The healthcare concept in India has undergone a tremendous change in recent years. People have become progressively aware about the importance of healthcare and this has led to higher expectations and an ever increased demand for a high quality of medical care and related facilities.A large number of private hospitals and clinics have come up all over the country with their increasing emphasis and endeavor on quality of health care and the utmost satisfaction of patient. Earlier there were just government and private hospitals. But now, the hospitals categorize themselves as ordinary hospitals, specialty hospitals and super specialty hospitals. There is an enormous growth especially in super specialty hospitals which has resulted in a drastic change in the healthcare sector of the country. Hence, there is manifold increase in the complexity and procedures in the successful management of a hospital in current scenario.
{"title":"Emerging Legal Issues in Hospital Management","authors":"S. Negi","doi":"10.2139/ssrn.2737290","DOIUrl":"https://doi.org/10.2139/ssrn.2737290","url":null,"abstract":"The healthcare concept in India has undergone a tremendous change in recent years. People have become progressively aware about the importance of healthcare and this has led to higher expectations and an ever increased demand for a high quality of medical care and related facilities.A large number of private hospitals and clinics have come up all over the country with their increasing emphasis and endeavor on quality of health care and the utmost satisfaction of patient. Earlier there were just government and private hospitals. But now, the hospitals categorize themselves as ordinary hospitals, specialty hospitals and super specialty hospitals. There is an enormous growth especially in super specialty hospitals which has resulted in a drastic change in the healthcare sector of the country. Hence, there is manifold increase in the complexity and procedures in the successful management of a hospital in current scenario.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130169222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of restraints in health care facilities is necessary but fraught with regulatory dangers, patient safety risks and negative optics. Proper use of restraints within regulatory guidelines can enhance patient safety and outcomes, but every use of restraints must be viewed as a risk event for the facility and the professionals involved.
{"title":"Restraints: Patient Safety and Regulatory Compliance - Extended Version","authors":"T. Ealey, E. Cameron","doi":"10.2139/SSRN.2712831","DOIUrl":"https://doi.org/10.2139/SSRN.2712831","url":null,"abstract":"The use of restraints in health care facilities is necessary but fraught with regulatory dangers, patient safety risks and negative optics. Proper use of restraints within regulatory guidelines can enhance patient safety and outcomes, but every use of restraints must be viewed as a risk event for the facility and the professionals involved.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128020768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this paper, we examine the effect of a major health care reform in Massachusetts on a broad set of financial outcomes using credit report data. We exploit variation in the impact of the reform across counties and age groups using pre-reform insurance coverage as a measure of the potential effect of the reform. We find that the reform reduced the amount of debt that was past due, improved credit scores, reduced personal bankruptcies and reduced third-party collections. Our results show that health care reform has implications that extend well beyond the health of those who gain insurance coverage.
{"title":"The Effects of the Massachusetts Health Reform on Household Financial Distress","authors":"B. Mazumder, Sarah Miller","doi":"10.2139/ssrn.2390186","DOIUrl":"https://doi.org/10.2139/ssrn.2390186","url":null,"abstract":"In this paper, we examine the effect of a major health care reform in Massachusetts on a broad set of financial outcomes using credit report data. We exploit variation in the impact of the reform across counties and age groups using pre-reform insurance coverage as a measure of the potential effect of the reform. We find that the reform reduced the amount of debt that was past due, improved credit scores, reduced personal bankruptcies and reduced third-party collections. Our results show that health care reform has implications that extend well beyond the health of those who gain insurance coverage.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126335653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2017, the Affordable Care Act’s (ACA) State Innovation Waiver (§ 1332) will enable states to waive many of the ACA’s provisions and to develop their own creative solutions to reign in healthcare spending. The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to encourage employers to sponsor benefit plans and minimize potential conflicts with existing state laws. Because of ERISA, the regulation of employee benefit plans, including health plans, falls primarily under federal jurisdiction for about 131 million people. This Note explores the ways in which ERISA presents significant roadblocks to meaningful state level healthcare reform under § 1332. State laws cannot directly refer to ERISA, nor influence the benefits, administration, or structure of an ERISA plan. Also, if a state law limits employer choices too much, it will likely violate ERISA. This Note proposes that ERISA needs to be waived, amended or repealed so that states can implement meaningful healthcare reforms under § 1332.
{"title":"The ACA's 2017 State Innovation Waiver: Is ERISA a Roadblock to Meaningful Healthcare Reform?","authors":"M. Tumber","doi":"10.2139/ssrn.2716787","DOIUrl":"https://doi.org/10.2139/ssrn.2716787","url":null,"abstract":"In 2017, the Affordable Care Act’s (ACA) State Innovation Waiver (§ 1332) will enable states to waive many of the ACA’s provisions and to develop their own creative solutions to reign in healthcare spending. The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to encourage employers to sponsor benefit plans and minimize potential conflicts with existing state laws. Because of ERISA, the regulation of employee benefit plans, including health plans, falls primarily under federal jurisdiction for about 131 million people. This Note explores the ways in which ERISA presents significant roadblocks to meaningful state level healthcare reform under § 1332. State laws cannot directly refer to ERISA, nor influence the benefits, administration, or structure of an ERISA plan. Also, if a state law limits employer choices too much, it will likely violate ERISA. This Note proposes that ERISA needs to be waived, amended or repealed so that states can implement meaningful healthcare reforms under § 1332.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131847424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper describes the principles of economics and their application to oral health and health care. After illustrating the economic determinants of oral health, the demand for oral health care is discussed with particular reference to asymmetric information between patient and provider. The reasons for the market failure in (oral) health care and its implications for efficiency and equity are explained. Moreover, it is described how economic evaluation can be used to maximize oral health gains in scenarios of scarce resources. The behavioural aspects of patients´ demand for and dental professionals´ provision of oral health services are discussed. Finally, methods for an optimized planning of the dental workforce are discussed.
{"title":"The Economics of Oral Health and Health Care","authors":"S. Birch, S. Listl","doi":"10.2139/ssrn.2611060","DOIUrl":"https://doi.org/10.2139/ssrn.2611060","url":null,"abstract":"This paper describes the principles of economics and their application to oral health and health care. After illustrating the economic determinants of oral health, the demand for oral health care is discussed with particular reference to asymmetric information between patient and provider. The reasons for the market failure in (oral) health care and its implications for efficiency and equity are explained. Moreover, it is described how economic evaluation can be used to maximize oral health gains in scenarios of scarce resources. The behavioural aspects of patients´ demand for and dental professionals´ provision of oral health services are discussed. Finally, methods for an optimized planning of the dental workforce are discussed.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132883970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-05-07DOI: 10.1093/OXFORDHB/9780199366521.013.43
Michael D. Frakes, Matthew B. Frank, K. Rozema
This article examines the economics of healthcare rationing. We begin with an overview of the various dimensions across which healthcare rationing operates, or at least has the potential to operate, in the first place. We then describe the types of economic analyses used in healthcare rationing decision-making, with particular reference to cost-benefit analysis and cost-effectiveness analysis. We also discuss healthcare rationing in practice, such as how economic analyses inform decisions regarding which services to cover, and conclude by discussing various practical and conceptual challenges that may arise with economic analyses and that span both economics and ethics.
{"title":"The Economics of Healthcare Rationing","authors":"Michael D. Frakes, Matthew B. Frank, K. Rozema","doi":"10.1093/OXFORDHB/9780199366521.013.43","DOIUrl":"https://doi.org/10.1093/OXFORDHB/9780199366521.013.43","url":null,"abstract":"This article examines the economics of healthcare rationing. We begin with an overview of the various dimensions across which healthcare rationing operates, or at least has the potential to operate, in the first place. We then describe the types of economic analyses used in healthcare rationing decision-making, with particular reference to cost-benefit analysis and cost-effectiveness analysis. We also discuss healthcare rationing in practice, such as how economic analyses inform decisions regarding which services to cover, and conclude by discussing various practical and conceptual challenges that may arise with economic analyses and that span both economics and ethics.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125639246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigates the prevalence and severity of job immobility induced by the provision of employer-sponsored health insurance – a phenomenon known as 'job-lock'. Using data from the National Longitudinal Survey of Youth from 1994 to 2010, job-lock is identified by measuring the impact of employer-sponsored health insurance on voluntary job turnover frequency. Estimates from a logistic regression with random effects indicate that job-lock reduces voluntary job turnover by 20% per year. These results that are consistent with past research and are also supported by two alternative identification strategies employed in this paper. Our results indicate a persistence of the job-lock effect, despite two major policy interventions designed to mitigate it (COBRA and HIPAA) and signal a fundamental misunderstanding of its causes. Both policies made health insurance more portable between employers, but this paper presents evidence from a quasi-natural experiment to suggest that the problem is a lack of viable alternative private sources of health insurance. In this model, we find evidence that access to health insurance through one's spouse or partner dramatically increases voluntary job turnover. This finding has significant bearing on predicted impacts of the Patient Protection and Affordable Care Act (2010) and the individual health insurance exchanges catalyzed by it; these new markets will create risk pools that may 'unlock' a job-locked individual by providing them a viable alternative to employer-sponsored health insurance.
{"title":"Is There a Link between Employer-Provided Health Insurance and Job Mobility? Evidence from Recent Micro Data","authors":"Benjamin W. Chute, Phanindra V. Wunnava","doi":"10.2139/ssrn.2598929","DOIUrl":"https://doi.org/10.2139/ssrn.2598929","url":null,"abstract":"This study investigates the prevalence and severity of job immobility induced by the provision of employer-sponsored health insurance – a phenomenon known as 'job-lock'. Using data from the National Longitudinal Survey of Youth from 1994 to 2010, job-lock is identified by measuring the impact of employer-sponsored health insurance on voluntary job turnover frequency. Estimates from a logistic regression with random effects indicate that job-lock reduces voluntary job turnover by 20% per year. These results that are consistent with past research and are also supported by two alternative identification strategies employed in this paper. Our results indicate a persistence of the job-lock effect, despite two major policy interventions designed to mitigate it (COBRA and HIPAA) and signal a fundamental misunderstanding of its causes. Both policies made health insurance more portable between employers, but this paper presents evidence from a quasi-natural experiment to suggest that the problem is a lack of viable alternative private sources of health insurance. In this model, we find evidence that access to health insurance through one's spouse or partner dramatically increases voluntary job turnover. This finding has significant bearing on predicted impacts of the Patient Protection and Affordable Care Act (2010) and the individual health insurance exchanges catalyzed by it; these new markets will create risk pools that may 'unlock' a job-locked individual by providing them a viable alternative to employer-sponsored health insurance.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127775504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The social role of science is to produce reliable knowledge within the bounds of safety for subjects and subsequent users. Regulations in human subjects protection, research misconduct and control of conflict of interest have failed to prevent widespread bias and irreproducibility in scientific findings, which weakened their protections as well as undermining production of reliable knowledge. Effects of conflicts of interest involving commercial interests have largely continued unabated despite legal attempts to control some of them. Quality control has been inadequately addressed under scientific self-regulation and research has not been done to assure that regulatory mechanisms are effective in meeting their purposes. Other fields (economics) and other countries (China) also show clear signs of institutional corruption. Better management of the current regulatory system will be insufficient. Institutional corruption provides a new lens for looking at research ethics in the biomedical sciences and suggests new regulatory approaches. Research could be treated as a product that must pass tests of verifiability. Bioethics commissions have been very useful in defining issues but require strong political follow-up to be implemented. Current legal mechanisms are in multiple ways a poor fit to ensure scientific integrity. Meta-science (the science of science) will continue to provide empirical evidence relevant to how well science is meeting its public purpose; stronger ethical norms and political will to impose them will be necessary.
{"title":"Are the Biomedical Sciences Sliding Toward Institutional Corruption? And Why Didn't We Notice It?","authors":"B. Redman","doi":"10.2139/SSRN.2585141","DOIUrl":"https://doi.org/10.2139/SSRN.2585141","url":null,"abstract":"The social role of science is to produce reliable knowledge within the bounds of safety for subjects and subsequent users. Regulations in human subjects protection, research misconduct and control of conflict of interest have failed to prevent widespread bias and irreproducibility in scientific findings, which weakened their protections as well as undermining production of reliable knowledge. Effects of conflicts of interest involving commercial interests have largely continued unabated despite legal attempts to control some of them. Quality control has been inadequately addressed under scientific self-regulation and research has not been done to assure that regulatory mechanisms are effective in meeting their purposes. Other fields (economics) and other countries (China) also show clear signs of institutional corruption. Better management of the current regulatory system will be insufficient. Institutional corruption provides a new lens for looking at research ethics in the biomedical sciences and suggests new regulatory approaches. Research could be treated as a product that must pass tests of verifiability. Bioethics commissions have been very useful in defining issues but require strong political follow-up to be implemented. Current legal mechanisms are in multiple ways a poor fit to ensure scientific integrity. Meta-science (the science of science) will continue to provide empirical evidence relevant to how well science is meeting its public purpose; stronger ethical norms and political will to impose them will be necessary.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114339513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roughly 30 percent of all Canadian healthcare is privately paid for, about the same proportion as the average for the 34 industrialized countries that are members of the Organisation for Economic Cooperation and Development (OECD). However, two things make Canada’s public-private mix unique. On the one hand, there is rather limited public coverage for items such as outpatient drugs, long-term care, and dental and vision care. But on the other hand, government pays for virtually all services delivered by physicians and acute-care hospitals. With limited government budgets for healthcare, these Canadian distinctions are linked: more spending on hospitals and doctors means there is less money for other areas of healthcare. In other countries, the public-private financing mix is typically more balanced, with government plans paying for a larger share of drugs, dental and continuing care, but with more private financing for hospital and physician services. In face of widespread calls for Canadian governments to expand public coverage for services such as drugs and homecare, policymakers must confront challenging trade-offs that rest on increasing taxes to help pay for these additional benefits. In this Commentary, we argue that a major contributing factor to Canada’s unbalanced public-private healthcare mix are the unique restrictions that many provinces impose on the private financing of hospital and physician care. Many health systems in Europe and elsewhere do not have similar restrictions and devote a much larger share of public resources to drugs and long-term care while still operating equitable and high-performing healthcare systems. Relaxing provincial regulations on physicians’ private income sources, such as opt-out prohibitions, limits on fees, and private insurance bans, could build on the strengths of our current system. Expanded patient choice and competition from healthcare providers outside medicare would create incentives for politicians and bureaucrats to manage the public system more efficiently. This Commentary also examines the Canada Health Act’s restrictions on the basic principles of our universal provincial health insurance plans. It describes the more pluralistic approaches to healthcare financing and production among other countries whose systems have been ranked well above ours in both efficiency and equity dimensions. Canada’s single-payer model for hospitals and doctors may be less expensive to administer than a pluralistic one with both public and private payment. However, a single-payer system in which doctors are expected to always use the best available medical care for every patient ultimately creates an impossible dilemma, as advancing medical technology raises the cost of doing so. Our single-payer system may have led to more equal healthcare between rich and poor than would have prevailed otherwise, but it arguably has made the social policy debate focus too much on healthcare to the detriment of other programs th
{"title":"Rethinking Canada's Unbalanced Mix of Public and Private Healthcare: Insights from Abroad","authors":"Å. Blomqvist, C. Busby","doi":"10.2139/SSRN.2572650","DOIUrl":"https://doi.org/10.2139/SSRN.2572650","url":null,"abstract":"Roughly 30 percent of all Canadian healthcare is privately paid for, about the same proportion as the average for the 34 industrialized countries that are members of the Organisation for Economic Cooperation and Development (OECD). However, two things make Canada’s public-private mix unique. On the one hand, there is rather limited public coverage for items such as outpatient drugs, long-term care, and dental and vision care. But on the other hand, government pays for virtually all services delivered by physicians and acute-care hospitals. With limited government budgets for healthcare, these Canadian distinctions are linked: more spending on hospitals and doctors means there is less money for other areas of healthcare. In other countries, the public-private financing mix is typically more balanced, with government plans paying for a larger share of drugs, dental and continuing care, but with more private financing for hospital and physician services. In face of widespread calls for Canadian governments to expand public coverage for services such as drugs and homecare, policymakers must confront challenging trade-offs that rest on increasing taxes to help pay for these additional benefits. In this Commentary, we argue that a major contributing factor to Canada’s unbalanced public-private healthcare mix are the unique restrictions that many provinces impose on the private financing of hospital and physician care. Many health systems in Europe and elsewhere do not have similar restrictions and devote a much larger share of public resources to drugs and long-term care while still operating equitable and high-performing healthcare systems. Relaxing provincial regulations on physicians’ private income sources, such as opt-out prohibitions, limits on fees, and private insurance bans, could build on the strengths of our current system. Expanded patient choice and competition from healthcare providers outside medicare would create incentives for politicians and bureaucrats to manage the public system more efficiently. This Commentary also examines the Canada Health Act’s restrictions on the basic principles of our universal provincial health insurance plans. It describes the more pluralistic approaches to healthcare financing and production among other countries whose systems have been ranked well above ours in both efficiency and equity dimensions. Canada’s single-payer model for hospitals and doctors may be less expensive to administer than a pluralistic one with both public and private payment. However, a single-payer system in which doctors are expected to always use the best available medical care for every patient ultimately creates an impossible dilemma, as advancing medical technology raises the cost of doing so. Our single-payer system may have led to more equal healthcare between rich and poor than would have prevailed otherwise, but it arguably has made the social policy debate focus too much on healthcare to the detriment of other programs th","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126810616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We examine the response of Medicare Advantage contracts to published quality ratings. We identify the effect of star ratings on premiums using a regression discontinuity design that exploits plausibly random variation around rating thresholds. We find that 3, 3.5, and 4-star contracts in 2009 significantly increased their 2010 monthly premiums by $20 or more relative to contracts just below the respective threshold values. High quality contracts also disproportionately dropped $0 premium plans or expanded their offering of positive premium plans. Welfare results suggest that the estimated premium increases reduced consumer welfare by over $250 million among the affected beneficiaries.
{"title":"Quality Ratings and Premiums in the Medicare Advantage Market","authors":"Ian Paul McCarthy, Michael E Darden","doi":"10.2139/ssrn.2549107","DOIUrl":"https://doi.org/10.2139/ssrn.2549107","url":null,"abstract":"We examine the response of Medicare Advantage contracts to published quality ratings. We identify the effect of star ratings on premiums using a regression discontinuity design that exploits plausibly random variation around rating thresholds. We find that 3, 3.5, and 4-star contracts in 2009 significantly increased their 2010 monthly premiums by $20 or more relative to contracts just below the respective threshold values. High quality contracts also disproportionately dropped $0 premium plans or expanded their offering of positive premium plans. Welfare results suggest that the estimated premium increases reduced consumer welfare by over $250 million among the affected beneficiaries.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115885189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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