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

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.

Cost Sharing
Cost Sharing

Author: Amy Margaret Lischko

Publisher:

Published: 2008

Total Pages: 430

ISBN-13:

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Abstract: Employers have recently moved to greater cost sharing to constrain health care costs through increased consumer cost-consciousness. Little information exists regarding patient knowledge and perception of costs and how it relates to utilization. This dissertation explores the following questions: (1) Are employees aware of their cost sharing responsibilities, and does that knowledge play a role regarding decisions to seek care?(2) Does perception of cost play a role regarding decisions to seek care? (3) What is the impact of increased cost sharing on utilization of health care services? This study merged claims data with survey responses resulting in a database including actual and perceived levels of cost sharing and utilization, and information on consumers' price sensitivity. The study included increases to cost sharing for physician, emergency department, outpatient surgery, hospitalization and mental health services. Both difference-in-difference and trend models were used. Two-thirds of respondents accurately reported the percent of the premium they paid and the co-payment for a doctor's visit. About half of respondents knew the co-payment for an emergency department visit. Knowledge of premium wasn't related to family size or use of health services; however, knowledge of co-payment for a doctor's visit was better among families with two or more people. Younger, less educated, and lower-income people reported their co-payments more accurately. Respondents more knowledgeable about costs used more office visits and had fewer visits to the emergency department. In addition, accurate and over-estimation of co-payments was associated with higher self-reported reductions and delays of office visits. Finally, increases in co-payments did not deter utilization with the exception of mental health and office visits. The decrease in office visits was almost entirely explained by decreases in visits for children. These results provide evidence that people more knowledgeable about costs use care in a manner that might be characterized as "more efficient." Middle-income workers may prefer increases in co-payments over increases to monthly premiums. If employers use increased cost sharing to reduce unnecessary health care utilization, they should couple it with a strong educational campaign. Policymakers struggling with these questions are provided with guidance in this regard.

Cost Reduction and Control Best Practices
Cost Reduction and Control Best Practices

Author: Institute of Management and Administration (IOMA)

Publisher: John Wiley & Sons

Published: 2012-07-03

Total Pages: 461

ISBN-13: 1118429028

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Cost Reduction and Control Best Practices provides financial manages with no-nonsense, balanced, and practical strategies that are being targeted and used nationwide for controlling costs by thousands of companies in areas such as human resources, compensation, benefits, purchasing, outsourcing, use of consultants, taxes, and exports. These best practices are based on the trenches experience, research, proprietary databases, and consultants from the Institute of Management and Administration (IOMA) and other leading experts in their fields. * Provides best practices and techniques for controlling costs within a company * New chapters focus on outsourcing costs, downsizing, consultants' costs, and business tax costs * Provides the latest strategies companies re using to control costs

Health Economic Outcomes of a Consumer Cost-Sharing Reform
Health Economic Outcomes of a Consumer Cost-Sharing Reform

Author: Marion Aouad

Publisher:

Published: 2017

Total Pages: 106

ISBN-13:

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This thesis studies the impacts of a consumer cost-sharing reform on several health economic outcomes. It is motivated in part by a need to better understand the effects of patient-cost sharing programs, which have become increasingly popular over time. Patient cost-sharing programs have become a particular subject of discussion as both public and private agencies are interested in effective ways of curbing the growth in health care spending. The specific cost-sharing program analyzed is reference pricing, which was introduced by the California Public Employees' Retirement System (CalPERS) in 2011. Reference pricing changed health insurance benefits for CalPERS PPO members such that it was now relatively more expensive for them to use higher-cost facilities (versus lower-cost facilities) when receiving certain medical procedures in the post-reference pricing period. This thesis uses detailed medical claims data to compare health outcomes and cost savings between an unaffected control group and CalPERS members. In the first chapter, Difference-in-Difference estimators are used to analyze the change in the share of patients using lower-cost health care facilities (versus higher-cost health care facilities) and the associated cost savings from this switching. Results indicate that patients are responsive to the reference pricing program and move to lower cost facilities in response to changes in the financial generosity of health insurance coverage due to reference price implementation. Furthering the analysis, instrumental variables methods are used to estimate the local average treatment effects in order to understand the treatment effects for the subpopulation of compliers. The focus is on measuring the changes in total cost-savings and health outcomes for this group. Additionally, compliers are characterized to understand how their observable characteristics tie into observed cost-savings from their movement to lower-cost health care facilities. The second chapter estimates the quantile treatment effects of the reference pricing health insurance reform. Specifically, using the estimator of Firpo, 2007, estimations of how the quantiles of the unconditional distribution of medical spending change after the introduction of reference pricing are performed. Heterogeneous impacts along the distribution of medical spending are found for the quantile treatment effect estimates. This suggests that there is not simply a location shift in the distribution of medical spending resulting from the introduction of reference pricing. Rather, some parts of the distribution are more affected than others, particularly, the right-tail of spending. These heterogeneous impacts are also larger for certain procedures and smaller for others. In the third chapter, I study how physicians' practice patterns respond to changes in patients' financial incentives, owing to the introduction of reference pricing. Motivating this analysis, I focus on issues of physician agency and how physicians' practice locations are a conduit by which cost-savings may be achieved. The results indicate that those physicians who have flexibility in where they can perform medical services are responsive to the change in the patients' cost-sharing and subsequently respond by increasingly treating CalPERS patients in lower-cost health care facilities (versus higher-cost facilities). This is measured relative to a control group who did not experience cost-sharing changes. These findings suggest that physician practice patterns are responsive to changes in patients' financial incentives.