research to examine the policy problems that underlie the myths and focus attention on addressing these fundamental challenges.
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Affiliation(s)
- Katherine Baicker
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
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Affiliation(s)
- Mark V. Pauly
- Mark Pauly is the Bendheim Professor in the Health Care Management Department at the Wharton School, University of Pennsylvania, in Philadelphia
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Lopert R, Rosenbaum S. What is fair? Choice, fairness, and transparency in access to prescription medicines in the United States and Australia. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2007; 35:643-513. [PMID: 18076515 DOI: 10.1111/j.1748-720x.2007.00187.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The importance of prescription drugs to modern medical practice, coupled with their increasing costs, has strengthened imperatives for national health policies that ensure safety and quality, facilitate affordable access, and promote rational use. Australia has made universal and affordable prescription drug coverage a priority for decades, within a policy framework that emphasizes equity and increasing transparency in coverage design and payment decisions. By contrast, the U.S. lacks such a national policy. Furthermore, federal Medicare reforms aimed at making appropriate drug coverage affordable and accessible employs two icons of the U.S. perception of fairness--the right to choose and the right to challenge coverage design limits--that mask the limited nature of the assistance. As the U.S. seeks to impose its values and priorities on other nations through the negotiation of bilateral and regional trade agreements, it becomes important to consider the two national experiences, in order to avoid trading illusory notions of fairness for true population equity.
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