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on Insurance Economics |
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Issue of 2017‒10‒22
nine papers chosen by Soumitra K. Mallick Indian Institute of Social Welfare and Business Management |
| By: | The program team is led by Mathematica Policy Research; in collaboration with the National Committee for Quality Assurance Center for Health Care Strategies. |
| Abstract: | This chart pack is a product of the Medicaid/CHIP Health Care Quality Measures Technical Assistance and Analytic Support Program, sponsored by the Centers for Medicare & Medicaid Services. |
| Keywords: | Medicaid, Adult Core Set, Health Care Quality Measures, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Affordable Care Act, Chart Pack |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:276758d5bc3e4a8d86556368fb47fd14&r=ias |
| By: | Amanda Michaud; David Wiczer |
| Abstract: | Using retrospective data, we introduce evidence that occupational exposure significantly affects disability risk. Incorporating this into a general equilibrium model, social disability insurance (SDI) affects welfare through (i) the classic, risk-sharing channel and (ii) a new channel of occupational reallocation. Both channels can increase welfare, but at the optimal SDI they are at odds. Welfare gains from additional risk-sharing are reduced by overly incentivizing workers to choose risky occupations. In a calibration, optimal SDI increases welfare by 2.3% relative to actuarially fair insurance, mostly due to risk sharing. |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:nys:sunysb:17-11&r=ias |
| By: | Sebastian Bauhoff; Lisa Fischer; Dirk Göpffarth; Amelie C. Wuppermann |
| Abstract: | Many competitive health insurance markets adjust payments to participating health plans according to their enrollees’ risk – including based on diagnostic information. We investigate responses of German health plans to the introduction of morbidity-based risk adjustment in the Statutory Health Insurance in 2009, which triggers payments based on “validated†diagnoses by providers. Using the regulator’s data from office-based physicians, we estimate a difference-in-difference analysis of the change in the share and number of validated diagnoses for ICD codes that are inside or outside the risk adjustment but are otherwise similar. We find a differential increase in the share of validated diagnoses of 2.6 and 3.6 percentage points (3-4%) between 2008 and 2013. This increase appears to originate from both a shift from not-validated toward validated diagnoses and an increase in the number of such diagnoses. Overall, our results indicate that plans were successful in influencing physicians’ coding practices in a way that could lead to higher payments. |
| Keywords: | health plan payment, risk adjustment, managed competition, diagnostic coding, German Statutory Health Insurance |
| JEL: | H51 I10 I13 I18 |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:ces:ceswps:_6507&r=ias |
| By: | The program team is led by Mathematica Policy Research; in collaboration with the National Committee for Quality Assurance Center for Health Care Strategies. |
| Abstract: | This chart pack is a product of the Medicaid/CHIP Health Care Quality Measures Technical Assistance and Analytic Support Program, sponsored by the Centers for Medicare & Medicaid Services. |
| Keywords: | Medicaid, Child Core Set, Centers for Medicare & Medicaid Services, Department of Health and Human Services, CHIP, CHIPRA, Health Care Quality Measures, Affordable Care Act, Chart Pack |
| JEL: | I |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:e971edcb219342739d36c804e6345089&r=ias |
| By: | Wasem, Jürgen; Buchner, Florian; Lux, Gerald; Schillo, Sonja |
| Abstract: | Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R2 as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implementing a model to reduce underfunding of high cost cases. |
| Date: | 2017 |
| URL: | http://d.repec.org/n?u=RePEc:zbw:vfsc17:168122&r=ias |
| By: | Caruso Bloeck, Martín (Universidad Nacional de la Plata); Galiani, Sebastian (University of Maryland); Ibarrarán, Pablo (Inter-American Development Bank) |
| Abstract: | This paper discusses theoretical and practical issues related to long-term care (LTC) services in Latin America. Demand for these services will rise as the region undergoes a swift demographic transition from its currently young population to a rapidly aging one, especially since the region's aging cohorts are more prone to experience a decline in their functional and physical abilities than elderly people elsewhere in the world. We argue that private insurance markets are ill-equipped to provide coverage to meet the need for LTC, while the amount of personal savings required to afford self-insurance is prohibitively high. We study how developed economies have dealt with the issue of LTC and pay special attention to the most salient features of their LTC programs. We then direct the discussion to Latin America, where LTC may not be an immediate priority, but governments are likely to encourage the development of LTC programs as demand for them steadily grows. In particular, policymakers are probably going to focus initially on LTC programs for the poor and the vulnerable, for whom LTC affordability is a greater problem. We therefore study how basic elements of policy design affect cost-effectiveness of LTC programs by means of a formal model. Our study shows that pro-poor programs are more cost effective when people have the option to receive cash subsidies, and the availability of in-kind and in-cash choices reduces program costs overall. We argue that our findings are natural starting points to start thinking about LTC program development in the region. |
| Keywords: | long-term care, long-term care insurance, population aging, Latin America |
| JEL: | J14 N36 |
| Date: | 2017–09 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp11035&r=ias |
| By: | Martin Boyer; Philippe De Donder; Claude Fluet; Marie-Louise Leroux; Pierre-Carl Michaud |
| Abstract: | We conduct a stated-choice experiment where respondents are asked to rate various insurance products aimed to protect against financial risks associated with long-term care needs. Using exogenous variation in prices from the survey design, and objective risks computed from a dynamic microsimulation model, these stated-choice probabilities are used to predict market equilibrium for long-term care insurance using the framework developed by Einav et al. (2010). We investigate in turn causes for the low observed take-up of long-term care insurance in Canada despite substantial residual out-of-pocket financial risk. We first find that awareness and knowledge of the product is low in the population: 44% of respondents who do not have long-term care insurance were never offered this type of insurance while overall 31% report no knowledge of the product. Although we find evidence of adverse selection, results suggest it plays a minimal role in limiting take-up. On the demand side, once respondents have been made aware of the risks, we find that demand remains low, in part because of misperceptions of risk, lack of bequest motive and home ownership which may act as a substitute. |
| JEL: | D14 I13 |
| Date: | 2017–10 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:23918&r=ias |
| By: | Laun, Lisa (IFAU - Institute for Evaluation of Labour Market and Education Policy); Palme, Mårten (Department of economics, Stockholm University) |
| Abstract: | This paper studies the background to the increase in labor force participation of older workers in Sweden since 2000. In the first part, we study how the characteristics of the elderly have changed with respect to health, education level and work environment, as well as the impact of joint decision-making within the household. In the second part, we study the importance of institutional changes, including a major reform of the old-age pension system, introduction of tax credits for older workers, changes of the mandatory retirement age and stricter eligibility criteria in the disability insurance program. We find that the rise in labor force participation has coincided with improvements in health and educational attainment across birth cohorts as well as increased screening stringency in the disability insurance program. |
| Keywords: | retirement; NDC pension plans; disability insurance |
| JEL: | I10 J26 |
| Date: | 2017–09–19 |
| URL: | http://d.repec.org/n?u=RePEc:hhs:ifauwp:2017_017&r=ias |
| By: | Lisa I. Iezzoni; Holly Matulewicz; Sarah A. Marsella; Kimberley S. Warsett; Dennis Heaphy; Karen Donelan |
| Abstract: | When assessing results of health care delivery system reforms targeting persons with disability, quality metrics must reflect the experiences and perspectives of this population. |
| Keywords: | Disability, Quality, Measurement, Survey, Medicare, Medicaid |
| JEL: | I J |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:25faf1d51c6344be8e5eba36a5353246&r=ias |