Are health insurers providing fair access?

How well did payers provide “fair” access policies? Based on an recent ICER report titled “Assessment of Barriers to Fair Access“, the headline figures seem pretty good: Overall rates of concordance with ICER’s criteria were 70% for cost sharing of fairly-priced drugs, 96% for clinical eligibility criteria, 98% for step therapy, and 100% for provider…

When is full health insurance not optimal

In many markets, however, we observe that lower income individuals do not purchase the most generous forms of health insurance. For instance, despite the passage of the Affordable Care Act–which provided subsidies to lower income individuals to purchase relatively generous insurance–some individuals preferred the less generous Association Health Plans (AHPs) also known as “skinny” health…

Estimating the price elasticity of demand through value-based formulary designs

In 2010, Premera Blue Cross (Premera), a large nonprofit health plan in the Pacific Northwest implemented a value-based formulary design for its beneficiaries.   In essence, enrollees could purchase high-value treatments for low copayments and low-value treatments for higher copayments.  Can we use this change from more standard to value-base formulary designs to estimate the price elasticity…

What’s Going on in Grand Junction?

Grand Junction has been lauded as one place that offers some of the best healthcare in the nation, at the lowest cost. “Grand Junction ranks near the top in Medicare’s Composite Quality of Care index, with a score of 91. That’s 21 points higher than McAllen. But costs in Grand Junction are among the lowest in…

Effect of delayed reimbursement on utilization of medical services

A recent paper by Hai Zhong (2011) finds that health insurance that provides immediate reimbursement for health care services significantly increases the likelihood of patients seeking outpatient treatment in China compared to reimbursement beneficiaries with a delay. China isn’t the only country where insurance companies provide delayed reimbursement. In fact, in France patients pay the full cost…

Cash and Counselling

Many economists claim that insurance that gives  sick people cash to pay for their medical treatments is more efficient than insurance that provides in-kind medical services directly.  Although providing in-kind services is more likely to decrease the number of false claimants than insurance that provides cash, cash benefits allow beneficiaries to control how they spend…