scholarly journals Regulation of private health insurance markets: Lessons from enrollment, plan type choice, and adverse selection in Medicare Part D

2009 ◽  
Author(s):  
Florian Heiss ◽  
Daniel McFadden ◽  
Joachim Winter
Keyword(s):  
Health Insurance ◽  
Adverse Selection ◽  
Private Health Insurance ◽  
Medicare Part D ◽  
Medicare Part ◽  
Insurance Markets ◽  
Part D ◽  
Health Insurance Markets

scholarly journals Technological Change and Risk Adjustment: Benefit Design Incentives in Medicare Part D

2017 ◽  
Vol 9 (1) ◽  
pp. 38-73 ◽  
Author(s):  
Colleen Carey
Keyword(s):  
Technological Change ◽  
Risk Adjustment ◽  
Medicare Part D ◽  
Medicare Part ◽  
Insurance Markets ◽  
Generic Competition ◽  
Part D ◽  
Benefit Design ◽  
Health Insurance Markets ◽  
Drug Entry

Subsidized health insurance markets use diagnosis-based risk adjustment to induce insurers to offer an equitable benefit to individuals of varying expected cost. I demonstrate that technological change after risk adjustment calibration—new drug entry and the onset of generic competition—made certain diagnoses profitable or unprofitable in Medicare Part D. I then exploit variation in diagnoses' profitability driven by technological change to show insurers designed more favorable benefits for drugs that treat profitable diagnoses as compared to unprofitable diagnoses. In the presence of technological change, risk adjustment may not fully neutralize insurers' incentives to select through benefit designs. (JEL G22, H51, I13, I18, L65, O33)

scholarly journals Strategic Formulary Design in Medicare Part D Plans

2018 ◽  
Vol 10 (3) ◽  
pp. 154-192 ◽  
Author(s):  
Kurt Lavetti ◽  
Kosali Simon
Keyword(s):  
Health Insurance ◽  
Adverse Selection ◽  
Medical Insurance ◽  
Medicare Part D ◽  
Healthcare Spending ◽  
Insurance Market ◽  
Medicare Part ◽  
Part D ◽  
To Receive ◽  
Formulary Design

The design of Medicare Part D causes most beneficiaries to receive fragmented health insurance, with drug and medical coverage separated. Fragmentation is potentially inefficient since separate insurers optimize over only one component of healthcare spending, despite complementarities and substitutabilities between healthcare types. Fragmentation of only some plans can also lead to market distortions due to differential adverse selection, as integrated plans may use drug formularies to induce enrollment by patients that are profitable in the medical insurance market. We study the design of insurance plans in Medicare Part D and find that formularies reflect these two differences in incentives. (JEL D82, G22, H51, I13, I18, L65)

scholarly journals Psychiatrist Participation in Private Health Insurance Markets: Paucity in the Land of Plenty

2020 ◽  
Vol 71 (12) ◽  
pp. 1232-1238
Author(s):  
Nicole M. Benson ◽  
Catherine Myong ◽  
Joseph P. Newhouse ◽  
Vicki Fung ◽  
John Hsu
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Insurance Markets ◽  
Health Insurance Markets

Economics, Ethics, and Health Insurance

2019 ◽  
pp. 497-520
Author(s):  
Daniel M. Hausman
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Private Health Insurance ◽  
Drop Out ◽  
Insurance Markets ◽  
Care Provision ◽  
Insurance Policies ◽  
Health Insurance Markets ◽  
Health Care Policies ◽  
Care Allocation

Evaluating health care institutions and policies should depend on understanding the economic complexities of health care provision and on our values of compassion, choice, efficiency, fairness, and solidarity. These values may conflict, so applying them is difficult. We must also understand the problems with health care allocation, including employing markets. Regulations are needed first because of asymmetric information: doctors know more about treatments than patients and can exploit them. Second, health insurance is a better bargain for those who expect to be sick. Consequently, health insurance policies attract purchasers more likely to make claims. This adverse selection makes claims and premiums skyrocket, healthy people drop out, and private health insurance markets collapse, unless everyone is forced to buy insurance or insurers deny insurance to those with pre-existing conditions. Third is moral hazard: if insurance pays for a health problem, there is less incentive to avoid it or to economize on treating it. Health care policies must be economically sound and morally defensible.

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