Care Without Coverage

Care Without Coverage

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2002-06-20

Total Pages: 213

ISBN-13: 0309083435

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Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.


Information Frictions and Adverse Selection

Information Frictions and Adverse Selection

Author: Benjamin R. Handel

Publisher:

Published: 2015

Total Pages: 78

ISBN-13:

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A large literature has analyzed pricing inefficiencies in health insurance markets due to adverse selection, typically assuming informed, active consumers on the demand side of the market. However, recent evidence suggests that many consumers have information frictions that lead to suboptimal health plan choices. As a result, policies such as information provision, plan recommendations, and smart defaults to improve consumer choices are being implemented in many applied contexts. In this paper we develop a general framework to study insurance market equilibrium and evaluate policy interventions in the presence of choice frictions. Friction-reducing policies can increase welfare by facilitating better matches between consumers and plans, but can decrease welfare by increasing the correlation between willingness-to-pay and costs, exacerbating adverse selection. We identify relationships between the underlying distributions of consumer (i) costs (ii) surplus from risk protection and (iii) choice frictions that determine whether friction-reducing policies will be on net welfare increasing or reducing. We extend the analysis to study how policies to improve consumer choices interact with the supply-side policy of risk-adjustment transfers and show that the effectiveness of the latter policy can have important implications for the effectiveness of the former. We implement the model empirically using proprietary data on insurance choices, utilization, and consumer information from a large firm. We leverage structural estimates from prior work with these data and highlight how the model's micro-foundations can be estimated in practice. In our specific setting, we find that friction-reducing policies exacerbate adverse selection, essentially leading to the market fully unraveling, and reduce welfare. Risk-adjustment transfers are complementary, substantially mitigating the negative impact of friction-reducing policies, but having little effect in their absence.


Health-Care Utilization as a Proxy in Disability Determination

Health-Care Utilization as a Proxy in Disability Determination

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2018-04-02

Total Pages: 161

ISBN-13: 030946921X

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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.


How Adverse Selection Affects the Health Insurance Market

How Adverse Selection Affects the Health Insurance Market

Author: Paolo Belli

Publisher: World Bank Publications

Published: 2001

Total Pages: 38

ISBN-13:

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There may be a price to pay (in terms of inefficient coverage) if competition among health insurers is encouraged as a way to give patients greater choice and to achieve better control over insurance providers.


Choice Matters

Choice Matters

Author: Gordon Moore

Publisher: Oxford University Press

Published: 2018-06-19

Total Pages: 265

ISBN-13: 0190886153

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The direct-to-consumer business model has transformed how people seek out goods and services from music to mortgages. So what happens now that the revolution has come for healthcare? While consumers have begun to insist on healthcare that is as convenient and personalized as nearly every other good or service they purchase, most healthcare provider organizations, physicians, and insurance companies remain woefully unprepared to meet this demand. Choice Matters is the healthcare sector's guide to understanding and delivering the brand of consumer-centered care that is an imperative for the Zocdoc age. Drawing on the authors' diverse backgrounds in medicine, business, and public policy, this practically-oriented resource offers an on-the-ground introduction for clinicians and managers to better understand: · The differences between healthcare and other consumer-driven markets · What factors are most important for consumers in seeking care providers · How consumers make decisions about healthcare · The system-wide effects of increased consumer choice in healthcare · The important distinction between patients and consumers By celebrating the possibilities inherent to consumer-centered healthcare, Choice Matters offers a refreshing, empirically informed take on how healthcare in the United States can flourish, not wither, in the new economy.


Choice, Price Competition and Complexity in Markets for Health Insurance

Choice, Price Competition and Complexity in Markets for Health Insurance

Author: Richard G. Frank

Publisher:

Published: 2013

Total Pages: 44

ISBN-13:

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The United States and other nations rely on consumer choice and price competition among competing health plans to allocate resources in the health sector. A great deal of research has examined the efficiency consequences of adverse selection in health insurance markets, less attention has been devoted to other aspects of consumer choice. The nation of Switzerland offers a unique opportunity to study price competition in health insurance markets. Switzerland regulates health insurance markets with the aim of minimizing adverse selection and encouraging strong price competition. We examine consumer responses to price differences in local markets and the degree of price variation in local markets. Using both survey data and observations on local markets we obtain evidence suggesting that as the number of choices offered to individuals grow their willingness to switch plans given a set of price dispersion differences declines allowing large price differences for relatively homogeneous products to persist. We consider explanations for this phenomenon from economics and psychology.


Moral Hazard in Health Insurance

Moral Hazard in Health Insurance

Author: Amy Finkelstein

Publisher: Columbia University Press

Published: 2014-12-02

Total Pages: 161

ISBN-13: 0231538685

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Addressing the challenge of covering heath care expenses—while minimizing economic risks. Moral hazard—the tendency to change behavior when the cost of that behavior will be borne by others—is a particularly tricky question when considering health care. Kenneth J. Arrow’s seminal 1963 paper on this topic (included in this volume) was one of the first to explore the implication of moral hazard for health care, and Amy Finkelstein—recognized as one of the world’s foremost experts on the topic—here examines this issue in the context of contemporary American health care policy. Drawing on research from both the original RAND Health Insurance Experiment and her own research, including a 2008 Health Insurance Experiment in Oregon, Finkelstein presents compelling evidence that health insurance does indeed affect medical spending and encourages policy solutions that acknowledge and account for this. The volume also features commentaries and insights from other renowned economists, including an introduction by Joseph P. Newhouse that provides context for the discussion, a commentary from Jonathan Gruber that considers provider-side moral hazard, and reflections from Joseph E. Stiglitz and Kenneth J. Arrow. “Reads like a fireside chat among a group of distinguished, articulate health economists.” —Choice


Frontiers in Health Policy Research

Frontiers in Health Policy Research

Author: David M. Cutler

Publisher: MIT Press

Published: 2004

Total Pages: 196

ISBN-13: 9780262532662

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Leading economists discuss current health policy challenges, including prescription drugs benefits as a component of Medicare and conversion to for-profit health plans.