The Erosion Of Health Insurance: The Unintended Consequences Of Tiered Products By Health Plans

2003 ◽  
Vol 22 (Suppl1) ◽  
pp. W3-158-W3-161 ◽  
Author(s):  
Thomas M. Priselac
Keyword(s):  
Health Insurance ◽  
Unintended Consequences ◽  
Health Plans

Impact of Health Plan Deductibles and Health Insurance Marketplace Enrollment on Health Care Experiences

2018 ◽  
Vol 77 (5) ◽  
pp. 483-497
Author(s):  
Weiwei Chen ◽  
Timothy F. Page
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
The United States ◽  
Health Plans ◽  
Medical Needs ◽  
Care Access ◽  
Health Care Experiences ◽  
Monitoring Survey ◽  
Using Data ◽  
The Impact

High-deductible health plans (HDHPs) have become increasingly prevalent among employer-sponsored health plans and plans offered through the Health Insurance Marketplace in the United States. This study examined the impact of deductible levels on health care experiences in terms of care access, affordability, routine checkup, out-of-pocket cost, and satisfaction using data from the Health Reform Monitoring Survey. The study also tested whether the experiences of Marketplace enrollees differed from off-Marketplace individuals, controlling for deductible levels. Results from multivariable and propensity score weighted regression models showed that many of the outcomes were adversely affected by deductible levels and Marketplace enrollment. These results highlight the importance of efforts to help individuals choose the plan that fits both their medical needs and their budgets. The study also calls for more attention to improving provider acceptance of HDHPs and Marketplace plans as these plans become increasingly common over time.

Contending with Risk Selection in Health Insurance Markets in Germany

2006 ◽  
Vol 7 (Supplement) ◽  
pp. 75-91 ◽  
Author(s):  
Jacob Glazer ◽  
Thomas G. McGuire
Keyword(s):  
Health Insurance ◽  
Risk Adjustment ◽  
Simple Approach ◽  
Insurance Markets ◽  
Risk Selection ◽  
Health Plans ◽  
Health Insurance Markets ◽  
The U.S

Abstract In many countries, competition among health plans or sickness funds raises issues of risk selection. Funds may discourage or encourage potential enrollees from joining, and these actions may have efficiency or fairness implications. This article reviews the experience in the U.S., and comments on the evidence for risk selection in Germany. There is little evidence that risk selection causes efficiency problems in Germany, but risk selection does lead to an inequality in contribution rates. A simple approach to equalizing contribution rates that does not involve risk adjustment is presented and discussed.

The funding status of retiree health plans in the public sector

2011 ◽  
Vol 10 (2) ◽  
pp. 291-314 ◽  
Author(s):  
ROBERT L. CLARK ◽  
MELINDA SANDLER MORRILL
Keyword(s):  
Labor Market ◽  
Health Insurance ◽  
Public Sector ◽  
Private Sector ◽  
Accounting Standards ◽  
Health Plans ◽  
The Public ◽  
Government Accounting ◽  
Retirement Benefit ◽  
Unfunded Liabilities

AbstractWhile no longer common in the private sector, most public sector employers offer retiree health insurance (RHI) as a retirement benefit to their employees. While these plans are thought to be an important tool for employers to attract, retain, motivate, and ultimately retire workers, they represent a large and growing cost. This paper reviews what is currently known about RHI in the public sector, while highlighting many important unanswered questions. The analysis is informed by data produced in accordance with the 2004 Government Accounting Standards Board Rule 45 (GASB 45). We consider the extent of the unfunded liabilities states face and explore what factors may explain the variation in liabilities across states. The importance and sustainability of RHI plans in the public sector ultimately depend on how workers view and value this post-retirement benefit, yet little is known about how RHI directly impacts the public sector labor market. We conclude with a discussion of the future of RHI plans in the public sector.

scholarly journals Financial Protection in Health Insurance Schemes: A Comparative Analysis of Mediclaim Policy and CHAT Scheme in India

2012 ◽  
Vol 14 (1) ◽  
pp. 13-25 ◽  
Author(s):  
Sukumar Vellakkal
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Private Health Insurance ◽  
Household Survey ◽  
Financial Protection ◽  
Health Plans ◽  
Total Health Expenditure ◽  
Hypothetical Situation ◽  
Resource Poor ◽  
Insurance Penetration

This article analyzes the level of financial protection to low-income people during illness in ‘private health insurance’ and ‘people’s preferred health insurance’. In a hypothetical situation of being insured with both the pro-poor version of the ‘Mediclaim policy’ (private health insurance) and CHAT—‘Choosing Health Plans All-Together’—scheme (people’s preferred health insurance), this study analyzed the out-of-pocket-spending for health care incurred by persons per reported illness episodes in four select resource-poor locations in India. Three data sources were used: (a) household survey, (b) CHAT: a field-based experiment conducted in India to reveal people’s preference for health insurance benefits and (c) the specification of conditions of Mediclaim policy. The study found, first, that the Mediclaim policy covers a small proportion (8 per cent) of the total reported illness episodes but CHAT scheme covers a large proportion (90 per cent) of illness episodes and, second, that the Mediclaim policy reimburses 5 per cent of the total health expenditure but CHAT scheme reimburses 37 per cent. The study concludes that private health insurance provides lower level of financial protection compared to ‘people’s preferred health insurance’ and hence recommends that health insurance packages must be comprehensive and reflect community preference to make it attractive so that health insurance penetration can be increased.

Insurance, Consumer Choice, and the Equilibrium Price and Quality of Hospital Care

2011 ◽  
Vol 11 (2) ◽  
Author(s):  
Michael L Katz
Keyword(s):  
Health Insurance ◽  
Managed Care ◽  
Consumer Choice ◽  
Hospital Care ◽  
Equilibrium Price ◽  
Health Plans ◽  
Quality Competition ◽  
Hospital System ◽  
Hospital Markets

Abstract I analyze price and quality competition in a model that captures important institutional features of U.S. hospital markets. I first consider duopoly hospitals serving a population of patients who are covered by insurance that their employers purchase from duopoly health plans. I show that second-best quality levels can be sustained as equilibrium outcomes under both indemnity insurance and managed care even when patients are fully insured. I also demonstrate that a monopoly hospital system can yield efficient quality levels and that prices may be lower under monopoly than duopoly even when there are no technical efficiencies associated with monopoly. The latter result arises when employers and health insurance plans view the hospitals as complements even though any given consumer views them as substitutes.

scholarly journals Impact of Oxycodone HCl Extended-release Formulary Restrictions on Extended-release Opioid Market Share, Healthcare Resource Utilization and Costs in Commercial and Medicare Plans

10.36469/9800 ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. 75-88
Author(s):  
Rolin L. Wade ◽  
Chi-Chang Chen ◽  
Ajita P. De ◽  
Jaren C. Howard
Keyword(s):  
Resource Utilization ◽  
Market Share ◽  
Extended Release ◽  
Healthcare Resource ◽  
Office Visit ◽  
The United States ◽  
Healthcare Resource Utilization ◽  
Unintended Consequences ◽  
Health Plans ◽  
The Impact

Background: Previous research demonstrated that utilization management (UM) such as prior authorization (PA) or non-formulary (NF) restrictions may reduce pharmacy costs when designed and applied appropriately to certain drug classes. However, such access barriers may also have unintended consequences. Few studies systemically analyzed the impact of major UM strategies to extended-release (ER) opioids on different types of health plans. Objective: This study evaluated, from payer perspective, the impact of formulary restrictions (PA, NF, or step therapy [ST]) for branded oxycodone HCl extended release (OER) on market share, and healthcare resource utilization/costs in ER opioids patients for multiple types of health plans in the United States. Methods: This retrospective, longitudinal case-control study analyzed prescription and outpatient medical claims data (2012 to 2015) for adult ER opioid patients from US plans (commercial,/Medicare, national/regional) that instituted OER PA, NF, or ST. Patients from each restricted plan (cases) were matched to patients in an unrestricted plan (controls) on key patient characteristics. ER opioid market share and healthcare resource utilization/costs for both cases and controls were evaluated for the 6-month period before and after the formulary restriction dates. A difference-in-differences (DiD) approach was utilized to evaluate change in the total per patient per month (PPPM) healthcare utilization and costs. Results: The study comprised 1622 (national commercial PA), 2020 (regional commercial PA), 34 703 (national commercial ST), and 4372 (national Medicare NF) cases and equivalent number of controls. OER market share decreased after the formulary restrictions, with the national Medicare NF plan showing the greatest decrease (9.2%). DiD analyses indicated that PPPM office visit change in the PA and NF plans were non-significant (decreased by 0.1 and 0.2, P>0.05), but significant in the ST plan (increased by 0.1, P=0.0001). For most plans, no significant total monthly cost change was observed; PPPM costs decreased by $48.74 and $59.87 in ST and regional PA plans and increased by $37.90 in national NF plans (all P>0.05). Conclusions: This study observed that despite reducing the market share of OER, OER formulary restrictions had negligible impact on overall ER opioid utilization, and did not result in substantial pharmacy/medical cost savings.

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