In response to the growing concern over diabetes, state-mandated health insurance benefits for diabetes have become popular since the late 1990s. However, little is known about whether these mandates improve the health of people with diabetes. In this paper, I use data from the Vital Statistics Multiple Cause of Death Mortality and the Behavioral Risk Factor Surveillance System to investigate the effects of these mandates on diabetes-related mortality rates, along with underlying mechanisms behind the estimated effects. Using a difference-in-differences framework that leverages variation in the enactment of mandates both across states and over time, I find that about 3.2 fewer diabetes-related deaths per 100,000 occur annually in mandate states than in non-mandate states. The mechanism analysis suggests higher utilization of the mandated medical benefits caused these mortality improvements.
{"title":"Do Mandated Health Insurance Benefits for Diabetes Save Lives?","authors":"Jinyeong Son","doi":"10.2139/ssrn.3891703","DOIUrl":"https://doi.org/10.2139/ssrn.3891703","url":null,"abstract":"In response to the growing concern over diabetes, state-mandated health insurance benefits for diabetes have become popular since the late 1990s. However, little is known about whether these mandates improve the health of people with diabetes. In this paper, I use data from the Vital Statistics Multiple Cause of Death Mortality and the Behavioral Risk Factor Surveillance System to investigate the effects of these mandates on diabetes-related mortality rates, along with underlying mechanisms behind the estimated effects. Using a difference-in-differences framework that leverages variation in the enactment of mandates both across states and over time, I find that about 3.2 fewer diabetes-related deaths per 100,000 occur annually in mandate states than in non-mandate states. The mechanism analysis suggests higher utilization of the mandated medical benefits caused these mortality improvements.","PeriodicalId":240368,"journal":{"name":"SIRN: Health Insurance Reform (Sub-Topic)","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134300452","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}
Abstract In recent years, Chinese local governments have experimented with integrating the social health insurance system segmented between rural and urban areas to unify the administration, policy, and funds of various health insurance programs. In this study, we take advantage of the staggered implementation of the urban-rural health insurance integration across cities over time to examine the impacts of the integration on rural residents' health care utilization and health outcomes. Based on an original city-year level policy dataset and the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011, 2013, and 2015, we find that the integration significantly increases the middle-aged and older rural residents' inpatient care utilization and this positive effect is particularly salient in poor areas. Moreover, we find that the positive policy effect of integration is attributed to enhanced health insurance benefits, such as a higher reimbursement rate for inpatient care. However, the integration has limited impacts on the middle-aged and older rural residents' health outcomes. This study reveals the partial success of urban-rural health insurance integration to reduce health care inequality in China.
{"title":"Impact of Urban-Rural Health Insurance Integration on Health Care: Evidence from Rural China","authors":"Xianguo Huang, Bingxiao Wu","doi":"10.2139/ssrn.3713228","DOIUrl":"https://doi.org/10.2139/ssrn.3713228","url":null,"abstract":"Abstract In recent years, Chinese local governments have experimented with integrating the social health insurance system segmented between rural and urban areas to unify the administration, policy, and funds of various health insurance programs. In this study, we take advantage of the staggered implementation of the urban-rural health insurance integration across cities over time to examine the impacts of the integration on rural residents' health care utilization and health outcomes. Based on an original city-year level policy dataset and the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011, 2013, and 2015, we find that the integration significantly increases the middle-aged and older rural residents' inpatient care utilization and this positive effect is particularly salient in poor areas. Moreover, we find that the positive policy effect of integration is attributed to enhanced health insurance benefits, such as a higher reimbursement rate for inpatient care. However, the integration has limited impacts on the middle-aged and older rural residents' health outcomes. This study reveals the partial success of urban-rural health insurance integration to reduce health care inequality in China.","PeriodicalId":240368,"journal":{"name":"SIRN: Health Insurance Reform (Sub-Topic)","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129091014","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 response to the recent moves to reduce prescription drug expenses and eliminate manufacturer pharmaceutical rebates for Medicare and Medicaid, this research investigates the pass-through of manufacturer pharmaceutical rebates to premiums and examines the potential prescription drug cost reductions through efficiency improvement. The results indicate that eliminating all pharmaceutical rebates but using 50% of the eliminated rebates to lower prescription drug list prices, the premium per member month would increase by $8.6 for the whole comprehensive line, and $19.1 for Medicare Advantage. Using the median efficiency as the efficiency goal, the total cost reductions on hospital/medical expenses, prescription drug expenses, and other expenses are always more than enough to offset any potential premium increases due to the elimination of pharmaceutical rebates, no matter how much of the eliminated rebates are used to lower prescription drug list prices.
{"title":"Prescription Drug Insurance Plans: Potential Cost Reductions and the Pass-Through of Manufacturer Pharmaceutical Rebates to Premiums","authors":"Charles C. Yang","doi":"10.2139/ssrn.3489645","DOIUrl":"https://doi.org/10.2139/ssrn.3489645","url":null,"abstract":"In response to the recent moves to reduce prescription drug expenses and eliminate manufacturer pharmaceutical rebates for Medicare and Medicaid, this research investigates the pass-through of manufacturer pharmaceutical rebates to premiums and examines the potential prescription drug cost reductions through efficiency improvement. The results indicate that eliminating all pharmaceutical rebates but using 50% of the eliminated rebates to lower prescription drug list prices, the premium per member month would increase by $8.6 for the whole comprehensive line, and $19.1 for Medicare Advantage. Using the median efficiency as the efficiency goal, the total cost reductions on hospital/medical expenses, prescription drug expenses, and other expenses are always more than enough to offset any potential premium increases due to the elimination of pharmaceutical rebates, no matter how much of the eliminated rebates are used to lower prescription drug list prices.","PeriodicalId":240368,"journal":{"name":"SIRN: Health Insurance Reform (Sub-Topic)","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126711678","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}
Throughout the Truman administration’s Fair Deal era, ideas for a national system of publicly financed universal health care were developed, debated, and even proposed in Congress. In spite of public support for health care reform, each legislative proposal that embodied these ideas failed, and the dream of truly universal health coverage has never been resurrected. Historians who have examined the failure of the Fair Deal proposals have generally agreed that opposition from within Truman’s own party and from congressional Republicans, combined with opposition from organized medicine, contributed to the ultimate failure of the proposals. But an examination of historical accounts of the Fair Deal health proposal failures written during a period beginning shortly after Medicare and Medicaid were enacted and ending amid President George W. Bush’s calls to privatize Medicare and Social Security shows that over time, historians’ interpretations of the failures shifted in two major ways. First, historians’ answers to the question of why the proposals failed changed. Over time, the roles played by politicians opposed to the programs and by organized medicine were viewed as less central to those failures. And second, historians began to ask a broader set of questions than simply “why did the proposals fail?” Later historians in this period asked about the ways in which the “universal” programs, had they been enacted, would have neglected many marginalized groups, and about the larger impacts of the proposals’ failures.This paper begins in Part I with a brief history of the Fair Deal proposals for a public, compulsory, universal system of health care coverage. In Part II, the accounts of five historians, written over a period of 34 years, are examined, with a focus on the factors to which each attributed the proposals’ failures, and on the broader implications — if any — that each historian addressed. And in Part III, I posit that two developments during the period in which these historians worked — the ascendency of a new conservative movement and the failure of the Clinton health care plan — partially account for the changes in their interpretations of the Fair Deal health proposals.
在杜鲁门政府的“公平交易”时期，建立一个由公共资金资助的全民医疗保健国家体系的想法在国会得到了发展、辩论，甚至提出。尽管公众支持医疗改革，但每一项体现这些理念的立法提案都以失败告终，真正实现全民医疗覆盖的梦想从未复活。研究公平交易提案失败原因的历史学家普遍认为，来自杜鲁门所在政党内部和国会共和党人的反对，加上有组织的医疗机构的反对，导致了该提案的最终失败。但是，对“公平交易”医保提案失败的历史记录的研究表明，随着时间的推移，历史学家对失败的解释在两个主要方面发生了变化，这些记录始于医疗保险和医疗补助计划颁布后不久，结束于乔治·w·布什(George W. Bush)总统呼吁医疗保险和社会保障私有化期间。首先，历史学家对提案失败原因的回答发生了变化。随着时间的推移，反对这些项目的政客和有组织的医学所扮演的角色被认为在这些失败中不那么重要。其次，历史学家开始提出一系列更广泛的问题，而不仅仅是“为什么这些提议失败了?”这一时期后来的历史学家提出疑问，如果这些“全民”计划得以实施，它们会以何种方式忽视许多边缘化群体，以及提案失败的更大影响。本文从第一部分开始，简要介绍了公平交易提案的历史，该提案旨在建立一个公共的、强制性的、全民的医疗保险体系。在第二部分中，五位历史学家在34年的时间里所写的描述被检查，重点是每个人认为提案失败的因素，以及更广泛的影响-如果有的话-每个历史学家都提到了。在第三部分中，我假设在这些历史学家工作的时期有两个发展——新保守主义运动的优势和克林顿医疗保健计划的失败——部分解释了他们对公平交易医疗提案解释的变化。
{"title":"The Fair Deal Universal Health Care Proposals: Historians’ Perspectives from 1970 to 2003","authors":"George Horvath","doi":"10.2139/ssrn.3428027","DOIUrl":"https://doi.org/10.2139/ssrn.3428027","url":null,"abstract":"Throughout the Truman administration’s Fair Deal era, ideas for a national system of publicly financed universal health care were developed, debated, and even proposed in Congress. In spite of public support for health care reform, each legislative proposal that embodied these ideas failed, and the dream of truly universal health coverage has never been resurrected. Historians who have examined the failure of the Fair Deal proposals have generally agreed that opposition from within Truman’s own party and from congressional Republicans, combined with opposition from organized medicine, contributed to the ultimate failure of the proposals. But an examination of historical accounts of the Fair Deal health proposal failures written during a period beginning shortly after Medicare and Medicaid were enacted and ending amid President George W. Bush’s calls to privatize Medicare and Social Security shows that over time, historians’ interpretations of the failures shifted in two major ways. First, historians’ answers to the question of why the proposals failed changed. Over time, the roles played by politicians opposed to the programs and by organized medicine were viewed as less central to those failures. And second, historians began to ask a broader set of questions than simply “why did the proposals fail?” Later historians in this period asked about the ways in which the “universal” programs, had they been enacted, would have neglected many marginalized groups, and about the larger impacts of the proposals’ failures.This paper begins in Part I with a brief history of the Fair Deal proposals for a public, compulsory, universal system of health care coverage. In Part II, the accounts of five historians, written over a period of 34 years, are examined, with a focus on the factors to which each attributed the proposals’ failures, and on the broader implications — if any — that each historian addressed. And in Part III, I posit that two developments during the period in which these historians worked — the ascendency of a new conservative movement and the failure of the Clinton health care plan — partially account for the changes in their interpretations of the Fair Deal health proposals.","PeriodicalId":240368,"journal":{"name":"SIRN: Health Insurance Reform (Sub-Topic)","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115373644","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 February the Centers for Medicare & Medicaid Services (“CMS”) clarified an oft quoted existing rule: Providers must return overpayments to Medicare within 60 days “after the date on which the overpayment was identified,” or in the alternative, “the date any corresponding cost report is due, if applicable.” For providers of any size, failure to report and return Medicare overpayments pursuant to these temporal requirements may result in potential liability under the Federal False Claims Act, resulting in substantial monetary penalties and the risk of being denied future claims for reimbursement.The systemic problems facing the Medicare system today should not be underestimated, especially when escalating health care expenses threaten the system’s future sustainability. Institutional survival, however, is also an undeniably critical component in the delivery of health care, especially if future Medicare beneficiaries intend to access the health care services to which they are entitled under any Federal health program. Fully understanding the alternative deviates slightly from tenets of medicine and science, and perhaps is better phrased by philosopher George Berkeley: “But, say you, surely there is nothing easier than for me to imagine trees, for instance, in a park [...] and nobody by to perceive them. [...] The objects of sense exist only when they are perceived; the trees therefore are in the garden [...] no longer than while there is somebody by to perceive them.”
{"title":"60 Days to Pay – Has Medicare Reached the Point of No Return?","authors":"C. Garner","doi":"10.2139/ssrn.2056289","DOIUrl":"https://doi.org/10.2139/ssrn.2056289","url":null,"abstract":"In February the Centers for Medicare & Medicaid Services (“CMS”) clarified an oft quoted existing rule: Providers must return overpayments to Medicare within 60 days “after the date on which the overpayment was identified,” or in the alternative, “the date any corresponding cost report is due, if applicable.” For providers of any size, failure to report and return Medicare overpayments pursuant to these temporal requirements may result in potential liability under the Federal False Claims Act, resulting in substantial monetary penalties and the risk of being denied future claims for reimbursement.The systemic problems facing the Medicare system today should not be underestimated, especially when escalating health care expenses threaten the system’s future sustainability. Institutional survival, however, is also an undeniably critical component in the delivery of health care, especially if future Medicare beneficiaries intend to access the health care services to which they are entitled under any Federal health program. Fully understanding the alternative deviates slightly from tenets of medicine and science, and perhaps is better phrased by philosopher George Berkeley: “But, say you, surely there is nothing easier than for me to imagine trees, for instance, in a park [...] and nobody by to perceive them. [...] The objects of sense exist only when they are perceived; the trees therefore are in the garden [...] no longer than while there is somebody by to perceive them.”","PeriodicalId":240368,"journal":{"name":"SIRN: Health Insurance Reform (Sub-Topic)","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125043002","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 : 2010-02-08DOI: 10.1111/j.1539-6975.2009.01345.x
S. Harrington
This article provides an overview of the U.S. health care reform debate and legislation, with a focus on health insurance. Following a synopsis of the main problems that confront U.S. health care and insurance, it outlines the health care reform bills in the U.S. House and Senate as of early December 2009, including the key provisions for expanding and regulating health insurance, and projections of the proposals' costs, funding, and impact on the number of people with insurance. The article then discusses (1) the potential effects of the mandate that individuals have health insurance in conjunction with proposed premium subsidies and health insurance underwriting and rating restrictions, (2) the proposed creation of a public health insurance plan and/or nonprofit cooperatives, and (3) provisions that would modify permissible grounds for health policy rescission and repeal the limited antitrust exemption for health and medical liability insurance. It concludes by contrasting the reform bills with market-oriented proposals and with brief perspective on future developments.
{"title":"The Health Insurance Reform Debate","authors":"S. Harrington","doi":"10.1111/j.1539-6975.2009.01345.x","DOIUrl":"https://doi.org/10.1111/j.1539-6975.2009.01345.x","url":null,"abstract":"This article provides an overview of the U.S. health care reform debate and legislation, with a focus on health insurance. Following a synopsis of the main problems that confront U.S. health care and insurance, it outlines the health care reform bills in the U.S. House and Senate as of early December 2009, including the key provisions for expanding and regulating health insurance, and projections of the proposals' costs, funding, and impact on the number of people with insurance. The article then discusses (1) the potential effects of the mandate that individuals have health insurance in conjunction with proposed premium subsidies and health insurance underwriting and rating restrictions, (2) the proposed creation of a public health insurance plan and/or nonprofit cooperatives, and (3) provisions that would modify permissible grounds for health policy rescission and repeal the limited antitrust exemption for health and medical liability insurance. It concludes by contrasting the reform bills with market-oriented proposals and with brief perspective on future developments.","PeriodicalId":240368,"journal":{"name":"SIRN: Health Insurance Reform (Sub-Topic)","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114617667","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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