Unbiased Analysis of Today's Healthcare Issues
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…
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…
Many countries allow private plans to administer health insurance benefits but with restrictions on premiums and with the potential for risk adjusted government payments based on the health of a health plan pool For instance, Belgium , Germany, Israel, the Netherlands and Switzerland all have mandatory health insurance schemes; Ireland and Australia have voluntary health…
From a recent article in NBER by Dunn et al. (2021): Observing the back-and-forth sequences of claims’ denials and resubmissions for past visits, we can estimate physicians’ costs of haggling with insurers to collect payments. Combining these costs with the revenue never collected, we estimate that physicians lose 17% of Medicaid revenue to billing problems,…
Last week I reviewed a paper the sought to understand why people don’t buy health insurance. A key finding was that there health insurance purchase was correlated with income, but not perfectly. One reason was that the cost of other goods–especially housing–affected individuals ability to purchase insurance. The paper was getting at whether health insurance…
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…
How are public and private insurance used in the real-world? The answer to this question varies across countries, however, there are generally 3 ways in which public and private health insurance systems interact. First, private insurance may substitute for public insurance. That is, people are either covered privately or publicly. This is the case in…
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…
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…
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…