Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance, 2017 University of Pennsylvania
Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance, Scott E. Harrington
Subsidized reinsurance represents a potentially important tool to help stabilize individual health insurance markets. This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. It summarizes specific state initiatives and Congressional proposals that include subsidized reinsurance. It compares approaches to each other and to more direct subsidies of individual market enrollment. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the ...
Narrow Networks On The Individual Marketplace In 2017, 2017 University of Pennsylvania
Narrow Networks On The Individual Marketplace In 2017, Daniel Polsky, Janet Weiner, Yuehan Zhang
This Issue Brief describes the breadth of physician networks on the ACA marketplaces in 2017. We find that the overall rate of narrow networks is 21%, which is a decline since 2014 (31%) and 2016 (25%). Narrow networks are concentrated in plans sold on state-based marketplaces, at 42%, compared to 10% of plans on federally-facilitated marketplaces. Issuers that have traditionally offered Medicaid coverage have the highest prevalence of narrow network plans at 36%, with regional/local plans and provider-based plans close behind at 27% and 30%. We also find large differences in narrow networks by state and by plan type.
The Forfeiture Of Coverage Defenses Rule: An Economic Analysis, 2017 University of Pennsylvania Law School
The Forfeiture Of Coverage Defenses Rule: An Economic Analysis, Tom Baker, Ezra Friedman, Kyle D. Logue
In liability insurance, the duty to defend is broader than the duty to cover. Thus it is possible that an insurer that has a duty to defend a suit may not have the duty to cover the policyholder's liabilities in the suit. However, if the penalty for a breach of the duty to defend is limited to actual legal costs spent by the defendant, the insurer may have an incentive to refuse to defend, even when the duty to defend is clear. This occurs because the insurer will not internalize the consequences of an inadequate defense when it ultimately ...
Property And Pecuniary Risk Exposures: An Investigation Into Smes’ Shutdown And Mitigation Methods In Nigeria, 2017 University of Jos, Jos-Nigeria
Property And Pecuniary Risk Exposures: An Investigation Into Smes’ Shutdown And Mitigation Methods In Nigeria, Joshua Solomon Adeyele, Olubunmi Florence Osemene, Idowu Emmanuel Olubodun
The Journal of Entrepreneurial Finance
Business Interruption (BI) insurance is not popular among the operators/owners of Small and Medium Enterprises (SMEs) in Nigeria. This study is an attempt to investigate causes of SMEs’ failure and to assist the owners on how to use BI to protect both the physical assets as well as future profits of their businesses. Hence, 389 SMEs were purposively selected from four major cities in Niger Delta Region (NDR) in Nigeria for this purpose. The statistical tools used for analysis were Phi and Cramer’s V. The extent of SMEs losses through means of sourcing for materials and strategy employed ...
35 Years In The Singaporean Life Insurance Industry, 2017 Singapore Management University
35 Years In The Singaporean Life Insurance Industry, Singapore Management University
How one man kept up with, and excelled in, an ever-changing landscape
A Discussion Of Social Protection And Private Insurance, 2017 Cornell University
A Discussion Of Social Protection And Private Insurance, Gary S. Fields
Gary S Fields
[Excerpt] This is a thoughtful and thought-provoking paper, informative and interesting. I learned a lot from reading this and have already passed it on to others. In my comments, I would like to do four things: highlight the major points and the rationale for them, raise a few quibbles, put forth some additional issues, and propose a possible resolution of a dilemma raised in the paper. But let us first try to be clear about what we are talking about. Professor Pestieau characterizes social insurance as being mandatory, universal, and redistributive. I would define it slightly differently: “Social insurance is ...
Using A Farmer's Beta For Improved Estimation Of Expected Yields, 2017 Iowa State University
Using A Farmer's Beta For Improved Estimation Of Expected Yields, Miguel A. Carriquiry, Bruce Babcock, Chad E. Hart
Effects of sampling error in estimation of farmers' mean yields for crop insurance purposes and their implications for actuarial soundness are explored using farm- level corn yield data in Iowa. Results indicate that sampling error, combined with nonlinearities in the indemnity function, leads to empirically estimated insurance rates that exceed actuarially fair values. The difference depends on the coverage level, the number of observations used, and the participation strategy followed by farmers. A new estimator for mean yields based on the decomposition of farm yields into systemic and idiosyncratic components is proposed, which could lead to improved rate-making and reduce ...
A Changing Industry: An Analysis Of The Effects Of Direct-To-Consumer Advertising On The Insurance Industry, 2017 University of Connecticut
A Changing Industry: An Analysis Of The Effects Of Direct-To-Consumer Advertising On The Insurance Industry, James Bonvicini
Honors Scholar Theses
Direct-to-consumer selling is a shift in the strategies of many companies. As technology continues to play a prominent role in business, companies need to adapt to accommodate, and take advantage of, new opportunities that become available. Many insurance companies are now focusing on improving their direct-to-consumer selling efforts and attracting consumers with new online selling platforms. This thesis looks at the changes inside and outside of the industry that led to this direct method of selling and the impact that this has on the intermediaries in the industry, with a focus on property and casualty businesses. Additionally, this thesis takes ...
A Mixed-Methods Study: Self-Efficacy And Barriers To Participation In Workplace Wellness Programs, 2017 Brandman University
A Mixed-Methods Study: Self-Efficacy And Barriers To Participation In Workplace Wellness Programs, Massiel Perez-Calhoon
America needs a healthy workforce to sustain the country. The scourge of obesity continues to plague Americans despite government initiatives such as the Affordable Care Act and wellness programs in the workplace to combat this epidemic. However, despite initiatives to make America healthy, barriers continued to impede the nation’s health. Lack of awareness and sensitivity to what motivates individual participants versus group participants built formidable barriers to accessing all workplace employees equitably. The purpose of this study was twofold. First, the intent of this study was to explore the relationship between self-efficacy and the impact on participation and engagement ...
Equity And Community-Based Health Insurance: How Does Insurance Coverage Affect Health Seeking Behavior Among Disadvantaged Groups In India?, Hazel Hering
Independent Study Project (ISP) Collection
The objective of this study is to examine how Community-Based Health Insurance (CBHI) can promote equity by improving health seeking behavior across gender and geography. Using a CBHI scheme from the Self-Employed Women’s Association (SEWA) as a case study, trends in claims filed between October 2016 and March 2017 are compared to the distribution of memberships in order to investigate whether health insurance coverage positively impacts health seeking behavior among disadvantaged groups, and what barriers to access exist when the burden of medical costs are reduced. This study concludes that the number of male and female claims in the ...
The Economic Realities Of Replacing The Affordable Care Act, 2017 University of Pennsylvania
The Economic Realities Of Replacing The Affordable Care Act, Hanming Fang
Penn Wharton Public Policy Initiative
Using simulations based on a new economic model, this brief empirically examines the pivotal mechanisms of the Affordable Care Act, such as the individual mandate, employer mandate, and premium subsidies, to inform the debate over repealing and replacing the Affordable Care Act. The research suggests that the ACA, if left intact, in the long run significantly reduces the uninsured rate. The simulations also suggest that the employer mandate is not a crucial pillar for the success of the ACA. The analysis indicates it is the premium subsidy, rather than the employer mandate or the individual mandate, that is crucial for ...
Mutually Assured Protection Among Large U.S. Law Firms, 2017 University of Pennsylvania Law School
Mutually Assured Protection Among Large U.S. Law Firms, Tom Baker, Rick Swedloff
Top law firms are notoriously competitive, fighting for prime clients and matters. But some of the most elite firms are also deeply cooperative, willingly sharing key details about their finances and strategy with their rivals. More surprisingly, they pay handsomely to do so. Nearly half of the AmLaw 100 and 200 belong to mutual insurance organizations that require member firms to provide capital; partner time; and important information about their governance, balance sheets, risk management, strategic plans, and malpractice liability. To answer why these firms do so when there are commercial insurers willing to provide coverage with fewer burdens, we ...
Risk Appetites And Empirical Survival Pattern Of Small And Medium Enterprises In Nigeria, 2017 University of Benin
Risk Appetites And Empirical Survival Pattern Of Small And Medium Enterprises In Nigeria, Joshua S. Adeyele Dr., Osazee G. Omorokunwa Dr.
The Journal of Entrepreneurial Finance
Small and medium enterprises (SMEs) are vital to economic growth and development of a nation. However, many of them fail in the first five years of incorporation due to their exposures to risk financing and strategies employed to meet customers’ need during business shutdown. Hence, this study is designed to verify how SMEs’ risk financing affect their continuity, and to model their survival patterns in context of risk financing and risk management approach employed by the operators. Two hundred and nine copies of valid questionnaire distributed to the respondents were filled and returned. Cramer’s V and multiple regressions ...
In Defense Of The Restatement Of Liability Insurance Law, 2017 University of Pennsylvania Law School
In Defense Of The Restatement Of Liability Insurance Law, Tom Baker, Kyle D. Logue
For most non-contractual legal claims for damages that are brought against individuals or firms, there is some form of liability insurance coverage. The Restatement of the Law Liability Insurance is the American Law Institute’s first effort to “restate” the common law governing such liability insurance policies, and we are the reporters. In a recent essay funded by the insurance industry, Yale Law Professor George Priest launched a strident critique of the Restatement project, arguing that the rules adopted in the Restatement:
(a) are radically contrary to existing case law,
(b) have a naïve “pro-policyholder” bias that ignores basic economic ...
Optimal Social Insurance With Informal Child Care, 2017 Singapore Management University
Optimal Social Insurance With Informal Child Care, Christine Ho
Research Collection School Of Economics
This study investigates whether the possibility of engaging in householdchildcaremayexacerbatetheincentivesofparentsandgrandparentsto falsely claim disability beneﬁts. I present an efﬁcient implementation case for subsidizing formal child care costs of the disabled and propose an implementation of the optimal scheme that consists of capped formal day care subsidies, non-linear income taxation and asset-testing. I calibrate a multigenerational family model with persistence in privately observed shocks to matchkeyfeaturesoftheUSlaborandchildcaremarkets,andﬁndthatday care subsidies may lead to sizeable cost savings.
Social Health Insurance Coverage And Financial Protection Among Rural-To-Urban Internal Migrants In China: Evidence From A Nationally Representative Cross-Sectional Study, 2017 Old Dominion University
Social Health Insurance Coverage And Financial Protection Among Rural-To-Urban Internal Migrants In China: Evidence From A Nationally Representative Cross-Sectional Study, Wen Chen, Qi Zhang, Andre M. N. Renzaho, Fangjing Zhou, Hui Zhang, Li Ling
Community & Environmental Health Faculty Publications
INTRODUCTION: Migrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We assessed social health insurance (SHI) coverage and its financial protection effect among rural-to-urban internal migrants (IMs) in China.
METHODS: Data from the '2014 National Internal Migrant Dynamic Monitoring Survey' were used. We categorised 170 904 rural-to-urban IMs according to their SHI status, namely uninsured by SHI, insured by the rural SHI scheme (new rural cooperative medical scheme (NCMS)) or the urban SHI schemes (urban employee-based basic medical insurance (UEBMI ...
Consumer Financial Protection In Health Care, 2017 Georgia State University College of Law
Consumer Financial Protection In Health Care, Erin C. Fuse Brown
Faculty Publications By Year
There are inadequate consumer protections from harmful medical billing practices that result in unavoidable, unexpected, and often financially devastating medical bills. The problem stems from the increasing costs shifting to patients in American health care and the inordinate complexity that makes health care transactions nearly impossible for consumers to navigate. A particularly outrageous example is the phenomenon of surprise medical bills, which refers to unanticipated and involuntary out-of-network bills in emergencies or from out-of-network providers at in-network facilities. Other damaging medical billing practices include the opaque and à la carte nature of medical bills, epitomized by added “facility fees,” as ...
The Affordable Care Act: A Study Of The Modern United States Health Insurance System, 2016 University of Wyoming
The Affordable Care Act: A Study Of The Modern United States Health Insurance System, Paige A. Cameron
Honors Theses AY 16/17
In this paper I examine the outcome of the Affordable Care Act as it pertains to increases in insurance coverage. As part of this, I use prior projections provided before the law took effect by the nonpartisan Congressional Budget Office as a benchmark to determine whether the law met expected growth in insurance rates. The ACA was enacted to make many changes to the U.S. healthcare structure, including the adoption of insurance marketplaces and a cost-sharing system, the expansion of Medicaid, imposing both employer and individual mandates, and consumer protective rules. After examining data gathered by multiple nonpartisan studies ...
Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, 2016 Marshall University
Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse
Alberto Coustasse, DrPH, MD, MBA, MPH
Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of ...
Determinants Of Health Insurance Coverage For Farm Family Households: A Midwestern Study, 2016 Iowa State University
Determinants Of Health Insurance Coverage For Farm Family Households: A Midwestern Study, Helen H. Jensen, William E. Saupe
Data from interviews with a random sample of farm households in eight counties in southwestern Wisconsin are used to describe the distribution of health insurance coverage among households and health related fringe benefits of off-farm employment. An analysis of health insurance coverage shows major factors associated with lack of health insurance to include lower total household income, larger household size, and being more conservative regarding risk in farming. Although not significant, the signs of coefficients estimated for formal education and lacking fringe benefits in operator off farm employment are consistent with expectations.