Forum for Health Economics and Policy最新文献_第9页

Measuring the Financial Exposure from Medical Care Spending Among Families with Employer Sponsored Insurance 衡量雇主赞助保险家庭医疗保健支出的财务风险

Forum for Health Economics and Policy Pub Date : 2013-01-01 DOI: 10.1515/fhep-2012-0012

J. Abraham, A. Royalty, T. DeLeire

{"title":"Measuring the Financial Exposure from Medical Care Spending Among Families with Employer Sponsored Insurance","authors":"J. Abraham, A. Royalty, T. DeLeire","doi":"10.1515/fhep-2012-0012","DOIUrl":"https://doi.org/10.1515/fhep-2012-0012","url":null,"abstract":"Abstract We develop an empirical method to assess the degree of financial exposure associated with medical care spending among non-elderly US families with employer-sponsored insurance. A key feature of this method is its simplicity – it only requires data on out-of-pocket (OOP) health care spending and total health care spending and does not require detailed knowledge of health insurance benefit design. We apply our method to assess whether families with a chronically ill member face more financial exposure given their level of total spending relative to families with no chronically ill members. We find that the insured chronically ill face more financial exposure than the insured non-chronically ill. Additional analyses suggest that the reason for this additional financial exposure is not that families with a chronically ill member are in different, less generous plans, on average. Rather, families with a chronically ill member have higher spending on certain types of medical services (e.g., pharmaceuticals) that face higher levels of coinsurance. Given recent work on value-based insurance design and coinsurance as an obstacle to medication adherence, our findings suggest that the current design of health plans could jeopardize both the health and the financial well-being of the chronically ill.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"198 1","pages":"193 - 217"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88136753","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

Price Shopping in Consumer-Directed Health Plans 消费者导向健康计划中的价格购物

Forum for Health Economics and Policy Pub Date : 2013-01-01 DOI: 10.1515/fhep-2012-0028

N. Sood, Z. Wagner, P. Huckfeldt, A. Haviland

{"title":"Price Shopping in Consumer-Directed Health Plans","authors":"N. Sood, Z. Wagner, P. Huckfeldt, A. Haviland","doi":"10.1515/fhep-2012-0028","DOIUrl":"https://doi.org/10.1515/fhep-2012-0028","url":null,"abstract":"Abstract We use health insurance claims data from 63 large employers to estimate the extent of price shopping for nine common outpatient services in consumer-directed health plans (CDHPs) compared to traditional health plans. The main measures of price shopping include (1) the total price paid on the claim, (2) the share of claims from low- and high-cost providers, and (3) the savings from price shopping relative to choosing prices randomly. All analyses control for individual and zip code level demographics and plan characteristics. We also estimate differences in price shopping within CDHPs depending on expected health care costs and whether the service was bought before or after reaching the deductible. For eight out of nine services analyzed, prices paid by CDHP and traditional plan enrollees did not differ significantly; CDHP enrollees paid 2.3% less for office visits. Similarly, office visits was the only service where CDHP enrollment resulted in a significantly larger share of claims from low-cost providers and greater savings from price shopping relative to traditional plans. There was also no evidence that, within CDHP plans, consumers with lower expected medical expenses exhibited more price shopping or that consumers exhibited more price shopping before reaching the deductible.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"16 1","pages":"35 - 53"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75398606","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: 11

Should Global Health be Tailored Toward the Rich? Altruism and Efficient R&D for Neglected Diseases 全球健康应该为富人量身定制吗?被忽视疾病的利他主义与高效研发

Forum for Health Economics and Policy Pub Date : 2013-01-01 DOI: 10.1515/fhep-2012-0036

A. Jena, Stéphane Mechoulan, T. Philipson

引用次数: 0

Quantifying the Value of Personalized Medicines: Evidence from COX-2 Inhibitors 量化个体化药物的价值:来自COX-2抑制剂的证据

Forum for Health Economics and Policy Pub Date : 2013-01-01 DOI: 10.1515/fhep-2013-0005

N. Sood, T. Philipson, P. Huckfeldt

引用次数: 5

The Effect of Comprehensive Smoking Bans in European Workplaces 欧洲工作场所全面禁烟的效果

Forum for Health Economics and Policy Pub Date : 2013-01-01 DOI: 10.1515/fhep-2012-0030

Federica Origo, Claudio Lucifora

引用次数: 1

Integrating Patient Incentives with Episode-Based Payment. 将患者激励措施与分段付费相结合。

Forum for Health Economics and Policy Pub Date : 2013-01-01 Epub Date: 2013-04-15 DOI: 10.1515/fhep-2012-0002

Lorens A Helmchen, William E Encinosa, Michael E Chernew, Richard A Hirth

{"title":"Integrating Patient Incentives with Episode-Based Payment.","authors":"Lorens A Helmchen, William E Encinosa, Michael E Chernew, Richard A Hirth","doi":"10.1515/fhep-2012-0002","DOIUrl":"10.1515/fhep-2012-0002","url":null,"abstract":"<p><p>To rein in cost, payers are exploring bundled payment, which aggregates fees for a range of services into a single prospective payment. While under bundled payment providers would have incentives to reduce cost, they might also withhold more expensive care that patients prefer. We explore how bundled payment could be aligned with a benefit design that would encourage patients' consideration of cost without jeopardizing access to the most expensive treatments. Least-costly-alternative approaches allow patient choice but might deter patients from choosing more expensive care by exposing them to potentially large out-of-pocket payments. A novel \"shared-savings supplement\" would reward patients for choosing the least costly alternative with a supplemental cash disbursement and thus allow them to share in any cost savings. This cash incentive for the least-costly-alternative allows a reduction of the out-of-pocket payment for the expensive alternative. Thus, patients would still have the option of the more expensive therapy while facing only a modest out-of-pocket cost. Such benefit modifications could be aligned with bundled payment by splitting the responsibility for the incremental cost of more expensive care between patients and their providers.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"16 1","pages":"123-136"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481942/pdf/nihms-1019059.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37190571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Why are Testing Rates so Low in Sub-Saharan Africa? Misconceptions and Strategic Behaviors 为什么撒哈拉以南非洲的检测率如此之低?误解和战略行为

Forum for Health Economics and Policy Pub Date : 2013-01-01 DOI: 10.1515/fhep-2012-0033

O. Sterck

{"title":"Why are Testing Rates so Low in Sub-Saharan Africa? Misconceptions and Strategic Behaviors","authors":"O. Sterck","doi":"10.1515/fhep-2012-0033","DOIUrl":"https://doi.org/10.1515/fhep-2012-0033","url":null,"abstract":"Abstract Voluntary testing and counseling (VTC) is a popular method for fighting the HIV/AIDS epidemic. The purpose of VTC is to reduce the incidence of the virus in a two-fold manner. First, testing provides access to health care and antiretroviral therapies that diminish the transmission rate of the virus. Second, counseling encourages safer behavior for not only individuals who test HIV-negative and wish to avoid HIV/AIDS infection but also altruistic individuals who test HIV-positive and wish to protect their partners from becoming infected by HIV. Surprisingly, DHS surveys that were conducted in sub-Saharan Africa provide empirical evidence that testing services are underutilized. Moreover, it is rare for both partners in a couple to be tested for HIV. This paper proposes a theoretical model that indicates how misperceptions about the HIV/AIDS virus may explain these puzzles. More specifically, this study demonstrates that individuals who are at risk of HIV infection may act strategically to avoid the cost of testing if they overestimate the risk of HIV transmission or believe that health care is not required if HIV is asymptomatic. The correction of false beliefs and the promotion of self-testing are expected to increase HIV testing rates.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"1 1","pages":"219 - 257"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89723204","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: 6

Formal and Informal Care: An Empirical Bayesian Analysis Using the Two-part Model 正式与非正式关怀:基于两部分模型的实证贝叶斯分析

Forum for Health Economics and Policy Pub Date : 2012-11-19 DOI: 10.1515/1558-9544.1253

Juan Du

{"title":"Formal and Informal Care: An Empirical Bayesian Analysis Using the Two-part Model","authors":"Juan Du","doi":"10.1515/1558-9544.1253","DOIUrl":"https://doi.org/10.1515/1558-9544.1253","url":null,"abstract":"Abstract Informal care provided to the elderly by their children is proposed as a less expensive alternative to institutional long-term care. This paper explores how the elderly's consumption of medical care changes in response to changes in the informal care they receive from their children. Many earlier studies have ignored both the endogeneity of informal care and the complicated nature of health care utilization data. This paper develops a two-part model with informal care treated as an endogenous regressor and imposes exclusion restrictions on the selection process. The model is fitted using the Bayesian Markov Chain Monte Carlo (MCMC) methods, in particular the Gibbs sampler and the Metropolis-Hasting algorithm. The average treatment effects and the distributions of the treatment effects are obtained via posterior simulation. The results indicate that informal care provides a substitute for nursing home care and hospital inpatient care, but it does not affect paid home health care on average. The treatment effects are heterogeneous. The largest substitution effects occur for nursing home and hospital inpatient care at the intensive margin. The policy analysis suggests that informal care policies targeting the group that incurs the largest substitution effect may help to reduce government spending on Medicaid and Medicare.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76400462","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: 6

The Distributional Effects of Health Reform Limits on Flexible Spending Accounts 医疗改革对灵活支出账户限制的分配效应

Forum for Health Economics and Policy Pub Date : 2012-11-19 DOI: 10.1515/1558-9544.1310

J. Cardon, J. Moore, M. Showalter

{"title":"The Distributional Effects of Health Reform Limits on Flexible Spending Accounts","authors":"J. Cardon, J. Moore, M. Showalter","doi":"10.1515/1558-9544.1310","DOIUrl":"https://doi.org/10.1515/1558-9544.1310","url":null,"abstract":"Abstract Flexible spending accounts (FSAs) are a widely used arrangement that allow employees to pay for qualified out-of-pocket health expenses with pre-tax dollars. The tax preference given to FSAs has been controversial and recent health care law (Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act) limits the tax exclusion to an inflation-adjusted value of $2,500 (2013 $s). The limit is estimated to increase federal payroll and income tax receipts by $13 billion between 2013 and 2019. But the welfare implications of this change are unclear.This paper uses a unique panel dataset to explore the demographic profile of households likely to be affected by the tax increase. We use a sample of 19,322 households observed over the period 1998–2008. The data include FSA expenditures, insurance claim information for covered medical and dental expenditures, and household demographic information. We explore patterns of FSA usage by income and health status.We find that households likely to be affected by the tax increase disproportionately tend to be households experiencing one or more chronic health conditions. The existence of chronic illness is associated with relatively high and persistent medical expenses and also with relatively older and wealthier households. We estimate an average tax increase of $101 in 2013 for 13.9 million households with an FSA.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74771661","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: 3

The Value of Patent Expiration 专利到期的价值

Forum for Health Economics and Policy Pub Date : 2012-11-19 DOI: 10.1515/1558-9544.1311

M. R. McKellar, Matthew B. Frank, H. Huskamp, M. Chernew

引用次数: 2