{"title":"The Teflon Idea: Market Mechanisms within Medicare","authors":"Jeremy B. Johnson, Daniel C Ehlke","doi":"10.2139/ssrn.2139760","DOIUrl":"https://doi.org/10.2139/ssrn.2139760","url":null,"abstract":"Employing Medicare as a case study, the authors present a new theory of ideational path dependence. In order to contrast ideational path-dependence with established models of policy-making, we will introduce our case study, the advocacy of, and attempted applications of, market mechanisms within the Medicare program (our article will specifically focus on HMOs, PPOs, vouchers, and HSAs). which include, among others, vouchers and the inclusion of managed care organizations. Ideational path-dependence poses various challenges to conventional understandings of institutional and policy path-dependence, the garbage can model of policy-making, multiple streams theory, and punctuated equilibrium. What connects these distinct threads is the role of ideas in policy-making.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133603734","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}
Sean R. Bleck, Barbara A. Isenhour, John A. Miller
{"title":"Preserving Wealth and Inheritance Through Medicaid Planning for Long-Term Care","authors":"Sean R. Bleck, Barbara A. Isenhour, John A. Miller","doi":"10.2139/SSRN.2126111","DOIUrl":"https://doi.org/10.2139/SSRN.2126111","url":null,"abstract":"In this article we explain the rules and planning techniques relevant to obtaining government funding for the long term health care of an elderly client. This is called Medicaid Planning. Medicaid planning poses particular challenges because it involves both a federal law template and a state law implementation system. In our article we use the law of the State of Washington to make our analysis concrete and specific, but most of the techniques and strategies that we describe are available in any state because federal law imposes the basic structure of Medicaid.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117201310","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":"Suicide and Organ Donors: Spillover Effects of Mental Health Insurance Mandates","authors":"Jose M. Fernandez, Matthew Lang","doi":"10.2139/ssrn.2115573","DOIUrl":"https://doi.org/10.2139/ssrn.2115573","url":null,"abstract":"This paper considers the effect of mental health insurance mandates on the supply of cadaveric donors. The mandate decreases the count of organ donors from suicides, specifically among females, causing the overall level of cadaveric donors to decrease by 0.69%.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114924341","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":"How You Pay Determines What You Get: Alternative Financing Options as a Determinant of Publicly Funded Health Care in Canada","authors":"Ronald Kneebone","doi":"10.11575/SPPP.V5I0.42392","DOIUrl":"https://doi.org/10.11575/SPPP.V5I0.42392","url":null,"abstract":"A Canadian returning home from a visit to a physician has no idea of the cost of providing the service just received. This is true for two reasons. One is because he or she does not receive a bill to pay. The other reason has to do the myriad of ways provincial governments fund the provision of health care. Health care is financed by a wide variety of types of taxation, by intergovernmental transfers determined by opaque and changing rules, by borrowing against future taxes and by drawing down savings. Confusion over how health care is funded creates a fiscal illusion that it is cheaper than it really is; a fiscal illusion that grows larger the less provincial governments rely on taxing individuals. In this paper it is shown that when provincial health spending is financed in ways other than taxation, it grows two to three times more quickly than it would have otherwise. From 2001-2008 alone, these distortions amounted to $6.75 billion at the national level, draining funds from other government services many of which have been shown to keep Canadians healthier and so reduce their demand for health care. Simply put, when Canadians are clear about the true cost of health care they more effectively play the traditional role of consumers by guarding against waste and inefficiency and so contribute to a more efficient and effective publicly-funded health care system.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130745460","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":"Effects of Employer Health Costs on the Trend and Distribution of Social Security-Taxable Wages","authors":"Gary T. Burtless, S. Milusheva","doi":"10.2139/ssrn.2039381","DOIUrl":"https://doi.org/10.2139/ssrn.2039381","url":null,"abstract":"The increasing cost of employer contributions for employee health insurance reduces the percentage of compensation that is subject to the payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages. Workers bear most of the burden of employer health contributions through lower money wages. Any change in the average cost and distribution of costs of employer health plans can have an effect on the distribution of wages and the percentage of wages subject to the payroll tax. This paper uses the Medical Expenditure Panel Survey (MEPS) to analyze trends in the cost of employer health contributions and the cross-worker distribution of health contributions. Our analysis shows that the 1996-2008 increase in employer health premiums was faster than overall compensation increases but only slightly faster among workers below the taxable maximum compared with those above the maximum. However, because employer health insurance premiums represent a much higher percentage of compensation below the maximum taxed earnings amount, the effect of health cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum, reducing the percentage of compensation subject to the payroll tax. We simulated the implications of the health reform law on the trend in employer health costs around 2016. We find only slight effects on the fraction of worker compensation that will be subject to Social Security taxes. The higher insurance costs faced by employers who will be required to offer health plans will be approximately offset by lower health costs on the part of employers who will see some insured employees accept subsidized health insurance outside of an employer plan. The main long-term impact of reform on the taxable wage base is likely to be through its effect on the trend in underlying health care costs.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117351952","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":"Who Benefits from Removing User Fees for Health Care? Evidence from a Randomised Experiment in Ghana","authors":"T. Powell-Jackson, K. Hanson, C. Whitty, E. Ansah","doi":"10.2139/ssrn.2010476","DOIUrl":"https://doi.org/10.2139/ssrn.2010476","url":null,"abstract":"The extent to which removing user fees for health care in developing countries improves population health rests, in part, on how behavioural responses vary across individuals with different health needs. Using data from a randomised experiment of free care in Ghana and a measure of baseline health that is both objective and broad-based, we examined differential effects for initially ill and healthy children. We find that free care improved health seeking behaviour, lowered out-of-pocket spending and reduced anaemia amongst children who were ill at baseline but had no effect on initially healthy children. Whilst there was no health effect on the intervention population taken overall, the evidence suggests that removing user fees may have enabled individuals with the greatest health need to take up primary health care, thereby improving their health. There was no indication that free care encouraged frivolous use of services.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130180448","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":"Lessons for Health Care Policy in the United States: Comparing Health Care Systems","authors":"C. Aspalter","doi":"10.2139/ssrn.1960821","DOIUrl":"https://doi.org/10.2139/ssrn.1960821","url":null,"abstract":"This paper compares health care systems. It looks beyond normal academic, political, or journalistic rhetoric, by exactly sticking to facts, i.e. empirical data (in particular data provided by the WHO) and comprehensive case study analyses. The paper finds that a number of myths and common believes in health care policy are not supported by emprical evidence. Global health care policy, as well as health care policy in United States, needs to look at statistical data and profound overall assessment studies to change global health care policies. The paper reveals that there is ample room for saving costs, i.e. increase efficiency, of public health care systems in order to save lives. Good health care and more health care can be generated by 'administrative' and 'incentive' reforms (usually involving systemic and structural reforms) of health care systems. Many millions of lives can be saved if we stick to statistical empricial data and case studies, and distance ourselves from harmful ideological blindness in health care politics.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"33 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133792520","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":"Housing Recovery on the Gulf Coast: Summary Report","authors":"U.S. Department of Housing and Urban Development","doi":"10.2139/ssrn.1947362","DOIUrl":"https://doi.org/10.2139/ssrn.1947362","url":null,"abstract":"Congress frequently provides supplemental appropriations through the U.S. Department of Housing and Urban Development’s (HUD’s) Community Development Block Grant (CDBG) program to help communities recover from natural and manmade disasters. These Disaster Recovery Grants have been used to help New York City recover from the attack on the World Trade Center on September 11, 2001; to help towns in the upper Midwest recover from severe flooding in 1993, 1997, and 2008; and to help the Gulf Coast in the wake of Hurricanes Katrina and Rita in 2005. Recent research by Abt Associates Inc., under contract with HUD, examines how $19.7 billion in Disaster Recovery Grants were used in Louisiana, Mississippi, and Texas to help with recovery from those devastating hurricanes of 2005.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128247120","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":"Are Married Spouses Insured by Their Partners’ Social Insurance?","authors":"M. Olsson, Peter Skogman Thoursie","doi":"10.2139/ssrn.2111148","DOIUrl":"https://doi.org/10.2139/ssrn.2111148","url":null,"abstract":"We use a Swedish sickness insurance reform to show that among married couples a partner’s benefit level affects spousal labour supply. The spousal elasticity of sick days with respect to the partner’s benefit is estimated to be 0.4, which is about one-fourth of the own labor supply elasticity. It is argued the main part of this effect is an insurance income effect.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123101805","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 American Dream or the American Delusion? The Private and External Benefits of Homeownership for Women","authors":"G. W. Bucchianeri","doi":"10.2139/ssrn.1877163","DOIUrl":"https://doi.org/10.2139/ssrn.1877163","url":null,"abstract":"This paper uses a unique data set with housing consumption, well-being measures and time use patterns to explore the implications of homeownership. After controlling for income, housing quality and health, female homeowners are not better off than renters by a variety of measures, both global and situational. Instead, they derive significantly more pain from their house and home – comparable to the unadjusted increase from a doubling in home value. Differences in financial security, health, self-esteem, perceived control, stress level cannot account for the well-being results. One potential mechanism is time use differences: female homeowners tend to spend less time on enjoyable activities, such as active leisure.","PeriodicalId":177602,"journal":{"name":"Health Care Delivery & Financing eJournal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132503758","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}