Health Care Delivery & Financing eJournal最新文献

{"title":"Long-Term Care","authors":"Alan S. Gutterman","doi":"10.2139/ssrn.3849759","DOIUrl":"https://doi.org/10.2139/ssrn.3849759","url":null,"abstract":"Long-term care includes activities undertaken by others to ensure that those with a significant ongoing loss of physical or mental capacity can maintain a level of ability to be and to do what they have reason to value and involves a variety of services provided in a number of places and by different groups of caregivers ranging from care in the home from unpaid family members and friends (mostly female), which is the most common form of long-term care;home-based services provided by paid caregivers, including caregivers found informally or through home health care agencies and healthcare professionals (i.e., nurses, home health care aides and therapists);and services provided by health and care professionals in institutional settings such as nursing homes or community-based adult day centers. Caregiving for older persons is an important issue, regardless of how and where the care is provided, since the data shows that the global population over age 65 will more than double over the next three decades, and steps need to be taken to determine the best means to fund and otherwise support the services that will be needed to maintain the physical and mental wellbeing of the most vulnerable members of this group. While there is no international human rights instrument specifically addressing long-term care for older persons, the human rights of older persons with respect to long-term care can be derived from a combination of several different rights explicitly recognized in international human rights. This chapter discusses the human rights law foundation for providing older persons with high quality long-term care alternatives and considers the current state of institutional care in nursing homes and assisted living centers, which is especially relevant in the aftermath of the Covid-19 pandemic. The chapter also describes the sweeping impact that caregiving provided outside of institutions by family members and friends has on all aspects of society and the steps that are being proposed to reduce economic and psychological stress on millions of older persons and their caregivers through development of an “infrastructure of care”.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132993351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On Sustainable Aged Care Financing in Australia","authors":"M. Sherris","doi":"10.2139/ssrn.3870864","DOIUrl":"https://doi.org/10.2139/ssrn.3870864","url":null,"abstract":"The Final Report of the Royal Commission into Aged Care Quality and Safety (2021) highlighted the challenges in developing a sustainable financing system for Aged Care in Australia. The Report recommended additional funding both in the short term and longer term, to provide an adequate level of aged care quality for older Australians including exploring an actuarially based contributory social insurance scheme for aged care. Sustainable financing of aged care requires a balance between government tax-based financing, individual contributions during working life through an aged care levy, co-payments for aged care costs for those receiving aged care and means testing for these co-payments. There should be a role for private market insurance and financing to supplement government financed aged care support.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115780790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Corona Virus More Serious Than Seasonal Influenza?: A Look at the Data","authors":"Robert W. McGee","doi":"10.2139/ssrn.3558751","DOIUrl":"https://doi.org/10.2139/ssrn.3558751","url":null,"abstract":"This paper compares current deaths in the United States due to the Corona virus with those caused by seasonal influenza. The study found that seasonal flu has killed 15 to 21 times as many people as the Corona virus in the first 10 weeks of 2020.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122992024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Spending from Ancient Times to the 21st Century","authors":"T. Getzen","doi":"10.2139/ssrn.3531969","DOIUrl":"https://doi.org/10.2139/ssrn.3531969","url":null,"abstract":"The historical record of medical expenditures over 3,800 years from the Code of Hammurabi to the current OECD Health Data Set is used to illustrate and analyze long-run trends. Scientific and industrial revolutions, demographic transition, urbanization, nationalism, professional organization, institutions, and insurance are seen to be necessary preconditions for the growth of national health expenditures. Modern health systems are both technologically dynamic and fiscally inertial. Country trends from 1960 to 2018 are illustrated graphically, providing a framework for macroeconomic extrapolations that can be used to make forecasts for decades 2030+. The most rapid expansion usually occurred during the 1960s, with medical costs rising more than +3% per year faster than national incomes. After 1975 excess growth moderated in most high-income developed countries, and since 2000 has averaged less than +1% annually. This long-run temporal pattern resembles the S-shaped exponential growth curves characteristic of many biologic and economic processes, having an inflexion point where rates peak and then slowly decelerate. Appendices and related articles provide context for this historical review with more detailed examination of the international development of national health accounting methods, measurement boundaries, comparability, and data sources, and an extended national case study of the USA from 1776 to 2026.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134188106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sources of Inertia in Health Plan Choice in the Individual Health Insurance Market","authors":"Coleman Drake, Conor Ryan, B. Dowd","doi":"10.2139/ssrn.3556857","DOIUrl":"https://doi.org/10.2139/ssrn.3556857","url":null,"abstract":"We decompose inertia in health plan choice in the individual health insurance market into three sources: inattention to alternatives, hassle costs related to switching, and tastes for provider continuity. Administrative 2014-2018 data from California’s Health Insurance Marketplace show that 83% of returning households select their default health plans. Using a default-consideration framework, we find that roughly three quarters of default plan selections are due to inertia, nearly 90% of which are due to inattention, hassle costs, and their interaction with one another. We validate our identification of inattention using information on whether households made active plan selections.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116184390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Caps and Coverage for All: How to Make Health Care Universally Affordable","authors":"D. Kendall, G. Horwitz, J. Kessler","doi":"10.2139/SSRN.3356722","DOIUrl":"https://doi.org/10.2139/SSRN.3356722","url":null,"abstract":"Cost Caps and Coverage for All is a comprehensive approach to health care. It protects everyone through two main parts: 1) Cost Caps: Caps premiums, deductibles, and other out-of-pocket costs for everyone based on income: 2) Universal Coverage: Ensures health care is a basic human right by automatically covering everyone not currently insured in an affordable plan. It would be paid for by protecting patients against high prices, realigning incentives to deliver better value for patients, reducing complexity for patients, and targeted tax increases on the wealthy.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131387652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Study of Mediclaim Policyholders in Indore City","authors":"Dr. Alice Thomas, Dr.Veena Jha","doi":"10.34218/ijm.10.1.2019/001","DOIUrl":"https://doi.org/10.34218/ijm.10.1.2019/001","url":null,"abstract":"Insurance plays an important role in covering risk, anyone can get insured by paying certain known costs in the form of premium and can get their risk covered. Among all the insurance policy, there is a mediclaim policy done for covering illness. The purpose of this research paper is to study about the mediclaim policy holders in Indore city. An empirical study has been conducted in Indore city with 80 respondents to get the required data. The questionnaire result was analysed with chi square test. In the research it was found that age plays an important role in getting information or awareness through internet. This research will help the insurance co. in making marketing strategy.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115438615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid Expansion After the ACA: Intensity of Treatment and Billing in Emergency Departments","authors":"S. Danagoulian, A. Janke, P. Levy","doi":"10.2139/ssrn.3261600","DOIUrl":"https://doi.org/10.2139/ssrn.3261600","url":null,"abstract":"Importance: Expanding health insurance coverage, in addition to increasing access to healthcare, affects medical provider revenue. While projections of medical expenditure include increased utilization attributable to improved access, they do not include changes in provider practice and billing misestimating the cost of insurance expansion. Objective: To evaluate changes to provider practice and billing following the Affordable Care Act (ACA) mandated Medicaid expansion in the emergency department (ED). We analyze total number of procedures and diagnoses on discharge records, then we focus on two diagnostic categories to examine use of specific tests. Design: We analyze 18,872,744 discharges in six states, four of which chose to expand Medicaid, and two which did not, using State Emergency Department Databases (SEDD) for 2013-2014. Using difference-in-differences analysis, we compared outcomes of interest adjusting for patient, visit, and zip code characteristics. Results: The number of procedures in expanding states increased by 0.27 per visit (95% CI, 0.09-0.45), while the number of diagnoses declined by 0.098 per visit (95% CI, -0.22 – 0.03) in 2014 compared to non-expanding states. Focusing on diagnoses of abdominal and pelvic symptoms, we find consistent evidence of decreased use of ultrasounds of abdomen and pelvis (-0.0076, 95% CI, -0.01- -0.002), and some evidence of decreased use of CTs of abdomen and pelvis (-0.0112, 95% CI, -0.01 - -0.001). For diagnoses of upper respiratory symptoms, we find evidence of substitution between tests: 3.2 percentage point decrease in use of ECGs (95% CI, -0.04 - -0.02), and a parallel 1.8 percentage point increase in use of chest x-rays (95% CI, 0.01-0.03). While these magnitudes appear small, the average CMS reimbursement for ECGs is $11.76 and for x-rays is $43.32, an almost four-fold increase in cost. Conclusion: We find that the Medicaid expansion led to between 2.7% to 4.0% increase in number of procedures per visit in the ED. This increase translates into 1,057,169 extra procedures performed in the four expanding states studied here in 2014, adding an estimated cost of $248 million to health expenditures in these states, of which $95.8 million was paid by Medicaid, a cost not captured by current policy projections.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121579921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Lifetime Medical Spending of Retirees","authors":"J. Jones, Mariacristina De Nardi, Eric French, Rory McGee, Justin Kirschner","doi":"10.3386/W24599","DOIUrl":"https://doi.org/10.3386/W24599","url":null,"abstract":"Retirees face considerable medical expenses during their remaining lives. Model simulations suggest that although a large amount of that spending can be predicted ? based on attributes such as income, health, and marital status ? there remains significant dispersion. Households with heads who turned seventy in 1992 will incur $122,000 in medical spending on average, including out-of-pocket expenditures and Medicaid payments. But the top 5 percent of households will incur more than $300,000 in such spending. The level and dispersion of this spending diminish only slowly with age.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127774772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Economics of Scale-Up","authors":"Jonathan M. V. Davis, Jonathan Guryan, K. Hallberg, Jens Ludwig","doi":"10.3386/w23925","DOIUrl":"https://doi.org/10.3386/w23925","url":null,"abstract":"Most randomized controlled trials (RCT) of social programs test interventions at modest scale. While the hope is that promising programs will be scaled up, we have few successful examples of this scale-up process in practice. Ideally we would like to know which programs will work at large scale before we invest the resources to take them to scale. But it would seem that the only way to tell whether a program works at scale is to test it at scale. Our goal in this paper is to propose a way out of this Catch-22. We first develop a simple model that helps clarify the type of scale-up challenge for which our method is most relevant. Most social programs rely on labor as a key input (teachers, nurses, social workers, etc.). We know people vary greatly in their skill at these jobs. So social programs, like firms, confront a search problem in the labor market that can lead to inelastically-supplied human capital. The result is that as programs scale, either average costs must increase if program quality is to be held constant, or else program quality will decline if average costs are held fixed. Our proposed method for reducing the costs of estimating program impacts at large scale combines the fact that hiring inherently involves ranking inputs with the most powerful element of the social science toolkit: randomization. We show that it is possible to operate a program at modest scale n but learn about the input supply curves facing the firm at much larger scale (S × n) by randomly sampling the inputs the provider would have hired if they operated at scale (S × n). We build a simple two-period model of social-program decision making and use a model of Bayesian learning to develop heuristics for when scale-up experiments of the sort we propose are likely to be particularly valuable. We also present a series of results to illustrate the method, including one application to a real-world tutoring program that highlights an interesting observation: The noisier the program provider’s prediction of input quality, the less pronounced is the scale-up problem.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132626800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}