SIRN: Individual Health Insurance (Sub-Topic)最新文献

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Group Mediclaim: A Product for Health Insurance 团体医疗保险:一种健康保险产品

SIRN: Individual Health Insurance (Sub-Topic) Pub Date : 2016-06-16 DOI: 10.2139/SSRN.2796432

Kshitiz Sharma, Thomason Rajan Kolath, M. G. Sharma

引用次数: 0

Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market 建立医疗补助、交易所和个人保险市场之间的关系

SIRN: Individual Health Insurance (Sub-Topic) Pub Date : 2012-01-09 DOI: 10.2139/SSRN.2005783

S. Rosenbaum, T. Riley

{"title":"Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market","authors":"S. Rosenbaum, T. Riley","doi":"10.2139/SSRN.2005783","DOIUrl":"https://doi.org/10.2139/SSRN.2005783","url":null,"abstract":"The alignment of Medicaid and State Health Insurance Exchange (Exchange) policy and practice is a basic tenet of the Patient Protection and Affordable Care Act (ACA). Through both legislative provisions and implementing regulations, the ACA addresses this relationship.1 At the same time, the federal framework provides states with considerable discretion to flesh out the fuller dimensions of system interaction.Even as the federal framework is still evolving, this report examines the practical and conceptual factors that underlie the federal/state relationship. It describes dimensions of collaboration that could help establish a seamless continuum of coverage for those who may move between eligibility for Medicaid or for tax subsidies in the Exchange. Proposed regulations outlining eligibility determination obligations of state Medicaid agencies and Exchanges have been issued. Still to appear are regulations defining essential health benefits, but sub-regulatory policies were issued in a special federal bulletin on December 16, 2011. These will define the scope of essential health benefits to be offered by Qualified Health Plans (QHPs)2, which in turn also will define the coverage obligations of Medicaid “benchmark” coverage for newly eligible persons.","PeriodicalId":253597,"journal":{"name":"SIRN: Individual Health Insurance (Sub-Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128960716","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}

引用次数: 1

The Changing Role of the State in the Dutch Healthcare System 国家在荷兰医疗保健系统中的角色变化

SIRN: Individual Health Insurance (Sub-Topic) Pub Date : 1900-01-01 DOI: 10.2139/ssrn.1715124

R. Götze

{"title":"The Changing Role of the State in the Dutch Healthcare System","authors":"R. Götze","doi":"10.2139/ssrn.1715124","DOIUrl":"https://doi.org/10.2139/ssrn.1715124","url":null,"abstract":"This paper deals with the changing role of the state in the Dutch healthcare system. At the eve of the first oil crisis the Netherlands had a relatively compound healthcare system combining several characteristics of the three Western healthcare system types: National Health Service, social health insurance system, and private health insurance system. Comparative case-studies on OECD countries indicate a hybridization trend from relatively pure to mixed healthcare systems during the era of 'permanent austerity'. The adequate question is therefore, how and why the role of the state has changed in the relatively mixed Dutch social health insurance system. In order to approach this research question in a systematic way, we distinguish between three dimensions of the healthcare system: regulation, financing, and service provision. In the regulation dimension we observe an increasing state influence on coverage by an incremental socialization of the private sector. This progress culminated in 2006 in the merger of sickness funds and private health insurances into a functional social health insurance under private law. Since the early 1980s the state also directly intervened in the corporatist bargaining of providers and insurers in order to contain costs and regain global competiveness. At the beginning of the new millennium tight budgets resulting in long waiting lists were no longer accepted against the background of a booming economy. Instead, the role of competition increased through new opportunities and incentives for selective contracting between insurers and providers. Therefore, we observe a shift from corporatist self-regulation towards state-regulated market competition within the institutional framework of a social health insurance system. This ongoing reform process towards a welfare market for medical goods was supported by the main political parties on the left and right in order to enhance efficiency and safeguard solidarity.","PeriodicalId":253597,"journal":{"name":"SIRN: Individual Health Insurance (Sub-Topic)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129260108","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}

引用次数: 9