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on Insurance Economics |
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Issue of 2020‒04‒27
28 papers chosen by Soumitra K. Mallick Indian Institute of Social Welfare and Business Management |
| By: | Mary E. Harrington |
| Abstract: | The Children's Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. |
| Keywords: | Affordable Care Act, Children's Health Insurance Program, Children's Health Insurance Program Reauthorization Act, health care access, health care utilization, health insurance coverage, Medicaid |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:fbfff85984b34dc39e77ba74ab83cbbc&r=all |
| By: | Joseph S. Zickafoose; Kimberly V. Smith; Claire Dye |
| Abstract: | The outcomes of Children's Health Insurance Program (CHIP) coverage for children with special health care needs (CSHCN) have not been assessed in the last decade. |
| Keywords: | children with special health care needs, Children's Health Insurance Program, health care access, health care utilization, public health insurance |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:46df1c630b4640b3b8595f36325f165a&r=all |
| By: | Bergquist, Savannah; Costa-Font, Joan; Swartz, Katherine |
| Abstract: | Long-term care partnership (LTCP) programs were designed to both encourage middle-income individuals to purchase private long-term care insurance, and defer the time when an individual would become eligible for Medicaid to pay her long term care services and supports (LTSS). This paper exploits the timing of state Partnership implementation (including four pilot states) to evaluate the program’s effects on new yearly insurance applications and contract uptake. We draw upon data from the National Association of Insurance Commissioners (NAIC) on new long term care insurance (LTCI) purchases (traditional and Partnership) by US state (weighted by the population over age 65 to make the data comparable). We use a difference-in-differences strategy to obtain estimates of the program effect of the LTCP on the overall uptake of private LTCI, and specifically of LTCP contracts and applications for a subsample of states. Findings suggest no significant effect of LTCP on insurance uptake and an increase in insurance applications. This result points towards a substitution between traditional and partnership contracts. |
| Keywords: | long-term care (LTC) insurance; LTC partnerserhips (LTCP); subsidization; Medicaid; difference-in-difference (DD); insurance underwriting |
| JEL: | H31 I18 I38 J14 |
| Date: | 2018–11–01 |
| URL: | http://d.repec.org/n?u=RePEc:ehl:lserod:87504&r=all |
| By: | Carpenter, Christopher S. (Vanderbilt University); Gonzales, Gilbert (Vanderbilt University); McKay, Tara (Vanderbilt University); Sansone, Dario (Georgetown University) |
| Abstract: | A large body of research documents that the 2010 dependent coverage mandate of the Affordable Care Act was responsible for significantly increasing health insurance coverage among young adults. No prior research has examined whether sexual minority young adults also benefitted from the dependent coverage mandate, despite previous studies showing lower health insurance coverage among sexual minorities and the fact that their higher likelihood of strained relationships with their parents might predict a lower ability to use parental coverage. Our estimates from the American Community Surveys using difference-in-differences and event study models show that men in same-sex couples age 21-25 were significantly more likely to have any health insurance after 2010 compared to the associated change for slightly older 27 to 31-year-old men in same-sex couples. This increase is concentrated among employer-sponsored insurance, and it is robust to permutations of time periods and age groups. Effects for women in same-sex couples and men in different-sex couples are smaller than the associated effects for men in same-sex couples. These findings confirm the broad effects of expanded dependent coverage and suggest that eliminating the federal dependent mandate could reduce health insurance coverage among young adult sexual minorities in same-sex couples. |
| Keywords: | Affordable Care Act, health insurance, dependent coverage, sexual minority, LGBTQ |
| JEL: | H75 I13 I18 J10 |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp13119&r=all |
| By: | Kimberly V. Smith; Claire Dye |
| Abstract: | This study presents updated and expanded evidence on primary care outcomes for Children's Health Insurance Program (CHIP) enrollees compared to uninsured children, including access to flu vaccinations, preventive care screenings, and anticipatory guidance. |
| Keywords: | CHIP, health care access, health care utilization, primary care, public health insurance |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:deeed2beb768409fa816f5dd34a76150&r=all |
| By: | Sean M. Orzol; Lauren Hula; Mary Harrington |
| Abstract: | Some children cycled in and out of Medicaid and the Children's Health Insurance Program, experiencing gaps in public coverage in the interim. These findings suggest that public program churning remains an issue and that continued efforts to simplify the process of remaining enrolled are needed. |
| Keywords: | children, CHIP, churning, coverage transfers, Medicaid |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:2ebc8a3e652c4f07b651b2c10b5c855b&r=all |
| By: | Matthew S. Rutledge |
| Abstract: | In contrast to traditional employment, where employers provide health and retirement benefits, workers in nontraditional jobs have to seek out other options for health insurance coverage and retirement saving. How successful are they at finding alternatives? This study uses the Health and Retirement Study to examine older workers ages 50-64, who are both the largest cohort of workers in nontraditional jobs, and probably the group most in need of consistent health coverage and the ability to save for their imminent retirement. The study finds that about one-third of older workers in nontraditional jobs are uninsured, with the majority finding coverage through a spouseÕs employer or a past employer of their own. The Affordable Care Act has also helped these workers find coverage, most often through Medicaid; the study finds that workers in nontraditional employment in states that expanded Medicaid saw greater increases in coverage (especially public coverage) than similar workers in non-expansion states. While policy reform has helped increase health insurance coverage, workers in nontraditional jobs are largely left without convenient, tax-deferred retirement saving options, in part because their spouses in traditional employment do not tend to save more to compensate. These results suggest that policies such as auto-IRA plans may be especially useful to workers in nontraditional employment. |
| Date: | 2020–03 |
| URL: | http://d.repec.org/n?u=RePEc:crr:crrwps:wp2020-9&r=all |
| By: | Christopher S. Carpenter; Gilbert Gonzales Jr.; Tara McKay; Dario Sansone |
| Abstract: | A large body of research documents that the 2010 dependent coverage mandate of the Affordable Care Act was responsible for significantly increasing health insurance coverage among young adults. No prior research has examined whether sexual minority young adults also benefitted from the dependent coverage mandate, despite previous studies showing lower health insurance coverage among sexual minorities and the fact that their higher likelihood of strained relationships with their parents might predict a lower ability to use parental coverage. Our estimates from the American Community Surveys using difference-in-differences and event study models show that men in same-sex couples age 21-25 were significantly more likely to have any health insurance after 2010 compared to the associated change for slightly older 27 to 31-year-old men in same-sex couples. This increase is concentrated among employer-sponsored insurance, and it is robust to permutations of time periods and age groups. Effects for women in same-sex couples and men in different-sex couples are smaller than the associated effects for men in same-sex couples. These findings confirm the broad effects of expanded dependent coverage and suggest that eliminating the federal dependent mandate could reduce health insurance coverage among young adult sexual minorities in same-sex couples. |
| JEL: | I1 |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26978&r=all |
| By: | Werbeck, Anna (RWI); Wübker, Ansgar (RWI); Ziebarth, Nicolas R. (Cornell University) |
| Abstract: | Using a randomized field experiment, we show that health care specialists cream-skim patients by their expected profitability. In the German two-tier system, outpatient reimbursement rates for both public and private insurance are centrally determined but are more than twice as high for the privately insured. In our field experiment, following a standardized protocol, the same hypothetical patient called 991 private practices in 36 German counties to schedule appointments for allergy tests, hearing tests and gastroscopies. Practices were 7% more likely to offer an appointment to the privately insured. Conditional on being offered an appointment, wait times for the publicly insured were twice as long than for the privately insured. Our findings show that structural differences in reimbursement rates lead to structural differences in health care access. |
| Keywords: | health care inequality, reimbursement rates, health care access, discrimination, cherry picking, gastroscopy, audiometry, allergy test, allergists, otorhinolaryngologist, gastroenterologist |
| JEL: | I14 I11 I18 |
| Date: | 2020–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp13100&r=all |
| By: | Sheila D. Hoag |
| Abstract: | Express Lane Eligibility (ELE) lets states enroll children in Medicaid or the Children's Health Insurance Program or lets them renew children's coverage using findings from other public programs. |
| Keywords: | CHIP, Express Lane Eligibility (ELE), Medicaid, spmplification |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:c0f1cf18d20844c9bd3db13316d7f923&r=all |
| By: | Stefan Borsky (University of Graz, Austria); Hannah B. Hennighausen (University of Graz, Austria) |
| Abstract: | This paper investigates the influence of public risk mitigating activities on individuals' decisions to privately mitigate their disaster risks. We exploit heterogeneity in measures under the Community Rating System in the U.S. to empirically demonstrate that government investment in flood risk communication activities crowd-in private flood insurance demand while activities that lower the flood hazard residents face crowd-out private flood insurance demand. We also give evidence that flood insurance abides by the law of demand: as communities receive price discounts on their insurance policies, demand increases. Our results imply that governments can amplify the price effect by investing in additional risk communication activities, or dilute it by investing in hazard mitigation. This paper contributes to the discussion of the efficacy of disaster risk mitigation strategies and who ultimately bears the costs of natural disasters. |
| Keywords: | Community Rating System (CRS), flood insurance, behavioral response, risk perception, risk mitigation |
| JEL: | D12 D83 Q54 |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:grz:wpaper:2020-09&r=all |
| By: | Christopher Trenholm; Mary Harrington; Claire Dye |
| Abstract: | This study combined 10-state household survey and administrative data to provide an unprecedented analysis of families' Children's Health Insurance Program (CHIP) enrollment, retention, and disenrollment experiences. |
| Keywords: | children, CHIP, enrollment, insurance, retention |
| URL: | http://d.repec.org/n?u=RePEc:mpr:mprres:5e319e81f03b4823a7899e2ba2fc8efd&r=all |
| By: | Zoe Xie |
| Abstract: | The COVID-19 pandemic led to an unprecedented expansion in unemployment insurance (UI) eligibility across states. While more than forty states had modified UI rules by the end of March, not all states responded in the same way. In this article, I summarize the changes to state UI rules in response to the crisis and explore factors that have contributed to the variation in states’ responses. |
| Keywords: | Fiscal policy; COVID-19; Unemployment insurance |
| JEL: | H72 J65 |
| Date: | 2020–04–14 |
| URL: | http://d.repec.org/n?u=RePEc:fip:a00001:87789&r=all |
| By: | Simplice A. Asongu (Yaounde, Cameroon); Nicholas M. Odhiambo (Pretoria, South Africa) |
| Abstract: | This study assesses how enhancing information and communication technology (ICT) affects life insurance and non-life insurance in a panel of forty-eight African countries with data for the period 2004-2014. The adopted ICT dynamics are: mobile phone penetration, internet penetration and fixed broadband subscriptions. The empirical evidence is based on Generalized Method of Moments. The results show that enhancing mobile phone penetration and fixed broadband subscriptions has a positive net effect on life insurance consumption while enhancing fixed broadband subscriptions also has a positive net impact of on non-life insurance penetration. |
| Keywords: | Insurance; Information technology |
| JEL: | I28 I30 L96 O16 O55 |
| Date: | 2019–01 |
| URL: | http://d.repec.org/n?u=RePEc:abh:wpaper:19/100&r=all |
| By: | Montserrat Guillen (Dept. Econometrics, Riskcenter-IREA, Universitat de Barcelona, Av. Diagonal, 690, 08034 Barcelona, Spain); Ana M. Pérez-Marín (Dept. Econometrics, Riskcenter-IREA, Universitat de Barcelona, Av. Diagonal, 690, 08034 Barcelona, Spain); Manuela Alcañiz (Dept. Econometrics, Riskcenter-IREA, Universitat de Barcelona, Av. Diagonal, 690, 08034 Barcelona, Spain) |
| Abstract: | Reference charts are widely used as a graphical tool for assessing and monitoring children’s growth given gender and age. Here, we propose a similar approach to the assessment of driving risk. Based on telematics data, and using quantile regression models, our methodology estimates the percentiles of the distance driven at speeds above the legal limit depending on drivers’ characteristics and the journeys made. We refer to the resulting graphs as risk reference charts for speeding and illustrate their use for a sample of drivers with Pay-How-You-Drive insurance policies. We find that percentiles of distance driven at excessive speeds depend mainly on total distance driven, the percentage of driving in urban areas and the driver’s gender. However, the impact on the estimated percentile for these covariates is not constant. We conclude that the heterogeneity in the risk of driving long distances above the speed limit can be easily represented using reference charts and that, conversely, individual drivers can be scored by calculating an estimated percentile for their specific case. The dynamics of this risk score can be assessed by recording drivers as they accumulate driving experience and cover more kilometres. Our methodology should be useful for accident prevention and, in the context of Manage-How-You-Drive insurance, reference charts can provide real-time alerts and enhance recommendations for ensuring safety. |
| Keywords: | Motor insurance, Speed, Telematics, Quantile regression, Reference curves, Risk score JEL classification: C21, G22 |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:ira:wpaper:202003&r=all |
| By: | Daniel Aaronson; Scott A. Brave; R. Andrew Butters; Daniel W. Sacks; Boyoung Seo |
| Abstract: | We leverage an event-study research design focused on the seven costliest hurricanes to hit the US mainland since 2004 to identify the elasticity of unemployment insurance filings with respect to search intensity. Applying our elasticity estimate to the state-level Google Trends indexes for the topic “unemployment,” we show that out-of-sample forecasts made ahead of the official data releases for March 21 and 28 predicted to a large degree the extent of the Covid-19 related surge in the demand for unemployment insurance. In addition, we provide a robust assessment of the uncertainty surrounding these estimates and demonstrate their use within a broader forecasting framework for US economic activity. |
| Keywords: | Covid-19; Google trends; hurricanes; unemployment; unemployment insurance |
| JEL: | C53 H12 J65 |
| Date: | 2020–04–07 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedhwp:87770&r=all |
| By: | Abe Dunn; Joshua D. Gottlieb; Adam Hale Shapiro; Pietro Tebaldi |
| Abstract: | What does it cost healthcare providers to collect payment in the complex U.S. health insurance system? We study this question using rich data on repeated interactions between a large sample of physicians and many different payers, and investigate the consequences when these costs are high. Payment uncertainty is high and variable, with 19% of Medicaid visits not reimbursed after the first claim submission. In such cases, physicians either forgo substantial revenue or incur costs to collect payment. Using physician movers and practices that span state boundaries, we find that providers respond to these costs by refusing to accept Medicaid patients in states with more severe billing hurdles. This supply margin is even more responsive to these costs than to reimbursement rates. Using these supply estimates, we calculate that the costs of billing Medicaid consume one-quarter of the average revenue from a Medicaid visit. We estimate a model of the billing process, and find that the variable costs of billing each visit account for 21 percentage points of this total cost. Analyzing healthcare prices without accounting for billing costs and payment uncertainty may substantially misrepresent differences between private payers and Medicaid. |
| Keywords: | healthcare markets; Medicaid; healthcare insurance; healthcare providers; healthcare pricing |
| Date: | 2020–04–13 |
| URL: | http://d.repec.org/n?u=RePEc:fip:fedfwp:87803&r=all |
| By: | Klein, Tobias J. (Tilburg University); Salm, Martin (Tilburg University); Upadhyay, Suraj (Tilburg University) |
| Abstract: | We develop a new approach to quantify how patients respond to dynamic incentives in health insurance contracts with a deductible. Our approach exploits two sources of variation in a differences-in-regression-discontinuities design: deductible contracts reset at the beginning of the year, and cost-sharing limits change over the years. Using rich claims-level data from a large Dutch health insurer we find that individuals are forward-looking. Changing dynamic incentives by increasing the deductible by €100 leads to a reduction in healthcare spending of around 3% on the first days of the year and 6% at the annual level. The response to dynamic incentives is an important part of the overall effect of cost-sharing schemes on healthcare expenditures—much more so than what the previous literature has suggested. |
| Keywords: | health insurance, patient cost-sharing, dynamic incentives |
| JEL: | I13 H51 |
| Date: | 2020–03 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp13108&r=all |
| By: | Maclean, J. Catherine (Temple University); Pichler, Stefan (ETH Zurich); Ziebarth, Nicolas R. (Cornell University) |
| Abstract: | This paper evaluates the labor market effects of sick pay mandates in the United States. Using the National Compensation Survey and difference-in-differences models, we estimate their impact on coverage rates, sick leave use, labor costs, and non-mandated fringe benefits. Sick pay mandates increase coverage significantly by 13 percentage points from a baseline level of 66%. Newly covered employees take two additional sick days per year. We find little evidence that mandating sick pay crowds-out other non-mandated fringe benefits. We then develop a model of optimal sick pay provision along with a welfare analysis. For a range of plausible parameter values, mandating sick pay increases welfare. |
| Keywords: | sick pay mandates, sick leave, medical leave, employer mandates, fringe benefits, moral hazard, unintended consequences, labor costs, National Compensation Survey (NCS), welfare effects, optimal social insurance, Baily-Chetty |
| JEL: | I12 I13 I18 J22 J28 J32 |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp13132&r=all |
| By: | Marika Cabral; Marcus Dillender |
| Abstract: | Optimal insurance benefit design requires understanding how coverage generosity impacts individual behavior and insured costs. Using unique comprehensive administrative data from Texas, we leverage a sharp increase in the maximum weekly wage replacement benefit in a difference-in-differences research design to identify the impact of workers' compensation wage replacement benefit generosity on individual behavior and program costs. We find that increasing the generosity of wage replacement benefits does not impact the number of claims but has a large impact on claimant behavior, leading to longer income benefit durations and increased medical spending. Our estimates indicate that behavioral responses to increased benefit generosity raised insured costs nearly 1.5 times as much as the mechanical effect on insured costs from the benefit increase. Drawing on these estimates along with an estimate of the consumption drop experienced by injured workers, we calibrate a model to estimate the marginal welfare impact of increasing the generosity of workers' compensation wage replacement benefits. This calibration suggests that increasing benefit generosity would not improve welfare, with much of the projected welfare loss attributable to the impact of income benefit generosity on medical spending. |
| JEL: | H00 I1 J01 |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:nbr:nberwo:26976&r=all |
| By: | Johnston, Andrew C. (University of California, Merced) |
| Abstract: | To finance unemployment insurance, states raise payroll tax rates on employers who engage in layoffs. Tax rates are, therefore, highest for firms after downturns, potentially hampering labor-market recovery. Using full-population, administrative records from Florida, I estimate the effect of these tax increases on firm behavior leveraging a regression kink design in the tax schedule. Tax hikes reduce hiring and employment substantially, with no effect on layoffs or wages. The results imply unanticipated costs of the financing regime which reduce the optimal benefit by a quarter and account for twelve percent of the unemployment in the wake of the Great Recession. |
| Keywords: | unemployment insurance, payroll taxes, recession |
| JEL: | D22 H22 H25 H71 J23 J32 J38 J65 |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:iza:izadps:dp13117&r=all |
| By: | Lehdonvirta, Vili; Lee, Sumin |
| Abstract: | Crowdfunding is becoming a popular way of financing healthcare. Some commentators suggest that crowdfunding could serve as a new institution that fills gaps in conventional safety nets. Others suggest that crowdfunding is simply another way of obtaining help from family, friends, and local associations, and has little transformative potential. We provide one of the first quantitative analyses of medical crowdfunding, and the first to model the broader societal context in which campaigns are situated. We scraped data on US medical campaigns from the leading platform, and combined them with county-level socioeconomic data to model predictors of campaign frequency and success. Our findings suggest that many seek help from crowdfunding when both formal and informal conventional safety nets fail them. Significantly more campaigns are initiated in US counties with poorer private insurance coverage, lower social security provision, fewer social associations, and weaker cultures of giving. However, campaigns are least likely to reach their goals where most needed. Campaigns are more likely to be successful in counties that are wealthier and healthier, and have more social associations. Crowdfunding is not merely ‘friendfunding’: fundraisers can increase their chances of success by having their appeals widely shared on social media. However, the returns to sharing are greater for campaigns initiated in wealthier areas. Overall, our findings suggest that medical crowdfunding is an entrepreneurial safety net: one where protection is not afforded universally or on the basis of need, but on the basis of one’s ability to appeal to the audience and out- compete rivaling needfuls. |
| Date: | 2020–03–24 |
| URL: | http://d.repec.org/n?u=RePEc:osf:osfxxx:9kecq&r=all |
| By: | Lisa B Kahn; Samuele Fabian Lange; David Wiczer |
| Abstract: | We use job vacancy data collected in real time by Burning Glass Technologies, as well as initial unemployment insurance (UI) claims data to study the impact of COVID-19 on the labor market. Our data allow us to track postings at disaggregated geography and by detailed occupation and industry. We find that job vacancies collapsed in the second half of March and are now 30\% lower than their level at the beginning of the year. To a first approximation, this collapse was broad based, hitting all U.S. states, regardless of the intensity of the initial virus spread or timing of stay-at-home policies. UI claims also largely match these patterns. Nearly all industries and occupations saw contraction in postings and spikes in UI claims, regardless of whether they are deemed essential and whether they have work-from-home capability. The only major exceptions are in essential retail and nursing, the "front line" jobs most in-demand during the current crisis. |
| Date: | 2020 |
| URL: | http://d.repec.org/n?u=RePEc:nys:sunysb:20-05&r=all |
| By: | Ryoji Hasegawa (Fukuyama City University); Masaya Yasuoka (Kwansei Gakuin University) |
| Abstract: | Long-term care insurance plays an important role in Japan, where dual problems of an aging population and low birthrate have continued. Such insurance affects the macro-economy through many mechanisms, with both negative and positive influences. Although increased taxes and insurance premiums from long-term care decrease consumption, decreasing precautionary saving eventually increases consumption because of decreased risks of long-term care and mitigation of self-payment for people receiving long-term care services. Furthermore, effects on household consumption by the aging population and low birthrate are expected to differ among regional economies. This study, particularly addressing insurance effects on household consumption and the regional economy, develops a theoretical model for household consumption and assesses numerical examples of macroeconomic effects using parameters that are consistent with data for Japan. Furthermore, using a multi-regional input?output (MRIO) table at the prefectural level in Japan, we examine long-term care insurance effects on household consumption and economic ripple effects occurring regionally and nationally. The results reveal differences in insurance effects by region and by household generation. Gross Domestic Product (GDP), representing total economic activity, rises. Gross Regional Product (GRP) can also be pulled up. However, because of a difference in the degrees of increase in GRP in the respective regions, GRP inequality can be magnified. Specifically considering these results, we assess relations between regional economic disparities and improvements in long-term care insurance. |
| Keywords: | Elderly care subsidy, Household consumption, Multi-regional Input?Output (MRIO) table, Precautionary saving |
| JEL: | R15 E21 |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:kgu:wpaper:209&r=all |
| By: | Michael Mounié (LEASP - Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps - UT3 - Université Toulouse III - Paul Sabatier - Université Fédérale Toulouse Midi-Pyrénées - INSERM - Institut National de la Santé et de la Recherche Médicale); Nadège Costa (LEASP - Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps - UT3 - Université Toulouse III - Paul Sabatier - Université Fédérale Toulouse Midi-Pyrénées - INSERM - Institut National de la Santé et de la Recherche Médicale); Cécile Conte (UT3 - Université Toulouse III - Paul Sabatier - Université Fédérale Toulouse Midi-Pyrénées); Dominique Petiot (CHU Toulouse [Toulouse]); Didier Fabre (CHU Toulouse [Toulouse]); Fabien Despas (Service d'hématologie - IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole - UT3 - Université Toulouse III - Paul Sabatier - Université Fédérale Toulouse Midi-Pyrénées - CHU Toulouse [Toulouse] - INSERM - Institut National de la Santé et de la Recherche Médicale); Maryse Lapeyre-Mestre (LEASP - Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps - UT3 - Université Toulouse III - Paul Sabatier - Université Fédérale Toulouse Midi-Pyrénées - INSERM - Institut National de la Santé et de la Recherche Médicale); Guy Laurent (IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole - UT3 - Université Toulouse III - Paul Sabatier - Université Fédérale Toulouse Midi-Pyrénées - CHU Toulouse [Toulouse] - INSERM - Institut National de la Santé et de la Recherche Médicale); Nicolas Savy (IMT - Institut de Mathématiques de Toulouse UMR5219 - INSA Toulouse - Institut National des Sciences Appliquées - Toulouse - INSA - Institut National des Sciences Appliquées - UT1 - Université Toulouse 1 Capitole - UT2J - Université Toulouse - Jean Jaurès - UT3 - Université Toulouse III - Paul Sabatier - Université Fédérale Toulouse Midi-Pyrénées - CNRS - Centre National de la Recherche Scientifique); Laurent Molinier (LEASP - Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps - UT3 - Université Toulouse III - Paul Sabatier - Université Fédérale Toulouse Midi-Pyrénées - INSERM - Institut National de la Santé et de la Recherche Médicale) |
| Abstract: | Background: Lymphomas are costly diseases that suffer from a lack of detailed economic information, notably in a real-world setting. Decision-makers are increasing the search for Real-World Evidence (RWE) to assess the impact, in real-life, of healthcare management and to support their public decisions. Thus, we aimed to assess the real-world net costs of the active treatment phases of adult Hodgkin Lymphoma (HL), Follicular Lymphoma (FL) and Diffuse Large B Cell Lymphoma (DLBCL). Methods: We performed a retrospective cohort study using population-based data from a national representative sample of the French population covered by the health insurance system. Cost analysis was performed from the French health insurance perspective and took into account direct and sick leave compensation costs (e2,018). Healthcare costs were studied over the active treatment phase. We used multivariate modeling to adjust cost differences between lymphoma subtypes. Results: Analyses were performed on 224 lymphoma patients and 896 controls. The mean additional monthly costs due to HL, FL and DLBCL patients were respectively e5,188, e3,242 and e7,659 for the active treatment phase. The main additional cost driver was principally inpatient stay (hospitalization costs and costly cancer-related drugs), followed by outpatient medication and productivity loss. When adjusted, DLBCL remains significantly the most costly lymphoma subtype. Conclusion: This study provides an accurate assessment of the main lymphoma subtypes related cost with high magnitude of details in a real-world setting. We underline where potential cost saving could be realized via the use of biosimilar medication, and where lymphoma management could be improved with the early management of adverse events. |
| Keywords: | administrative claims databases,real-world evidence,French health insurance,Lymphoma,cost evaluation |
| Date: | 2020 |
| URL: | http://d.repec.org/n?u=RePEc:hal:journl:hal-02533775&r=all |
| By: | Bernadette Dia Kamgnia (University of Yaoundé II Cameroon) |
| URL: | http://d.repec.org/n?u=RePEc:aer:wpaper:179&r=all |
| By: | Sultana, Abida; Sharma, Rachit; Hossain, Md Mahbub; Bhattacharya, Sudip; Purohit, Neetu |
| Abstract: | Burnout is a major occupational problem among healthcare providers. During coronavirus disease (COVID-19) pandemic, the frontline health workforce is experiencing a high workload and multiple psychosocial stressors, which may affect their mental and emotional health, leading to burnout symptoms. Moreover, sleep deprivation and a critical lack of psychosocial support may aggravate such symptoms amidst COVID-19. Global evidence informs the need for adopting multipronged evidence-based approaches addressing burnout during this pandemic. Such interventions may include increasing the awareness of work-related stress and burnout, promoting mindfulness and self-care practices for promoting mental wellbeing, ensuring optimal mental health services, using digital technologies to address workplace stress and deliver mental health interventions, and improving organizational policies and practices emphasizing on addressing burnout among healthcare providers. As COVID-19 may impose unique workplace stress in addition to preexisting psychosocial burden among individuals, it is essential to prevent burnout through effective measures ensuring the mental and emotional wellbeing of healthcare providers globally. |
| Date: | 2020–04–14 |
| URL: | http://d.repec.org/n?u=RePEc:osf:socarx:4hxga&r=all |
| By: | Julia Coronado (Macropolicy Perspectives); Simon Potter (Peterson Institute for International Economics) |
| Abstract: | In the second part of their Policy Brief, Coronado and Potter discuss how the system of digital payment providers (DPPs) proposed in their first Policy Brief on this topic adds a new weapon to the monetary toolkit that could be implemented in a timely, effective, and inclusive manner. They describe how a digital currency backed by the Federal Reserve could augment automatic fiscal stabilizers and—more importantly—harness the power of “helicopter†money or quantitative easing directly to consumers in a disciplined manner. To implement QE directly to consumers, Coronado and Potter propose the creation of recession insurance bonds (RIBs)—zero-coupon bonds authorized by Congress and calibrated as a percentage of GDP sufficient to provide meaningful support in a downturn. Congress would create these contingent securities; Treasury would credit households’ digital accounts with them. The Fed could purchase them from households in a downturn after its policy rate hits zero. The Fed’s balance sheet would grow by the value of RIBs purchased; the initial matching liability would be deposits into the DPP system. The mechanism is easy for consumers to understand and could boost inflation expectations more than a debt-financed fiscal stimulus could. |
| Date: | 2020–04 |
| URL: | http://d.repec.org/n?u=RePEc:iie:pbrief:pb20-5&r=all |