Open Access. Powered by Scholars. Published by Universities.®

Insurance Commons

Open Access. Powered by Scholars. Published by Universities.®

Health Care Management Papers

Discipline
Keyword
Publication Year

Articles 1 - 30 of 38

Full-Text Articles in Insurance

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 ...


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.


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.


Value-Based Differential Pricing: Efficient Prices For Drugs In A Global Context, Patricia. M. Danzon, Adrian Towse, Jorge Mestre-Ferrandiz Mar 2015

Value-Based Differential Pricing: Efficient Prices For Drugs In A Global Context, Patricia. M. Danzon, Adrian Towse, Jorge Mestre-Ferrandiz

Health Care Management Papers

This paper analyzes pharmaceutical pricing between and within countries to achieve second-best static and dynamic efficiency. We distinguish countries with and without universal insurance, because insurance undermines patients' price sensitivity, potentially leading to prices above second-best efficient levels. In countries with universal insurance, if each payer unilaterally sets an incremental cost-effectiveness ratio (ICER) threshold based on its citizens' willingness-to-pay for health; manufacturers price to that ICER threshold; and payers limit reimbursement to patients for whom a drug is cost-effective at that price and ICER, then the resulting price levels and use within each country and price differentials across countries are ...


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 ...


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 ...


Plan Selection In Medicare Part D: Evidence From Administrative Data, Florian Heiss, Adam Leive, Daniel Mcfadden, Joachim Winter Dec 2013

Plan Selection In Medicare Part D: Evidence From Administrative Data, Florian Heiss, Adam Leive, Daniel Mcfadden, Joachim Winter

Health Care Management Papers

We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets, focusing on the ability of consumers to evaluate and optimize their choices of plans. Our analysis of administrative data on medical claims in Medicare Part D suggests that fewer than 25% of individuals enroll in plans that are ex ante as good as the least cost plan specified by the Plan Finder tool made available to seniors by the Medicare administration, and that consumers on average have expected excess spending of about $300 per year, or about 15% of ...


Consumers' Misunderstanding Of Health Insurance., George Loewenstein, Joelle Y Friedman, Barbara Mcgill, Sarah Ahmad, Suzanne Linck, Stacey Sinkula, John Beshears, James J Choi, Jonathan Kolstad, David Laibson, Brigitte C Madrian, John A List, Kevin. G. Volpp Sep 2013

Consumers' Misunderstanding Of Health Insurance., George Loewenstein, Joelle Y Friedman, Barbara Mcgill, Sarah Ahmad, Suzanne Linck, Stacey Sinkula, John Beshears, James J Choi, Jonathan Kolstad, David Laibson, Brigitte C Madrian, John A List, Kevin. G. Volpp

Health Care Management Papers

We report results from two surveys of representative samples of Americans with private health insurance. The first examines how well Americans understand, and believe they understand, traditional health insurance coverage. The second examines whether those insured under a simplified all-copay insurance plan will be more likely to engage in cost-reducing behaviors relative to those insured under a traditional plan with deductibles and coinsurance, and measures consumer preferences between the two plans. The surveys provide strong evidence that consumers do not understand traditional plans and would better understand a simplified plan, but weaker evidence that a simplified plan would have strong ...


The Unanticipated Consequences Of Postponing The Employer Mandate, Mark. V. Pauly, Adam. A. Leive Aug 2013

The Unanticipated Consequences Of Postponing The Employer Mandate, Mark. V. Pauly, Adam. A. Leive

Health Care Management Papers

No abstract provided.


The Impact Of Health Care Reform On Hospital And Preventive Care: Evidence From Massachusetts, Jonathan T. Kolstad, Amanda E. Kowalski Dec 2012

The Impact Of Health Care Reform On Hospital And Preventive Care: Evidence From Massachusetts, Jonathan T. Kolstad, Amanda E. Kowalski

Health Care Management Papers

In April 2006, Massachusetts passed legislation aimed at achieving near-universal health insurance coverage. The key features of this legislation were a model for national health reform, passed in March 2010. The reform gives us a novel opportunity to examine the impact of expansion to near-universal coverage state-wide. Among hospital discharges in Massachusetts, we find that the reform decreased uninsurance by 36% relative to its initial level and to other states. Reform affected utilization by decreasing length of stay, and the number of inpatient admissions originating from the emergency room. When we control for patient severity, we find evidence that preventable ...


Affording To Wait: Medicare Initiation And The Use Of Health Care, Guy David, Victoria Acevedo-Perez, Phil Saynisch, Mark D. Neuman Aug 2012

Affording To Wait: Medicare Initiation And The Use Of Health Care, Guy David, Victoria Acevedo-Perez, Phil Saynisch, Mark D. Neuman

Health Care Management Papers

Delays in receipt of necessary diagnostic and therapeutic medical procedures related to the timing of Medicare initiation at age 65 years have potentially broad welfare implications. We use 2005–2007 data from Florida and North Carolina to estimate the effect of initiation of Medicare benefits on healthcare utilization across procedures that differ in urgency and coverage. In particular, we study trends in the use of elective procedures covered by Medicare to treat conditions that vary in symptoms; these are compared with elective surgical procedures not eligible for Medicare reimbursement, and to a set of urgent and emergent procedures. We find ...


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.


Paying A Premium On Your Premium? Consolidation In The Us Health Insurance Industry, Leemore Dafny, Mark Duggan, Subramaniam Ramanarayanan Apr 2012

Paying A Premium On Your Premium? Consolidation In The Us Health Insurance Industry, Leemore Dafny, Mark Duggan, Subramaniam Ramanarayanan

Health Care Management Papers

We examine whether and to what extent consolidation in the US health insurance industry has contributed to higher employer-sponsored insurance premiums. We exploit the differential impact across local markets of a national merger of two insurers to identify the causal effect of concentration on premiums. Using data for large groups, we estimate premiums in average markets were approximately seven percentage points higher by 2007 due to increases in local concentration from 1998-2006. We also find evidence consolidation facilitates the exercise of monopsonistic power vis-Ã -vis physicians, leading to reductions in their absolute employment and earnings relative to other healthcare workers


Transparency Through Insurance: Mandates Dominate Discretion, Tom Baker Jan 2012

Transparency Through Insurance: Mandates Dominate Discretion, Tom Baker

Health Care Management Papers

This chapter describes how liability insurance has contributed to the transparency of the civil justice system. The chapter makes three main points. First, much of what we know about the empirics of the civil justice system comes from access to liability insurance data and personnel. Second, as long as access to liability insurance data and personnel depends on the discretion of liability insurance organizations, this knowledge will be incomplete and, most likely, biased in favor of the public policy agenda of the organizations providing discretionary access to the data. Third, although mandatory disclosure of liability insurance data would improve transparency ...


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 ...


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.


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 ...


Why Are The Disability Rolls Skyrocketing? The Contribution Of Population Characteristics, Economic Conditions, And Program Generosity, Mark Duggan, Scott. A. Imberman Jan 2009

Why Are The Disability Rolls Skyrocketing? The Contribution Of Population Characteristics, Economic Conditions, And Program Generosity, Mark Duggan, Scott. A. Imberman

Health Care Management Papers

This chapter, which addresses three categories of explanation—the characteristics of individuals insured by the Disability Insurance (DI) program, the state of the economy, and the generosity of program benefits—argues that the growth in DI rolls is likely to continue and perhaps accelerate going forward. The data indicate that the recessions of 1991 and 2001 can explain 24 percent of the growth in DI receipt among men and 12 percent of the growth among women. Changes in health during the past two decades have slowed rather than added to the growth of the DI rolls. DI awards for certain ...


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 ...


Distinguishing Income From Substitution Effects In Disability Insurance, David H. Autor, Mark Duggan May 2007

Distinguishing Income From Substitution Effects In Disability Insurance, David H. Autor, Mark Duggan

Health Care Management Papers

No abstract provided.


The Impact Of Child Ssi Enrollment On Household Outcomes, Mark Duggan, Melissa S. Kearney Jan 2007

The Impact Of Child Ssi Enrollment On Household Outcomes, Mark Duggan, Melissa S. Kearney

Health Care Management Papers

We use data from the Survey of Income and Program Participation (SIPP) to investigate the impact that child Supplemental Security Income (SSI) enrollment has on household outcomes, including poverty, household earnings, and health insurance coverage. The longitudinal nature of the SIPP allows us to control for unobserved, time-invariant differences across households by measuring outcomes in the same household in the months leading up to and immediately following the first reporting of child SSI income. Our regression analyses demonstrate that for every $100 increase in household SSI income, total household income increases by roughly $72, reflecting some modest offset of other ...


Is Health Insurance Affordable For The Uninsured?, M Kate Bundorf, Mark V. Pauly Phd Jul 2006

Is Health Insurance Affordable For The Uninsured?, M Kate Bundorf, Mark V. Pauly Phd

Health Care Management Papers

In this paper, we investigate the meaning of “affordability” in the context of health insurance. Assessing the relationship between the affordability of coverage and the large number of uninsured in the U.S. is important for understanding the barriers to purchasing coverage and evaluating the role of policy in reducing the number of uninsured. We propose several definitions of affordability and examine the implications of alternative definitions for estimates of the proportion of uninsured who are unable to afford coverage. We find that, depending on the definition, health insurance was affordable to between one-quarter and three-quarters of the uninsured in ...


The Distortionary Effects Of Government Procurement: Evidance From Medicaid Prescription Drug Purchasing, Mark Duggan, Fiona M Scott Morton Feb 2006

The Distortionary Effects Of Government Procurement: Evidance From Medicaid Prescription Drug Purchasing, Mark Duggan, Fiona M Scott Morton

Health Care Management Papers

In 2003 the federal-state Medicaid program provided prescription drug coverage to more than 50 million people. To determine the price that it will pay for each drug, Medicaid uses the average private sector price. When Medicaid is a large part of the demand for a drug, this creates an incentive for its maker to increase prices for other health care consumers. Using drug utilization and expenditure data for the top 200 drugs in 1997 and in 2002, we investigate the relationship between the Medicaid market share (MMS) and the average price of a prescription. Our estimates imply that a 10-percentage-point ...


The Growth In The Social Security Disability Rolls: A Fiscal Crisis Unfolding, David H. Autor, Mark Duggan Jan 2006

The Growth In The Social Security Disability Rolls: A Fiscal Crisis Unfolding, David H. Autor, Mark Duggan

Health Care Management Papers

The U.S. Social Security Disability Insurance (DI) program has grown dramatically over the last 20 years in size and expense. This growth poses significant risks to the finances of the DI program and the broader Social Security system, and raises troubling questions as to whether the program is being misused by claimants. This article first provides an overview of the Disability Insurance program, describing who qualifies for the program, how an individual applies for benefits and how the level of benefits is determined. Next, we summarize the factors responsible for the growth in the DI rolls and discuss how ...


Insurance Decision-Making And Market Behavior, Howard Kunreuther, Mark V. Pauly Jan 2005

Insurance Decision-Making And Market Behavior, Howard Kunreuther, Mark V. Pauly

Health Care Management Papers

Considerable evidence suggests that many people for whom insurance is worth purchasing do not have coverage and others who appear not to need financial protection against certain events actually have purchased coverage. There are certain types of events for which one might expect to see insurance widely marketed that are viewed today by insurers as uninsurable and there are other polices one might not expect to be successfully marketed that exist on a relatively large scale. In addition, evidence suggests that cost-effective preventive measures are sometimes not rewarded by insurers in ways that could change their clients' behavior. These examples ...


Reference Pricing Of Pharmaceuticals For Medicare: Evidence From Germany, The Netherlands, And New Zealand, Patricia. M. Danzon, Jonathan. D. Ketcham Jan 2004

Reference Pricing Of Pharmaceuticals For Medicare: Evidence From Germany, The Netherlands, And New Zealand, Patricia. M. Danzon, Jonathan. D. Ketcham

Health Care Management Papers

This paper describes three prototypical systems of therapeutic reference pricing (RP) for pharmaceuticals—Germany, the Netherlands, and New Zealand—and examines their effects on the availability of new drugs, reimbursement levels, manufacturer prices, and out-of-pocket sur-charges to patients. RP for pharmaceuticals is not simply analogous to a defined contribution approach to subsidizing insurance coverage. Although a major purpose of RPis to stimulate competition, theory suggests that the achievement of this goal is unlikely, and this is confirmed by the empirical evidence. Other effects of RPdiffer across countries in predictable ways, reflecting each country’s system design and other cost-control policies ...


The Rise In The Disability Rolls And The Decline In Unemployment, Mark Duggan, David H. Autor Feb 2003

The Rise In The Disability Rolls And The Decline In Unemployment, Mark Duggan, David H. Autor

Health Care Management Papers

Between 1984 and 2001, the share of nonelderly adults receiving Social Security Disability Insurance income (DI) rose by 60 percent to 5.3 million beneficiaries. Rapid program growth despite improving aggregate health appears to be explained by reduced screening stringency, declining demand for less skilled workers, and an unforeseen increase in the earnings replacement rate. We estimate that the sum of these forces doubled the labor force exit propensity of displaced high school dropouts after 1984, lowering measured U. S. unemployment by one-half a percentage point. Steady state calculations augur a further 40 percent increase in the rate of DI ...


Health Insurance And The Growth In Pharmaceutical Expenditures*, Patricia. M. Danzon, Mark V. Pauly Oct 2002

Health Insurance And The Growth In Pharmaceutical Expenditures*, Patricia. M. Danzon, Mark V. Pauly

Health Care Management Papers

This paper examines the contribution of insurance coverage to the recent unprecedented growth in spending on pharmaceuticals. Trends in drug spending over time closely paralleled the growth in drug coverage. Most of the coverage growth reflects an increase in the number of people with coverage, 65 percent from 1987 to 1996, rather than increased depth of coverage. The direct moral hazard effect of this insurance growth accounts for between one‐fourth and one‐half of the increase in drug spending. Technological change contributed to these changes, because both the flow of new drugs increased the demand for insurance and information ...


Comments On “The Assault On Managed Care: Vicarious Liability, Erisa Preemption, And Class Actions”, Patricia. M. Danzon, Frank Sloan Jun 2001

Comments On “The Assault On Managed Care: Vicarious Liability, Erisa Preemption, And Class Actions”, Patricia. M. Danzon, Frank Sloan

Health Care Management Papers

Managed care organizations (MCOs), as insurance entities, should be liable under contract for inappropriate denial of coverage, whereas treatment errors should be conventional malpractice claims against physicians. Most MCOs are loose networks of independent practices that lack the requisite information or technology to improve care. Holding such MCOs vicariously liable for their physicians’ negligence would lead to increased “false positive” claims and distort deterrence. Integrated MCOs already contractually assume responsibility for the negligence of their salaried physicians, which appears to be efficient. Maintaining the distinction between medical error and coverage denial requires that treatment decisions be evaluated relative to a ...