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Full-Text Articles in Insurance

How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver Jan 2019

How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver

Faculty Scholarship at Penn Law

Forty years after the publication of the first systematic study of adverse medical events, there is greater access to information about adverse medical events and increasingly widespread acceptance of the view that patient safety requires more than vigilance by well-intentioned medical professionals. In this essay, we describe some of the ways that medical liability insurance organizations contributed to this transformation, and we catalog the roles that those organizations play in promoting patient safety today. Whether liability insurance in fact discourages providers from improving safety or encourages them to protect patients from avoidable harms is an empirical question that a survey ...


Out-Of-Pocket Cost For Individuals Being Treated For Opioid Dependence In Rutland County, Vermont, Christopher T. Veal Jan 2018

Out-Of-Pocket Cost For Individuals Being Treated For Opioid Dependence In Rutland County, Vermont, Christopher T. Veal

Family Medicine Clerkship Student Projects

Each day more than 140 Americans die from drug overdoses, 91 specifically due to opioids. In Vermont, more than 50 people die each year from opioid poisoning. With insurance coverage being a critical component of Opioid Dependence Recovery, many people seeking treatment are unaware of the financial barriers to recovery- namely the out-of-pocket costs associated with treatment. This study sought to provide insight on the financial impact of Opioid Dependence Treatment on the patient, and provide financial assistance information to the Rutland County community.


Narrow Networks On The Individual Marketplace In 2017, Daniel Polsky, Janet Weiner, Yuehan Zhang Sep 2017

Narrow Networks On The Individual Marketplace In 2017, Daniel Polsky, Janet Weiner, Yuehan Zhang

Issue Briefs

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.


Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance, Scott E. Harrington Sep 2017

Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance, Scott E. Harrington

Issue Briefs

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 ...


Demand For Health Insurance: Evidence From The California And Washington Aca Marketplaces, Evan Saltzman Jan 2017

Demand For Health Insurance: Evidence From The California And Washington Aca Marketplaces, Evan Saltzman

Health Care Management Papers

I estimate demand for health insurance using consumer-level data from the California and Washington ACA marketplaces. I use the demand estimates to simulate the impact of policies targeting adverse selection, including subsidies and the individual mandate. I find (1) high own-premium elasticities of —6.9 to —7.8, but low insurance coverage elasticities of —0.5 to —0.6; (2) minimal response to the mandate penalty amount, but significant response to the penalty's existence, suggesting consumers have a "taste for compliance"; (3) mandate repeal has minimal effect on consumer surplus because ACA subsidies already mitigate adverse selection by shielding ...


Consumer Financial Protection In Health Care, Erin C. Fuse Brown Jan 2017

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 ...


Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse Nov 2016

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 ...


Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse Oct 2016

Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse

Management Faculty Research

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 ...


Behavioral Economics And Insurance: Principles And Solutions, Howard Kunreuther, Mark V. Pauly Phd Aug 2015

Behavioral Economics And Insurance: Principles And Solutions, Howard Kunreuther, Mark V. Pauly Phd

Health Care Management Papers

It is easy for a consumer to make mistakes in insurance markets, especially when deciding whether to purchase insurance against low-probability, high-consequence (LP-HC) events. They have a hard time collecting and processing information to determine the likelihood and consequences of these risks which (by definition) they have had limited or no experience. Hence, people often rely on feelings and intuition rather than careful thought when it comes time to decide what coverage to purchase.


Medicare Secondary Payer And Settlement Delay, Eric Helland, Jonathan Klick Jul 2015

Medicare Secondary Payer And Settlement Delay, Eric Helland, Jonathan Klick

Faculty Scholarship at Penn Law

The Medicare Secondary Payer Act of 1980 and its subsequent amendments require that insurers and self-insured companies report settlements, awards, and judgments that involve a Medicare beneficiary to the Centers for Medicare and Medicaid Services. The parties then may be required to compensate CMS for its conditional payments. In a simple settlement model, this makes settlement less likely. Also, the reporting delays and uncertainty regarding the size of these conditional payments are likely to further frustrate the settlement process. We provide results, using data from a large insurer, showing that, on average, implementation of the MSP reporting amendments led to ...


Pharmacy Benefit Management: Are Reporting Requirements Pro- Or Anticompetitive?, Patricia M. Danzon Jun 2015

Pharmacy Benefit Management: Are Reporting Requirements Pro- Or Anticompetitive?, Patricia M. Danzon

Health Care Management Papers

The market-based US health care system relies on pharmacy benefit managers (PBMs) to control pharmaceutical costs, in contrast to most other countries that regulate drug prices and access. Optimal strucuturing and regulation of PBM contracts poses significant agency challenges for private and public payers. However, recent reporting requirements for PBMs may be counterproductive and reflect the interests of competitors rather than customers.


Priority-Setting, Cost-Effectiveness, And The Affordable Care Act, Govind Persad Jan 2015

Priority-Setting, Cost-Effectiveness, And The Affordable Care Act, Govind Persad

Georgetown Law Faculty Publications and Other Works

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations,this Article attempts to defend three substantive propositions.

First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality.

Second ...


The Effect Of Entry Regulation In The Health Care Sector: The Case Of Home Health, Daniel Polsky, Guy David, Jianing Yang, Bruce Kinosian, Rachel M. Werner Feb 2014

The Effect Of Entry Regulation In The Health Care Sector: The Case Of Home Health, Daniel Polsky, Guy David, Jianing Yang, Bruce Kinosian, Rachel M. Werner

Health Care Management Papers

The consequences of government regulation in the post-acute care sector are not well understood. We examine the effect of entry regulation on quality of care in home health care by analyzing the universe of hospital discharges during 2006 for publicly insured beneficiaries (about 4.5 million) and subsequent home health admissions to determine whether there is a significant difference in home health utilization, hospital readmission rates, and health care expenditures in states with and without Certificate of Need laws (CON) regulating entry. We identify these effects by looking across regulated and nonregulated states within Hospital Referral Regions, which characterize well-defined ...


Navigating The Health Care Labyrinth: Portraits Of The Socioeconomically Disadvantaged, Thomas C. Crawford Phd Jan 2014

Navigating The Health Care Labyrinth: Portraits Of The Socioeconomically Disadvantaged, Thomas C. Crawford Phd

Dissertations & Theses

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being ...


Want More Value From Prescription Drugs? We Need To Let Prices Rise And Fall, Dana. P. Goldman, Adam Leive, Darius Lakdawalla Dec 2013

Want More Value From Prescription Drugs? We Need To Let Prices Rise And Fall, Dana. P. Goldman, Adam Leive, Darius Lakdawalla

Health Care Management Papers

The high price of some cancer drugs has recently come under attack by the medical profession. We examine the reasons behind the pricing strategies of cancer drugs. On the one hand, prices should reflect value and research demonstrates that the health benefits from novel cancer drugs have been enormous in terms of additional years of life patients can now enjoy. This provides some justification for the high price tag of these drugs. On the other hand, drug pricing is also a product of a hidebound reimbursement system that does a poor job in letting prices adjust to new information about ...


Emotional Intelligence And Community Healthcare Productivity, Christopher Jacob Fox Dec 2013

Emotional Intelligence And Community Healthcare Productivity, Christopher Jacob Fox

Dissertations

Economic crisis is threatening state budgets. The strain on state budgets effects pensions and the healthcare benefits to communities. Rising healthcare costs and lagging insurance reimbursement rates are forcing healthcare organizations to sustain programs with fewer financial resources. Research studies indicate that payment increases from Medicare and Medicaid will not keep pace with the historical trend in hospital cost inflation (Kaufman, 2011). Of the healthcare facilities affected by federal budget constraints are community mental healthcare centers. The strain on state budgets has taken its toll on community mental healthcare facilities in particular struggling under the healthcare reform initiatives (Simpson, 1995 ...


Improving Health Outcomes For Children (Ihoc): Summary Of Pediatric Quality Measures For Children Enrolled In Mainecare Ffy 2009 - Ffy 2012, Nathaniel J. Anderson Ms, Mph, Tracey Meagher Apr 2013

Improving Health Outcomes For Children (Ihoc): Summary Of Pediatric Quality Measures For Children Enrolled In Mainecare Ffy 2009 - Ffy 2012, Nathaniel J. Anderson Ms, Mph, Tracey Meagher

Population Health & Health Policy

his report, authored by USM Muskie School research staff, presents the results of the 16 CHIPRA Core Measures that were collected using MaineCare claims or Vital Statistics data and reported in the State of Maine’s FFY 2012 CHIP Annual Report to the Centers for Medicare and Medicaid Services (CMS). Also included in this report are an additional three measures from the Improving Health Outcomes for Children (IHOC) project’s Master List of Pediatric Measures. In addition to presenting results in graphs and narrative, this report also provides measure definitions and background information about each measure topic.

The goal of ...


Global Budgets, Payment Reform And Single Payer: Understanding Vemont's Health Reform, Trish Riley Apr 2013

Global Budgets, Payment Reform And Single Payer: Understanding Vemont's Health Reform, Trish Riley

Population Health & Health Policy

The Muskie School of Public Service hosted two health policy colloquia this April to promote informed discussion throughout the state regarding MaineCare coverage options under the ACA and the implications of Vermont’s move toward a single-payer system.The series, sponsored by the Muskie School Board of Visitors, offers community conversations in which experts from various disciplines and perspectives inform and engage the broader public to explore and debate critical policy issues. On April 22, community and sector leaders joined for Global Budgets, Payment Reform, and Single Payer: Understanding Vermont's Health Reform. Participants discussed Vermont's recent movie toward ...


Health Reform, Health Insurance, And Selection: Estimating Selection Into Health Insurance Using The Massachusetts Health Reform, Martin B. Hackmann, Jonathan T. Kolstad, Amanda E. Kowalski May 2012

Health Reform, Health Insurance, And Selection: Estimating Selection Into Health Insurance Using The Massachusetts Health Reform, Martin B. Hackmann, Jonathan T. Kolstad, Amanda E. Kowalski

Health Care Management Papers

We implement an empirical test for selection into health insurance using changes in coverage induced by the introduction of mandated health insurance in Massachusetts. Our test examines changes in the cost of the newly insured relative to those who were insured prior to the reform. We find that counties with larger increases in insurance coverage over the reform period face the smallest increase in average hospital costs for the insured population, consistent with adverse selection into insurance before the reform. Additional results, incorporating cross-state variation and data on health measures, provide further evidence for adverse selection.


The Medium-Term Impact Of Medicare Part D On Pharmaceutical Prices, Mark Duggan, Fiona S. Morton May 2011

The Medium-Term Impact Of Medicare Part D On Pharmaceutical Prices, Mark Duggan, Fiona S. Morton

Health Care Management Papers

Medicare Part D began coverage of prescription drugs in 2006. Using data from the first year of the program we found that Part D reduced pharmaceutical prices for Medicare recipients, with these effects driven by enrollees previously without drug coverage. In this paper we extend our analysis through 2009, the fourth year of the program, to investigate whether plans continued to extract price concessions in return for favorable formulary placement, or if consumer inertia or other factors caused prices to bounce back after their initial decline. We find price declines persisted through at least the third year of the program.


Insurance And The Demand For Medical Care, Mark V. Pauly Phd Apr 2011

Insurance And The Demand For Medical Care, Mark V. Pauly Phd

Health Care Management Papers

Insurance coverage affects the use and cost of medical care, and so potentially can play a role in assuring that spending comes closer to the optimum. This article describes the implications of third party financing, whether public or private. The key issue is that—in the absence of direct user payment for services—there is an incentive for inefficient moral hazard, or excess use of services. This article uses the voluntary insurance purchasing model to frame the discussion of demand effects because that is the model used extensively in the literature. It later raises the alternative social goals model and ...


Health Care Reform's Effect On Private Medical Practices, Spencer R. Clark Jan 2011

Health Care Reform's Effect On Private Medical Practices, Spencer R. Clark

CMC Senior Theses

In March of 2010, the 44th President of the United States, Barack Obama, signed into law a health care reform bill that will change the medical and business approach to healthcare that has been witnessed for quite some time. The Patient Protection and Affordable Care Act, aims to eliminate several inefficiencies encountered in our current health care system, as well as extend coverage by providing affordable care for the roughly forty six million Americans currently uninsured. Many of the changes will be implemented over the next several years, but hospitals, businesses, physicians, and insurance companies are no doubt planning ...


The Effect Of Medicare Part D On Pharmaceutical Prices And Utilization, Mark Duggan, Fiona S. Morton Mar 2010

The Effect Of Medicare Part D On Pharmaceutical Prices And Utilization, Mark Duggan, Fiona S. Morton

Health Care Management Papers

Medicare Part D began coverage of prescription drugs in 2006. Rather than setting pharmaceutical prices, the government contracted with private insurers to provide drug coverage. Theory suggests that additional insured consumers will raise the optimal price of a branded drug, while the insurer's ability to move demand to substitute treatments may lower prices. We estimate the program's effect on the price and utilization of pharmaceutical treatments. We find that Part D enrollees paid substantially lower prices than while uninsured, and increased their utilization of prescription drugs. We find relative price declines only for drugs with significant therapeutic competition.


Collaborating With A Financial Therapist: The Why, Who, What And How, Cicily Maton, Michelle Maton, William Marty Martin Jan 2010

Collaborating With A Financial Therapist: The Why, Who, What And How, Cicily Maton, Michelle Maton, William Marty Martin

William Marty Martin

Financial planning clients are seeking holistic solutions to their financial opportunities and challenges. Yet, few financial planners and mental health professionals work together to benefit clients. This article showcases a partnership between a financial therapist, trained as a psychologist, and two financial planners who have implemented an evidence-based model of financial planning drawing upon the behavioral finance, neureconomics, evolutionary psychology, and coaching literature.


The Psychology Of Money: Beyond Behavioral Finance, Cicily Maton, William Marty Martin Apr 2009

The Psychology Of Money: Beyond Behavioral Finance, Cicily Maton, William Marty Martin

William Marty Martin

Behavioral finance has attracted the attention of both academics and practitioners. This article explores the roots of behavioral finance, psychology, and showns how these principles are actually used in practice.


The Effects Of Tort Reform On Medical Malpractice Insurers' Ultimate Losses, Patricia Born, W. Kip Viscusi, Tom Baker Mar 2009

The Effects Of Tort Reform On Medical Malpractice Insurers' Ultimate Losses, Patricia Born, W. Kip Viscusi, Tom Baker

Health Care Management Papers

Whereas the literature evaluating the effect of tort reforms has focused on the impact of reforms on insurers' reported incurred losses, this article examines the ultimate effects of reforms using the developed losses from a comprehensive sample of insurers writing medical malpractice insurance from 1984 to 2003. Noneconomic damages caps are particularly influential in reducing medical malpractice losses and increasing insurer profitability. The long‐run effects of these reforms are greater than insurers' expected effects; for example, 5‐ and 7‐year developed loss ratios are below the initially reported incurred loss ratios for those years following the enactment of noneconomic ...


Healthcare Could Your Organization Save Money With Complementary And Alternative Medicine?, William Martin, Hugh Long Jan 2009

Healthcare Could Your Organization Save Money With Complementary And Alternative Medicine?, William Martin, Hugh Long

William Marty Martin

Some evidence suggests complementary and alternative medicine could reduce costs and improve efficiency while increasing patient satisfaction.


Technical Analysis: The Interface Of Rational And Irrational Decision Making, William Marty Martin Nov 2008

Technical Analysis: The Interface Of Rational And Irrational Decision Making, William Marty Martin

William Marty Martin

No abstract provided.


The Walmart Effect: Retailing Of Health Care, William Marty Martin Feb 2008

The Walmart Effect: Retailing Of Health Care, William Marty Martin

William Marty Martin

No abstract provided.


Providing Prescription Drug Coverage To The Elderly: America’S Experiment With Medicare Part D, Mark Duggan, Patrick Healy, Fiona S. Morton Jan 2008

Providing Prescription Drug Coverage To The Elderly: America’S Experiment With Medicare Part D, Mark Duggan, Patrick Healy, Fiona S. Morton

Health Care Management Papers

The federal government's Medicare program did not provide general prescription drug coverage for the first 40 years of its existence. Thus, more than 30 percent of the 44 million elderly and disabled beneficiaries of the program lacked insurance coverage for prescribed medications. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established a voluntary outpatient prescription drug benefit known as Medicare Part D. This program took effect in 2006 and represents the largest expansion of an entitlement program since the start of Medicare itself. The design of Part D is of particular interest to economists for at least ...