Health Care Delivery & Financing eJournal最新文献

{"title":"The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of the ACA","authors":"M. Dickstein, M. Duggan, Joe Orsini, Pietro Tebaldi","doi":"10.3386/W20907","DOIUrl":"https://doi.org/10.3386/W20907","url":null,"abstract":"Under the Affordable Care Act, individual states have discretion in how they define coverage regions, within which insurers must charge the same premium to buyers of the same age, family structure, and smoking status. We exploit variation in these definitions to investigate whether the size of the coverage region affects outcomes in the ACA marketplaces. We find large consequences for small and rural markets. When states combine small counties with neighboring urban areas into a single region, the included rural markets see .6 to .8 more active insurers, on average, and savings in annual premiums of between $200 and $300.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127509658","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":"Challenges Facing Current and Future Residents of Continuing Care Communities","authors":"Katherine C. Pearson","doi":"10.2139/SSRN.2365015","DOIUrl":"https://doi.org/10.2139/SSRN.2365015","url":null,"abstract":"The financial crisis that hit the headlines in 2008 exposed a weakness in the sector of the senior living industry known as Continuing Care Retirement Communities (CCRCs). CCRCs were frequently using entrance fees to fund daily operating expenses, while relying on turnover of properties and quick resales to generate additional fees needed to fund the rising cost of health care in Type A & B facilities, or to honor promises of \"refundability\" of entrance fees in Type C contract facilities. In some instances, state lawmakers, regulatory authorities, resident organizations and industry leaders have responded to concerns by working together to provide better transparency and greater actuarial accountability. This keynote address to the Maryland Continuing Care Residents Association (MaCCRA) in 2013 focuses on key points of ongoing concern for current and future CCRC residents.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131556825","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 National Health Insurance Scheme in Ghana: Implementation Challenges and Proposed Solutions","authors":"Gissele Gajate-Garrido, Rebecca Owusua","doi":"10.2139/ssrn.2373242","DOIUrl":"https://doi.org/10.2139/ssrn.2373242","url":null,"abstract":"Healthcare financing through social health insurance has become a very important tool in providing access to and utilization of health services in most developing countries such as Ghana. Ghana’s National Health Insurance Scheme (NHIS) is a promising tool for policymakers. Yet since its inception in 2003, few studies have assessed the scheme. This paper aims to explore the challenges facing the District Mutual Health Insurance Schemes (DMHISs), how these challenges have been managed over the years, and what can be done to improve the DMHIS operation. The scope of this study is to improve policies and guide support for Ghanaian DMHISs as well as to provide recommendations when implementing future NHISs in a developing-country context.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"227 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131882248","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":"Explaining the Lack of Non-Public Actors in the USA Social Insurance System (Chapter 11 in Non-Public Actors in Social Security Administration: A Comparative Study)","authors":"Paul M. Secunda","doi":"10.2139/SSRN.2029367","DOIUrl":"https://doi.org/10.2139/SSRN.2029367","url":null,"abstract":"There are currently very few non-public actors playing a role in the federal and state social insurance programs in the United States. Yet, “projected long-run program costs for both Medicare and Social Security are not sustainable under currently scheduled financing, and will require legislative corrections if disruptive consequences for beneficiaries and taxpayers are to be avoided.” As financial pressure increases on these programs, as it surely will, Americans may become more willing to go the privatization route and engage more non-public actors in the provision of social insurance.In the meantime, the paradox of the American social insurance system is that while disclaiming any desire for socialist-type programs, most Americans today believe that only the government should be responsible for providing the social insurance safety net. On the one hand, this could be because U.S. citizens are seeking to hold on to what meager social safety net they have left. On the other hand, scarred from the recent global recession and underhanded actions by many private investment firms and banks, most Americans are not yet ready to place their faith in these private actors, even if more efficiency, cost-savings, and activation could be achieved by doing so.What this all means is that unlike its counterparts in Europe, the United States social insurance system does not appear to have an incipient movement in which non-public actors will start to play a larger role in any American social insurance program in the near future. At the same time, the stability of the current system means there is unlikely to be the same diminishment in solidarity that is sometimes seen with the introduction of non-public actors into these programs in other countries.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114017271","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":"Evidence Matters Summer 2013","authors":"Rachelle Levitt","doi":"10.2139/ssrn.2375282","DOIUrl":"https://doi.org/10.2139/ssrn.2375282","url":null,"abstract":"The articles in this issue of Evidence Matters explore a range of strategies designed to promote affordable housing preservation at the national, state, and local levels. The lead article, “Preserving Affordable Rental Housing: A Snapshot of Growing Need, Current Threats, and Innovative Solutions,” reviews the economic and demographic trends prompting increasing demand for affordable housing, the threats to the existing housing stock, and the programs and tactics used by governmental and nonprofit organizations to preserve affordable housing. “Research Spotlight: How Research Tools Are Assisting Communities To Preserve, Plan Affordable Housing” considers the efforts of New York University’s Furman Center and the University of Florida’s Shimberg Center to map affordable housing subsidies and availability to better target areas most in need of preservation. And “In Practice: Models for Affordable Housing Preservation” examines the role that preservation compacts and state housing trust funds play in protecting affordable housing and economic diversity.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124518141","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":"Rethinking Pharmacare in Canada","authors":"Steve Morgan, Jamie Daw, Michael R. Law","doi":"10.2139/ssrn.2303892","DOIUrl":"https://doi.org/10.2139/ssrn.2303892","url":null,"abstract":"All developed countries with universal healthcare systems provide universal coverage for prescription drugs – except Canada. Instead, Canadian provinces allocate limited public subsidies for prescriptions drugs, leaving the majority of costs to be financed out-of-pocket and through private insurance. We review three of the main approaches to provincial pharmacare policy – exemplified by British Columbia, Ontario, and Quebec – and compare them with policies in other countries. We find that Canadian models for prescription drug financing have major shortcomings. All provincial systems involve considerable patient charges and multiple payers that are not responsible for financing patients’ medical and hospital care. The costs borne by patients are known to reduce the use of medicines that might otherwise improve patient health and reduce costs elsewhere in the healthcare system. And the involvement of multiple payers adds administrative costs, diminishes purchasing power and creates funding silos that limit the potential for healthcare managers and providers to consider the full benefits and opportunity costs of prescription drugs as an input into the broader healthcare system. The performance of countries with comparable healthcare systems shows that integrating pharmaceuticals into the healthcare system by covering medically necessary prescription drugs at little or no cost to patients would result in improved performance on all key pharmacare policy goals. Countries with such coverage achieve better access to medicines, and greater financial protection for the ill, at significantly lower total cost than any Canadian province achieves. In this Commentary, we suggest that provinces expand public pharmacare programs to all segments of the population with a specific focus on promoting access to medicines of proven value-for-money in our healthcare system. Though the immediate effect of this would be an increase in government spending, this would, over time, be more than offset by savings to patients, employers and individuals who purchase stand-alone private drug coverage.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134432496","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":"Labor Supply Response to Income Cutoffs of Health Insurance in the Massachusetts Reform","authors":"Julie Shi","doi":"10.2139/ssrn.2244677","DOIUrl":"https://doi.org/10.2139/ssrn.2244677","url":null,"abstract":"This paper analyzes the labor supply response to income cutoffs of a subsidized health insurance program in the Massachusetts reform. Subsidies in the program are based on household income and have explicit income cutoffs. This feature creates non- linear budget constraints for the households’ consumption, and potentially distorts their income and labor supply. I test the existence of income manipulation using the regression discontinuity approach. Using data from the American Community Survey, I find clear evidence of income manipulation around the cutoffs of 150% and 300% Federal Poverty Level (FPL). The 150% FPL is the first cutoff and the cutoff between plans with zero out-of-pocket premiums and non-zero out-of-pocket premiums, and the manipulation is concentrated among the self-employed. The 300% FPL is the cutoff with the largest cost difference for enrollee, and the manipulation is concentrated among the wage workers. I construct a structural model to estimate the elasticity of labor supply with respect to wage rate using the discontinuity evidence. Based on the estimation results, I calculate the welfare loss, which is measured as the change of income, due to the subsidized program.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125499190","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":"After the ACA: Freeing the Market for Health Care","authors":"J. Cochrane","doi":"10.2139/SSRN.2213027","DOIUrl":"https://doi.org/10.2139/SSRN.2213027","url":null,"abstract":"I survey the supply, demand, and market for health care and health insurance. I conclude that a much less regulated system is possible, and necessary. Cost control and technology improvement must come from disruptive competition from new suppliers, as it has in airlines, retail, internet, and other successful industries. People must direct their expenditures at the margin, and feel the benefits and costs of their decisions. Individual, portable, guaranteed renewable insurance can then emerge, addressing the pathologies of today’s insurance markets. I discuss how current law and regulations rather than fundamental market failures are the main reasons a healthy market does not emerge, and why a regulatory approach must fail. I address common objections to market-based health care and insurance.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130218496","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":"Going Formal or Informal, Who Cares? The Influence of Public Long-Term Care Insurance","authors":"P. Bakx, Claudine de Meijer, E. Schut, E. van Doorslaer","doi":"10.2139/ssrn.2211670","DOIUrl":"https://doi.org/10.2139/ssrn.2211670","url":null,"abstract":"International differences in long-term care (LTC) use are well documented, but not well understood. Using comparable data from two countries with universal public LTC insurance, the Netherlands and Germany, we examine how institutional differences relate to differences in the choice for informal and formal LTC. Although the overall LTC utilization rate is similar in both countries, use of formal care is more prevalent in the Netherlands and informal care use in Germany. Decomposition of the between-country differences in formal and informal LTC use reveals that these differences are not chiefly the result of differences in population characteristics but mainly derive from differences in the effects of these characteristics that are associated with between-country institutional differences. These findings demonstrate that system features such as eligibility rules and coverage generosity and, indirectly, social preferences can influence the choice between formal and informal care. Less comprehensive coverage also has equity implications: for the poor, access to formal LTC is more difficult in Germany than in the Netherlands.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127609030","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":"Hyde-Care for All: The Expansion of Abortion-Funding Restrictions Under Health Care Reform","authors":"Cynthia Soohoo","doi":"10.31641/CLR150217","DOIUrl":"https://doi.org/10.31641/CLR150217","url":null,"abstract":"The historic health care reform law passed in 2010 has the potential to dramatically increase the number of Americans able to access health care. Health care reform is projected to result in health care coverage for thirty million Americans who are currently un-insured. While increasing health coverage is a good thing, health care reform will also dramatically increase the impact that the government will have on the provision of health care. The law achieves broader health care coverage by increasing the number of people covered by Medicaid and creating state insurance exchanges that allow individuals to buy health insurance with premium and cost-sharing credits. The federal government will set minimum requirements for policies sold on the exchanges, and state governments will have significant power to dictate policy requirements and exclusions. This expansion of government influence over health care can be dangerous if government policies are driven by politics instead of medicine and if no legal or political constraints are imposed to protect individual rights. Nowhere is this danger more pronounced than government policies around reproductive health and abortion. Since the 1980 case Harris v. McRae, the Supreme Court has held that it is constitutional for the federal government to use its reimbursement of health care services to dissuade women who rely on government health services from having abortions. Under the federal Hyde Amendment, Congress has prohibited the use of federal Medicaid funds to pay for abortion care even where a woman requires an abortion for health reasons since 1976. Over the past thirty years, similar restrictions have been imposed on other groups that rely on the federal government for health care, including federal employees and military personnel and their dependents, Native Americans who rely on the Indian Health Services for medical care, Peace Corps volunteers, adolescents covered by the Children’s Health Insurance Program (“CHIP”), and women in prison. The Supreme Court also expanded Harris to federal funding in other contexts, upholding laws prohibiting the use of public health facilities or employees in the provision of abortion services and restrictions prohibiting recipients of federal family planning funds from providing counseling or referrals for abortion.During the 2009 debates around health care reform, anti-choice legislators sought to use health care reform to expand the reach of abortion funding restrictions even further by arguing that because some policies offered on the new state insurance exchanges would receive government subsidies, the federal “policy” prohibiting public abortion funding required that exchange policies ban abortion coverage. Rather than questioning the underlying logic of prohibiting federal health care funding for medically necessary abortions, President Obama and supporters of health care reform accepted the Hyde Amendment as the starting point for the debate. In the end, Congr","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122290120","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}