Implicit Tax: Medicare as a Secondary Payer

“Medicare adopted its [Medicare as a Secondary Payer] MSP policy in 1982, effective January 1, 1983. This legislation states that for individuals working at firms with 20 or more employees, and otherwise eligible for Medicare benefits, Medicare serves as a secondary payer for health care expenses. The employer’s health insurance is the first payer. Because…

Medicaid Market and Pediatric Patient Safety

How do market forces affect the safety of children in hospitals? A paper by Smith, et al. (HSR 2007) looks at data from Florida, New York and Wisconsin and they see if Medicaid market concentration affects quality of care for children aged 0-17.  It is important to examine Medicaid’s affect on patient safety since about…

Schwarzenegger’s Health Reform Proposal

What exactly is Governor Arnold Schwarzenegger proposing in his health care initiative unveiled early this year? Below I briefly summarize his press release, as to what the reforms will entail and then follow with some of my comments. Individual Mandate All individuals must have a minimum level of insurance. Children Children of families whose income…

Nursing Home Residents, Hospice Care and Hospitalizations

A recent paper in the Health Services Research journal (“Hospice…“) looks at whether hospice care reduces hospitalizations for elderly terminally ill patients in nursing homes. In the introduction, authors Pedro Gozalo and Susan Miller state that there are two main implications which result from end-of-life hospitalizations: “At the patient level, hospitalizations of frail NH [nursing…

Patient Cost-Sharing, Hospitalization Offsets, and the Design of Optimal Health Insurance for the Elderly

The RAND health insurance experiment (HIE) demonstrated that increasing coinsurance rates decreases medical care utilization. The HIE also found that health outcomes did not vary between individuals with high, low and zero coinsurance rates. A working paper by Chandra, Gruber and McKnight (“Patient Cost Sharing…“) re-examines whether or not this is the case using a…

Government Expenditures and Health Outcomes

Do increases in government spending affect health outcomes? While this seems like a simple question, proving whether or not spending impacts outcomes is difficult. There are questions of reverse causality: the governments of countries or regions with more serious health problems ceteris paribus may decide to increase their allocation of health spending; thus one may…

Reauthorizing SCHIP

Politicians are faced with a serious dilemma in the near future: reauthorize the State Children’s Health Insurance Program (SCHIP) and spend billions of dollars on a single-payer government health program or fail to renew the program and leave many children uninsured and many constituents angry. The Kaiser Family Foundation reports (“Several Lawmakers…“) that the SCHIP…

Crowd Out

In recent years, the federal government has attempted to increase access to government provided health insurance. Between 1984 and 2004, the percentage of non-elderly individual with government provided health insurance rose from 13.5% to 17.5%. Over the same time period, however, the percentage of American without health insurance also rose from 13.7% to 17.8%. In…