scholarly journals Selective contracting by health insurers

2018 ◽  
Author(s):  
Bes
Keyword(s):  
Selective Contracting ◽  
Health Insurers

Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system

2010 ◽  
Vol 6 (2) ◽  
pp. 219-235 ◽  
Author(s):  
Lieke H. H. M. Boonen ◽  
Frederik T. Schut
Keyword(s):  
Health Care ◽  
Consumer Attitudes ◽  
Managed Competition ◽  
Credible Commitment ◽  
Selective Contracting ◽  
Provider Quality ◽  
Dutch Health ◽  
Dutch Health Care ◽  
Commitment Problem ◽  
Health Insurers

AbstractWe investigate the impact of the transition towards managed competition in the Dutch health care system on health insurers’ contracting behaviour. Specifically, we examine whether insurers have been able to take up their role as prudent buyers of care and examine consumers’ attitudes towards insurers’ new role. Health insurers’ contracting behaviour is investigated by an extensive analysis of available information on purchasing practices by health insurers and by interviews with directors of health care purchasing of the four major health insurers, accounting for 90% of the market. Consumer attitudes towards insurers’ new role are investigated by surveys among a representative sample of enrollees over the period 2005–2009. During the first four years of the reform, health insurers were very reluctant to engage in selective contracting and preferred to use ‘soft’ positive incentives to encourage preferred provider choice rather than engaging in restrictive managed care activities. Consumer attitudes towards channelling vary considerably by type of provider but generally became more negative in the first two years after the reform. Insurers’ reluctance to use selective contracting can be at least partly explained by the presence of a credible-commitment problem. Consumers do not trust that insurers with restrictive networks are committed to provide good quality care. The credible-commitment problem seems to be particularly relevant to the Netherlands, since Dutch enrollees are not used to restrictions on provider choice. Since consumers are quite sensitive to differences in provider quality, more reliable information about provider quality is required to reduce the credible-commitment problem.

Manual Explains Autism Law to Health Insurers

ASHA Leader ◽  
2011 ◽  
Vol 16 (1) ◽  
pp. 19-19
Author(s):  
Carol Polovoy
Keyword(s):  
Health Insurers

scholarly journals Optimal cost reimbursement of health insurers to reduce risk selection

2011 ◽  
Vol 20 (5) ◽  
pp. 532-552 ◽  
Author(s):  
Mathias Kifmann ◽  
Normann Lorenz
Keyword(s):  
Risk Selection ◽  
Optimal Cost ◽  
Reduce Risk ◽  
Health Insurers

How important is price variation between health insurers?

2021 ◽  
Vol 77 ◽  
pp. 102423
Author(s):  
Stuart V. Craig ◽  
Keith Marzilli Ericson ◽  
Amanda Starc
Keyword(s):  
Price Variation ◽  
Health Insurers

Genetic Privacy Laws and Patients' Fear of Discrimination by Health Insurers: The View from Genetic Counselors

2000 ◽  
Vol 28 (3) ◽  
pp. 245-257 ◽  
Author(s):  
Mark A. Hall ◽  
Stephen S. Rich
Keyword(s):  
Health Insurance ◽  
Genetic Information ◽  
Federal Law ◽  
Genetic Privacy ◽  
Genetic Tests ◽  
Group Health ◽  
Privacy Laws ◽  
Similar Legislation ◽  
Do So ◽  
Health Insurers

Since 1991, over half the states have enacted laws that restrict or prohibit insurers’ use of genetic information in pricing, issuing, or structuring health insurance. Wisconsin was the first state to do so, in 1991, followed by Ohio in 1993, California and Colorado in 1994, and then several more states a year in each of the next five years. Similar legislation has been pending in Congress for several years. Also, a 1996 federal law known as the Health Insurance Portability and Accountability Act (HIPAA) prohibits group health insurers from applying “preexisting condition” exclusions to genetic conditions that are indicated solely by genetic tests and not by any actual symptoms.

scholarly journals British health insurers fail to learn lessons from the US

BMJ ◽  
1996 ◽  
Vol 312 (7044) ◽  
pp. 1482-1482
Author(s):  
A. Hopkins
Keyword(s):  
The Us ◽  
British Health ◽  
Health Insurers

FACTORS INFLUENCING HEALTH INSURERS' DECISIONS TO COVER NEW GENETIC TECHNOLOGIES

2000 ◽  
Vol 16 (1) ◽  
pp. 178-189 ◽  
Author(s):  
Michele M. Schoonmaker ◽  
Barbara A. Bernhardt ◽  
Neil A. Holtzman
Keyword(s):  
Gene Therapy ◽  
Critical Role ◽  
Medical Costs ◽  
Outpatient Setting ◽  
Carrier Screening ◽  
Consensus Conference ◽  
Detection Rates ◽  
Factors Influencing ◽  
Genetic Technologies ◽  
Health Insurers

Objective: To examine the relative importance of factors influencing health insurers' coverage of new genetic technologies.Methods: A national survey in which the decision makers for private health insurers were asked whether they would cover cystic fibrosis (CF) carrier screening, testing for genetic susceptibility to breast cancer (BRCA test), and medical costs of a clinical trial of gene therapy for CF under a variety of conditions.Results: Respondents' coverage of the two tests and of medical costs of clinical trials was low at the time of the study (4%–15.5% of insurers.) Their coverage of CF carrier screening and BRCA testing would be increased significantly if the group tested was restricted to those at high risk, if detection rates were higher and costs lower, and if testing was endorsed by a national professional group or consensus conference. Coverage of the medical costs of a trial of CF gene therapy would be significantly more likely if the trial was restricted to children or adults with severe CF, safety and effectiveness was proven, and therapy could be administered in a regional hospital or an outpatient setting rather than in a research hospital.Conclusions: Health insurers play a critical role in the diffusion of new genetic technologies. The validity of genetic tests and the safety and effectiveness of new therapies are primary factors influencing health insurers' coverage. Lower costs and approval of professional groups are other factors associated with increased coverage.

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