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Articles 1 - 26 of 26
Full-Text Articles in Health Economics
A Public Option For Employer Health Plans, Allison K. Hoffman, Howell E. Jackson, Amy Monahan
A Public Option For Employer Health Plans, Allison K. Hoffman, Howell E. Jackson, Amy Monahan
All Faculty Scholarship
Following the 2020 presidential election, health care reform discussions have centered on two competing proposals: Medicare for All and an individual public option (“Medicare for all who want it”). Interestingly, these two proposals take starkly different approaches to employer-provided health coverage, long the bedrock of the U.S. health care system and the stumbling block to many prior reform efforts. Medicare for All abolishes employer-provided coverage, while an individual public option leaves it untouched.
This Article proposes a novel solution that finds a middle ground between these two extremes: an employer public option. In contrast to the more familiar public option …
Choice Architecture For Healthier Insurance Choices: Ordering And Partitioning Can Improve Decisions, Benedict G.C. Dellaert, Eric J. Johnson, Tom Baker
Choice Architecture For Healthier Insurance Choices: Ordering And Partitioning Can Improve Decisions, Benedict G.C. Dellaert, Eric J. Johnson, Tom Baker
All Faculty Scholarship
Health insurance decisions are a challenge for many consumers and influence welfare, health outcomes, and longevity. Two choice architecture tools are examined that can improve these decisions: informed ordering of options (from best to worst) and choice set partitioning. It is hypothesized that these tools can improve choices by changing: (1) decision focus: the options in a set on which consumers focus their attention, and (2) decision strategy: how consumers integrate the different attributes that make up the options. The first experiment focuses on the mediating role of the hypothesized decision processes on consumer decision outcomes. The outcome results are …
How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver
How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver
All Faculty Scholarship
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 …
Unlocking Access To Health Care: A Federalist Approach To Reforming Occupational Licensing, Gabriel Scheffler
Unlocking Access To Health Care: A Federalist Approach To Reforming Occupational Licensing, Gabriel Scheffler
All Faculty Scholarship
Several features of the existing occupational licensing system impede access to health care without providing appreciable protections for patients. Licensing restrictions prevent health care providers from offering services to the full extent of their competency, obstruct the adoption of telehealth, and deter foreign-trained providers from practicing in the United States. Scholars and policymakers have proposed a number of reforms to this system over the years, but these proposals have had a limited impact for political and institutional reasons.
Still, there are grounds for optimism. In recent years, the federal government has taken a range of initial steps to reform licensing …
Health Care's Market Bureaucracy, Allison K. Hoffman
Health Care's Market Bureaucracy, Allison K. Hoffman
All Faculty Scholarship
The last several decades of health law and policy have been built on a foundation of economic theory. This theory supported the proliferation of market-based policies that promised maximum efficiency and minimal bureaucracy. Neither of these promises has been realized. A mounting body of empirical research discussed in this Article makes clear that leading market-based policies are not efficient — they fail to capture what people want. Even more, this Article describes how the struggle to bolster these policies — through constant regulatory, technocratic tinkering that aims to improve the market and the decision-making of consumers in it — has …
The Developmental Effect Of State Alcohol Prohibitions At The Turn Of The 20th Century, Mary F. Evans, Eric Helland, Jonathan Klick, Ashwin Patel
The Developmental Effect Of State Alcohol Prohibitions At The Turn Of The 20th Century, Mary F. Evans, Eric Helland, Jonathan Klick, Ashwin Patel
All Faculty Scholarship
We examine the quasi-randomization of alcohol consumption created by state-level alcohol prohibition laws passed in the U.S. in the early part of the 20th century. Using a large dataset of World War II enlistees, we exploit the differential timing of these laws to examine their effects on adult educational attainment, obesity, and height. We find statistically significant effects for education and obesity that do not appear to be the result of pre-existing trends. Our findings add to the growing body of economic studies that examines the long-run impacts of in utero and childhood environmental conditions.
Medicare Secondary Payer And Settlement Delay, Eric Helland, Jonathan Klick
Medicare Secondary Payer And Settlement Delay, Eric Helland, Jonathan Klick
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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 …
Actavis And Error Costs: A Reply To Critics, Aaron S. Edlin, C. Scott Hemphill, Herbert J. Hovenkamp, Carl Shapiro
Actavis And Error Costs: A Reply To Critics, Aaron S. Edlin, C. Scott Hemphill, Herbert J. Hovenkamp, Carl Shapiro
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The Supreme Court’s opinion in Federal Trade Commission v. Actavis, Inc. provided fundamental guidance about how courts should handle antitrust challenges to reverse payment patent settlements. In our previous article, Activating Actavis, we identified and operationalized the essential features of the Court’s analysis. Our analysis has been challenged by four economists, who argue that our approach might condemn procompetitive settlements.
As we explain in this reply, such settlements are feasible, however, only under special circumstances. Moreover, even where feasible, the parties would not actually choose such a settlement in equilibrium. These considerations, and others discussed in the reply, serve to …
Conditional Spending And The Conditional Offer Puzzle, Mitchell N. Berman
Conditional Spending And The Conditional Offer Puzzle, Mitchell N. Berman
All Faculty Scholarship
No abstract provided.
Health Care Spending And Financial Security After The Affordable Care Act, Allison K. Hoffman
Health Care Spending And Financial Security After The Affordable Care Act, Allison K. Hoffman
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Health insurance has fallen notoriously short of protecting Americans from financial insecurity caused by health care spending. The Patient Protection and Affordable Care Act (“ACA”) attempted to ameliorate this shortcoming by regulating health insurance. The ACA offers a new policy vision of how health insurance will (and perhaps should) serve to promote financial security in the face of health care spending. Yet, the ACA’s policy vision applies differently among insured, based on the type of insurance they have, resulting in inconsistent types and levels of financial protection among Americans.
To examine this picture of inconsistent financial protection, this Article offers …
Can Consumers Make Affordable Care Affordable? The Value Of Choice Architecture, Eric J. Johnson, Ran Hassin, Tom Baker, Allison T. Bajger, Galen Treuer
Can Consumers Make Affordable Care Affordable? The Value Of Choice Architecture, Eric J. Johnson, Ran Hassin, Tom Baker, Allison T. Bajger, Galen Treuer
All Faculty Scholarship
Starting this October, tens of millions will be choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do …
An Optimist's Take On The Decline Of Small-Employer Health Insurance, Allison K. Hoffman
An Optimist's Take On The Decline Of Small-Employer Health Insurance, Allison K. Hoffman
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In their Article, Saving Small-Employer Health Insurance, Amy Monahan and Dan Schwarcz contend that the Patient Protection and Affordable Care Act (“ACA”) could be the death of small-group health insurance by incentivizing many small employers not to offer coverage. While their prediction that the ACA, after implemented, will destabilize the small-group insurance market may prove true, I argue why their prescription that it should be saved is flawed and why we may be better off without small group insurance.
Transparency Through Insurance: Mandates Dominate Discretion, Tom Baker
Transparency Through Insurance: Mandates Dominate Discretion, Tom Baker
All Faculty Scholarship
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, …
A Cost-Benefit Interpretation Of The "Substantially Similar" Hurdle In The Congressional Review Act: Can Osha Ever Utter The E-Word (Ergonomics) Again?, Adam M. Finkel, Jason W. Sullivan
A Cost-Benefit Interpretation Of The "Substantially Similar" Hurdle In The Congressional Review Act: Can Osha Ever Utter The E-Word (Ergonomics) Again?, Adam M. Finkel, Jason W. Sullivan
All Faculty Scholarship
The Congressional Review Act permits Congress to veto proposed regulations via a joint resolution, and prohibits an agency from reissuing a rule “in substantially the same form” as the vetoed rule. Some scholars—and officials within the agencies themselves—have understood the “substantially the same” standard to bar an agency from regulating in the same substantive area covered by a vetoed rule. Courts have not yet provided an authoritative interpretation of the standard.
This Article examines a spectrum of possible understandings of the standard, and relates them to the legislative history (of both the Congressional Review Act itself and the congressional veto …
The Shifting Terrain Of Risk And Uncertainty On The Liability Insurance Field, Tom Baker
The Shifting Terrain Of Risk And Uncertainty On The Liability Insurance Field, Tom Baker
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Recent sociological and historical work suggests that insurance risks often are not reliably calculable, except in hindsight. Insurance is “an uncertain business,” characterized by competition for premiums that pushes insurers into the unknown. This essay takes some preliminary steps that extend this insight into the liability insurance field. The essay first provides a simple quantitative comparison of U.S. property and liability insurance premiums over the last sixty years, setting the stage to make three points: (1) liability insurance premiums have grown at a similar rate as property insurance premiums and GDP over this period, providing yet another piece of evidence …
Health Insurance, Risk, And Responsibility After The Patient Protection And Affordable Care Act, Tom Baker
Health Insurance, Risk, And Responsibility After The Patient Protection And Affordable Care Act, Tom Baker
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This essay explores the new social contract of healthcare solidarity through private ownership, markets, choice, and individual responsibility embodied in the Patient Protection and Affordable Care Act. This essay first explains the four main health care risk distribution institutions affected by the Act – Medicare, Medicaid, the individual and small employer market, and the large group market – with an emphasis on how the Act changes those institutions and how they are financed. The essay then describes the “fair share” approach to health care financing embodied in the Act. This approach largely rejects the actuarial fairness vision of what constitutes …
A New Deal In A World Of Old Ones, Theodore Ruger
A New Deal In A World Of Old Ones, Theodore Ruger
All Faculty Scholarship
No abstract provided.
Tontines For The Invincibles: Enticing Low Risks Into The Health-Insurance Pool With An Idea From Insurance History And Behavioral Economics, Tom Baker, Peter Siegelman
Tontines For The Invincibles: Enticing Low Risks Into The Health-Insurance Pool With An Idea From Insurance History And Behavioral Economics, Tom Baker, Peter Siegelman
All Faculty Scholarship
Over one third of the uninsured adults in the U.S. below retirement age are between 19 and 29 years old. Young adults, especially men, often go without insurance, even when buying it is mandatory and sometimes even when it is a low cost employment benefit. This paper proposes a new form of health insurance targeted at this group—the “Young Invincibles”—those who (wrongly) believe that they don’t need health insurance because they won’t get sick. Our proposal offers a cash bonus to those who turn out to be right in their belief that they did not really need health insurance. The …
Oil And Water: Mixing Individual Mandates, Fragmented Markets, And Health Reform, Allison K. Hoffman
Oil And Water: Mixing Individual Mandates, Fragmented Markets, And Health Reform, Allison K. Hoffman
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With momentum toward national health reform, there is wide support for legislation to include an individual mandate that would require all Americans to carry health insurance. Discussion of the individual mandate has relied largely on whether the mandate will generate universal coverage as a gauge for success. This article challenges the notion that an individual mandate is successful if it leads to universal coverage, revealing a critical problem the individual mandate will face even if all Americans were to have health insurance. To uncover this problem, this article sets out a novel framework that disentangles the three different policy objectives …
Can A Patient-Centered Ethos Be Other-Regarding? Ought It Be?, Theodore Ruger
Can A Patient-Centered Ethos Be Other-Regarding? Ought It Be?, Theodore Ruger
All Faculty Scholarship
No abstract provided.
Contingent Valuation Studies And Health Policy, Matthew D. Adler
Contingent Valuation Studies And Health Policy, Matthew D. Adler
All Faculty Scholarship
This short comment argues that both cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA) should be seen as imperfect tools for evaluating health policy. This is true, not only for extra-welfarists, but even for welfarists, since both CBA and CEA can deviate from the use of social welfare functions (SWF). A simple model is provided to illustrate the divergence between CBA, CEA, and the SWF approach. With this insight in mind, the comment considers the appropriate role of contingent-valuation studies. For full text, please see: http://www.law.upenn.edu/cf/faculty/madler/workingpapers/578A59B6d01.pdf.
The Effects Of Tort Reform On Medical Malpractice Insurers’ Ultimate Losses, Patricia Born, W. Kip Viscusi, Tom Baker
The Effects Of Tort Reform On Medical Malpractice Insurers’ Ultimate Losses, Patricia Born, W. Kip Viscusi, Tom Baker
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Whereas the literature evaluating the effect of tort reforms has focused on reported incurred losses, this paper examines the long run effects using a comprehensive sample by state of individual firms writing medical malpractice insurance from 1984-2003. The long run effects of reforms are greater than insurers' expected effects, as five year developed losses and ten year developed losses are below the initially reported incurred losses for those years following reform measures. The quantile regressions show the greatest effects of joint and several liability limits, noneconomic damages caps, and punitive damages reforms for the firms that are at the high …
Law, Society, And Medical Malpractice Litigation In Japan, Eric Feldman
Law, Society, And Medical Malpractice Litigation In Japan, Eric Feldman
All Faculty Scholarship
No abstract provided.
Diabetes Treatments And Moral Hazard, Jonathan Klick, Thomas Stratmann
Diabetes Treatments And Moral Hazard, Jonathan Klick, Thomas Stratmann
All Faculty Scholarship
In the face of rising rates of diabetes, many states have passed laws requiring health insurance plans to cover medical treatments for the disease. Although supporters of the mandates expect them to improve the health of diabetics, the mandates have the potential to generate a moral hazard to the extent that medical treatments might displace individual behavioral improvements. Another possibility is that the mandates do little to improve insurance coverage for most individuals, as previous research on benefit mandates has suggested that mandates often duplicate what plans already cover. To examine the effects of these mandates, we employ a triple-differences …
Medical Malpractice Reform And Physicians In High-Risk Specialties, Jonathan Klick, Thomas Stratmann
Medical Malpractice Reform And Physicians In High-Risk Specialties, Jonathan Klick, Thomas Stratmann
All Faculty Scholarship
If medical malpractice reform affects the supply of physicians, the effects will be concentrated in specialties facing high liability exposure. Many doctors are likely to be indifferent regarding reform, because their likelihood of being sued is low. This difference can be exploited to isolate the causal effect of medical malpractice reform on the supply of doctors in high-risk specialties, by using doctors in low-risk specialties as a contemporaneous within-state control group. Using this triple-differences design to control for unobserved effects that correlate with the passage of medical malpractice reform, we show that only caps on noneconomic damages have a statistically …
Subsidizing Addiction: Do State Health Insurance Mandates Increase Alcohol Consumption?, Jonathan Klick, Thomas Stratmann
Subsidizing Addiction: Do State Health Insurance Mandates Increase Alcohol Consumption?, Jonathan Klick, Thomas Stratmann
All Faculty Scholarship
A model of addiction in which individuals are forward looking implies that as the availability of addiction treatment options grows, individuals will consume more of an addictive good. We test this implication using cross-state variation in the adoption of mental health parity mandates that include substance abuse treatments. We examine the effects of these mandates on the consumption of alcohol and find that parity legislation leads to an increase in alcohol consumption. To account for the possible endogeneity of the adoption of mental health parity mandates, we perform an instrumental variables analysis and find that the ordinary least squares estimation …