A. Chandra, J. MacEwan, A. Campinha-Bacote, Z. Khan
Abstract Background: Since the start of the War on Cancer there have been enormous investments in improving oncology treatment. The return to society generated by this investment is unknown. We estimate the returns generated over the previous four decades and extrapolate future returns from current investment in cancer R&D. Methods: Using data on cancer incidence, mortality, and treatment-specific R&D expenditures from 1973 to 2010, we used regression models and two-sided significance tests to relate investment in cancer treatment R&D to cancer mortality, by tumor type. For investment, we used a measure of the knowledge stock generated by cancer treatment R&D expenditures over the previous 25 years to capture the cumulative benefits of past innovations and advances in treatment. Results: Investment of an additional $1 million in cervical, breast, colorectal, and prostate cancer between 1973 and 1990 was associated with a cumulative return of more than $5 million from cancer R&D by 2010. Through 2010, investment in cancer R&D was associated with average benefits in excess of costs in all but two cancers, ovarian and pancreatic. Regarding future returns, we estimated that each additional $1 million invested in cancer treatment research and development in 2010 will produce over $28 million in value over the following 50 years. Conclusions: The return to society from spending on cancer treatment R&D is large, but varies across tumor types.
{"title":"Returns to Society from Investment in Cancer Research and Development","authors":"A. Chandra, J. MacEwan, A. Campinha-Bacote, Z. Khan","doi":"10.1515/fhep-2014-0022","DOIUrl":"https://doi.org/10.1515/fhep-2014-0022","url":null,"abstract":"Abstract Background: Since the start of the War on Cancer there have been enormous investments in improving oncology treatment. The return to society generated by this investment is unknown. We estimate the returns generated over the previous four decades and extrapolate future returns from current investment in cancer R&D. Methods: Using data on cancer incidence, mortality, and treatment-specific R&D expenditures from 1973 to 2010, we used regression models and two-sided significance tests to relate investment in cancer treatment R&D to cancer mortality, by tumor type. For investment, we used a measure of the knowledge stock generated by cancer treatment R&D expenditures over the previous 25 years to capture the cumulative benefits of past innovations and advances in treatment. Results: Investment of an additional $1 million in cervical, breast, colorectal, and prostate cancer between 1973 and 1990 was associated with a cumulative return of more than $5 million from cancer R&D by 2010. Through 2010, investment in cancer R&D was associated with average benefits in excess of costs in all but two cancers, ovarian and pancreatic. Regarding future returns, we estimated that each additional $1 million invested in cancer treatment research and development in 2010 will produce over $28 million in value over the following 50 years. Conclusions: The return to society from spending on cancer treatment R&D is large, but varies across tumor types.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"66 1","pages":"71 - 86"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85055437","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}
M. Unruh, D. Stevenson, R. Frank, Marc Cohen, D. Grabowski
Abstract Demand-side barriers are known to be important toward explaining the limited purchase of private long-term care insurance (LTCI). In this study, we examine several factors associated with the demand for LTCI including the availability of less costly substitutes (e.g., Medicaid, family), consumer information, and risk perception. Using buyer surveys from 2000, 2005, and 2010, our results suggest that, among individuals not eliminated through medical underwriting, consumer risk perception and the presence of lower cost, imperfect substitutes are strongly associated with the limited purchase of LTCI. These factors were also predictive of the generosity of coverage purchased. If policymakers seek to stimulate demand for LTCI, new public policies might include Medicaid reform, integrating LTCI with Medicare Advantage plans, enhanced LTCI offerings through employers, and targeted informational campaigns.
{"title":"Demand-Side Factors Associated with the Purchase of Long-Term Care Insurance","authors":"M. Unruh, D. Stevenson, R. Frank, Marc Cohen, D. Grabowski","doi":"10.1515/fhep-2014-0020","DOIUrl":"https://doi.org/10.1515/fhep-2014-0020","url":null,"abstract":"Abstract Demand-side barriers are known to be important toward explaining the limited purchase of private long-term care insurance (LTCI). In this study, we examine several factors associated with the demand for LTCI including the availability of less costly substitutes (e.g., Medicaid, family), consumer information, and risk perception. Using buyer surveys from 2000, 2005, and 2010, our results suggest that, among individuals not eliminated through medical underwriting, consumer risk perception and the presence of lower cost, imperfect substitutes are strongly associated with the limited purchase of LTCI. These factors were also predictive of the generosity of coverage purchased. If policymakers seek to stimulate demand for LTCI, new public policies might include Medicaid reform, integrating LTCI with Medicare Advantage plans, enhanced LTCI offerings through employers, and targeted informational campaigns.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"239 1","pages":"23 - 43"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81572918","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 Medicare today is a better program on almost every dimension than it was just after July 30, 1965 when Lyndon Johnson signed public law 89–97. Nonetheless, short-comings, limitations, and inadequacies remain. What should be done to make Medicare a better program? What should Medicare look like in 2030? In this paper we try to answer these questions. Three perspectives are relevant: that of beneficiaries, current and future; that of policymakers and administrators, the program’s stewards; and that of society at large. We posit certain objectives and goals that we believe – and that we think a broad swath of Americans would agree – should be pursued to improve the Medicare program. Those goals include (a) affordability for Medicare beneficiaries, (b) affordability for the working population that is paying and should continue to pay for much of the current cost of the program, (c) reduction in what we regard as needless complexity, and (d) stability and continuity in several different senses. We restrict ourselves to changes that we judge to be affordable and feasible – politically, technically, and administratively – if not today, then over the next decade or two. We believe that changes in Medicare will remain incremental, as they have been for the last 50 years. We shall assume that the ACA takes root and that the exchanges, whether managed by states or by the federal government on behalf of the states, continue to operate. We shall assume that federal and state officials eventually surmount the administrative challenges they still confront. In particular, we assume that the exchanges come to serve a growing share of the American population and that they increasingly exercise the rather considerable regulatory powers over insurance offerings that the ACA grants to them. We divide Medicare reforms into four categories: payment reform, benefit reform, quality reform and management, and the role of private insurance plans (Medicare Advantage [MA]).
{"title":"The Transformation of Medicare, 2015 to 2030","authors":"H. Aaron, R. Reischauer","doi":"10.1515/fhep-2015-0043","DOIUrl":"https://doi.org/10.1515/fhep-2015-0043","url":null,"abstract":"Abstract Medicare today is a better program on almost every dimension than it was just after July 30, 1965 when Lyndon Johnson signed public law 89–97. Nonetheless, short-comings, limitations, and inadequacies remain. What should be done to make Medicare a better program? What should Medicare look like in 2030? In this paper we try to answer these questions. Three perspectives are relevant: that of beneficiaries, current and future; that of policymakers and administrators, the program’s stewards; and that of society at large. We posit certain objectives and goals that we believe – and that we think a broad swath of Americans would agree – should be pursued to improve the Medicare program. Those goals include (a) affordability for Medicare beneficiaries, (b) affordability for the working population that is paying and should continue to pay for much of the current cost of the program, (c) reduction in what we regard as needless complexity, and (d) stability and continuity in several different senses. We restrict ourselves to changes that we judge to be affordable and feasible – politically, technically, and administratively – if not today, then over the next decade or two. We believe that changes in Medicare will remain incremental, as they have been for the last 50 years. We shall assume that the ACA takes root and that the exchanges, whether managed by states or by the federal government on behalf of the states, continue to operate. We shall assume that federal and state officials eventually surmount the administrative challenges they still confront. In particular, we assume that the exchanges come to serve a growing share of the American population and that they increasingly exercise the rather considerable regulatory powers over insurance offerings that the ACA grants to them. We divide Medicare reforms into four categories: payment reform, benefit reform, quality reform and management, and the role of private insurance plans (Medicare Advantage [MA]).","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"72 1","pages":"119 - 136"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79699255","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 : 2015-12-01Epub Date: 2015-11-28DOI: 10.1515/fhep-2015-0037
Étienne Gaudette, Bryan Tysinger, Alwyn Cassil, Dana P Goldman
On Medicare's 50th anniversary, we use the Future Elderly Model (FEM) - a microsimulation model of health and economic outcomes for older Americans - to generate a snapshot of changing Medicare demographics and spending between 2010 and 2030. During this period, the baby boomers, who began turning 65 and aging into Medicare in 2011, will drive Medicare demographic changes, swelling the estimated US population aged 65 or older from 39.7 million to 67.0 million. Among the risks for Medicare sustainability, the size of the elderly population in the future likely will have the highest impact on spending but is easiest to forecast. Population health and the proportion of the future elderly with disabilities are more uncertain, though tools such as the FEM can provide reasonable forecasts to guide policymakers. Finally, medical technology breakthroughs and their effect on longevity are most uncertain and perhaps riskiest. Policymakers will need to keep these risks in mind if Medicare is to be sustained for another 50 years. Policymakers may also want to monitor the equity of Medicare financing amid signs that the program's progressivity is declining, resulting in higher-income people benefiting relatively more from Medicare than lower-income people.
{"title":"Health and Health Care of Medicare Beneficiaries in 2030.","authors":"Étienne Gaudette, Bryan Tysinger, Alwyn Cassil, Dana P Goldman","doi":"10.1515/fhep-2015-0037","DOIUrl":"https://doi.org/10.1515/fhep-2015-0037","url":null,"abstract":"<p><p>On Medicare's 50th anniversary, we use the Future Elderly Model (FEM) - a microsimulation model of health and economic outcomes for older Americans - to generate a snapshot of changing Medicare demographics and spending between 2010 and 2030. During this period, the baby boomers, who began turning 65 and aging into Medicare in 2011, will drive Medicare demographic changes, swelling the estimated US population aged 65 or older from 39.7 million to 67.0 million. Among the risks for Medicare sustainability, the size of the elderly population in the future likely will have the highest impact on spending but is easiest to forecast. Population health and the proportion of the future elderly with disabilities are more uncertain, though tools such as the FEM can provide reasonable forecasts to guide policymakers. Finally, medical technology breakthroughs and their effect on longevity are most uncertain and perhaps riskiest. Policymakers will need to keep these risks in mind if Medicare is to be sustained for another 50 years. Policymakers may also want to monitor the equity of Medicare financing amid signs that the program's progressivity is declining, resulting in higher-income people benefiting relatively more from Medicare than lower-income people.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"18 2","pages":"75-96"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2015-0037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34502546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Revamping Provider Payment in Medicare","authors":"P. Ginsburg, G. Wilensky","doi":"10.1515/fhep-2015-0044","DOIUrl":"https://doi.org/10.1515/fhep-2015-0044","url":null,"abstract":"","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"123 1","pages":"137 - 149"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85689643","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 US population over 65 has seen significant and sustained improvement in its absolute and relative well-being over the past half century. This paper offers a survey of trends in old-age poverty, income, inequality, labor market activity, educational attainment, insurance coverage, and health status. It concludes with a brief discussion of whether the favorable trends of the past half century can continue in the next few decades. Even though the absolute and relative positions of the nation’s aged have steadily improved over time, much of the improvement is traceable to public programs like Social Security and Medicare. These programs face gloomy financial prospects. If future voters and lawmakers scale back benefits to keep payroll taxes close to their current level, the nation’s elderly will need to rely on private resources to pay for a bigger fraction of their retirement needs. The statistics on saving and wealth accumulation suggest that relatively few working-age Americans plan to accomplish this by increasing the share of their current incomes they devote to saving. The future economic well-being of the elderly may therefore depend on their willingness to work longer and delay the age at which they rely on public programs and private savings to pay for their consumption.
{"title":"Trends in the Well-Being of the Aged and Their Prospects through 2030","authors":"Gary T. Burtless","doi":"10.1515/FHEP-2015-0039","DOIUrl":"https://doi.org/10.1515/FHEP-2015-0039","url":null,"abstract":"The US population over 65 has seen significant and sustained improvement in its absolute and relative well-being over the past half century. This paper offers a survey of trends in old-age poverty, income, inequality, labor market activity, educational attainment, insurance coverage, and health status. It concludes with a brief discussion of whether the favorable trends of the past half century can continue in the next few decades. Even though the absolute and relative positions of the nation’s aged have steadily improved over time, much of the improvement is traceable to public programs like Social Security and Medicare. These programs face gloomy financial prospects. If future voters and lawmakers scale back benefits to keep payroll taxes close to their current level, the nation’s elderly will need to rely on private resources to pay for a bigger fraction of their retirement needs. The statistics on saving and wealth accumulation suggest that relatively few working-age Americans plan to accomplish this by increasing the share of their current incomes they devote to saving. The future economic well-being of the elderly may therefore depend on their willingness to work longer and delay the age at which they rely on public programs and private savings to pay for their consumption.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"68 1","pages":"118 - 97"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86470715","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 About 30 percent of Medicare beneficiaries enroll in private Medicare Advantage (MA) plans but do so at a relatively high-cost. This paper explores the advantages and challenges of introducing competitive bidding among MA plans (Plan One) or among MA plans and Fee-for-Service (Plan Two or Premium Support). We conclude that competitive bidding could reduce the cost of Medicare, especially in densely populated urban areas. However, there would be serious challenges in rural areas and risk adjustment methodology would have to be substantially improved. In Plan Two, sicker beneficiaries might move to Fee-for-Service and beneficiaries might have to pay more to stay with a preferred provider or broader network. If these problems are addressed, we believe that premium support can be a meaningful improvement to the MA program.
{"title":"Could Improving Choice and Competition in Medicare Advantage be the Future of Medicare?","authors":"A. Rivlin, Willemsen Daniel","doi":"10.1515/fhep-2015-0046","DOIUrl":"https://doi.org/10.1515/fhep-2015-0046","url":null,"abstract":"Abstract About 30 percent of Medicare beneficiaries enroll in private Medicare Advantage (MA) plans but do so at a relatively high-cost. This paper explores the advantages and challenges of introducing competitive bidding among MA plans (Plan One) or among MA plans and Fee-for-Service (Plan Two or Premium Support). We conclude that competitive bidding could reduce the cost of Medicare, especially in densely populated urban areas. However, there would be serious challenges in rural areas and risk adjustment methodology would have to be substantially improved. In Plan Two, sicker beneficiaries might move to Fee-for-Service and beneficiaries might have to pay more to stay with a preferred provider or broader network. If these problems are addressed, we believe that premium support can be a meaningful improvement to the MA program.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"181 1","pages":"151 - 168"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74383235","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 Legal prohibitions on sex-selective abortions are proliferating in the United States. Eight state legislatures have banned abortions sought on the basis of the sex of the fetus, 21 states have considered such laws since 2009, and a similar bill is pending in U.S. Congress. These laws have been introduced and enacted without any empirical data about their impact or effectiveness. Prior studies of U.S. Census data found sex ratios among foreign-born Chinese, Korean and Indian immigrants were skewed in favor of boys, but only in families where there were already one or two girls. Using the variation in the timing of bans in Illinois and Pennsylvania as natural experiments, we compare the pre-ban and post-ban sex ratios of certain Asian newborn children in these states over 12-year periods. We then compare these ratios with the sex ratios of Asian newborn children in neighboring states during the same period. We find that the bans in Illinois and Pennsylvania are not associated with any changes in sex ratios at birth among Asians. In Illinois and its neighboring states, the sex ratio at birth of Asian children was not male-biased during our study period. On the other hand, the sex ratio at birth among Asians in Pennsylvania and its neighboring states was skewed slightly in favor of boys, but the enactment of the ban did not normalize the sex ratio. This strongly suggests that sex-selective abortion bans have had no impact on the practice of sex selection, to the extent that it occurs, in these states. This finding is highly relevant to legislative and policy debates in the U.S. Congress and state legislatures where sex-selective abortion laws are being considered.
{"title":"Sex-selective Abortion Bans are Not Associated with Changes in Sex Ratios at Birth among Asian Populations in Illinois and Pennsylvania","authors":"Arindam Nandi, Sital Kalantry, B. Citro","doi":"10.1515/fhep-2014-0018","DOIUrl":"https://doi.org/10.1515/fhep-2014-0018","url":null,"abstract":"Abstract Legal prohibitions on sex-selective abortions are proliferating in the United States. Eight state legislatures have banned abortions sought on the basis of the sex of the fetus, 21 states have considered such laws since 2009, and a similar bill is pending in U.S. Congress. These laws have been introduced and enacted without any empirical data about their impact or effectiveness. Prior studies of U.S. Census data found sex ratios among foreign-born Chinese, Korean and Indian immigrants were skewed in favor of boys, but only in families where there were already one or two girls. Using the variation in the timing of bans in Illinois and Pennsylvania as natural experiments, we compare the pre-ban and post-ban sex ratios of certain Asian newborn children in these states over 12-year periods. We then compare these ratios with the sex ratios of Asian newborn children in neighboring states during the same period. We find that the bans in Illinois and Pennsylvania are not associated with any changes in sex ratios at birth among Asians. In Illinois and its neighboring states, the sex ratio at birth of Asian children was not male-biased during our study period. On the other hand, the sex ratio at birth among Asians in Pennsylvania and its neighboring states was skewed slightly in favor of boys, but the enactment of the ban did not normalize the sex ratio. This strongly suggests that sex-selective abortion bans have had no impact on the practice of sex selection, to the extent that it occurs, in these states. This finding is highly relevant to legislative and policy debates in the U.S. Congress and state legislatures where sex-selective abortion laws are being considered.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"53 1","pages":"41 - 64"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79408534","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 Tobacco taxes in Canada varied markedly across time and across regions in the early 1990s. We exploit this variation to estimate the long reach of prices faced in adolescence on smoking behavior roughly a decade later in early to mid-adulthood. Results from a variety of econometric approaches suggest that there is a small but detectable long-run effect of price faced during adolescence. A 10% increase in prices faced during adolescence, holding contemporaneous prices constant, leads to roughly a 1% reduction in adult smoking propensity and intensity. The results are somewhat sensitive to specification and to how price during adolescence is measured.
{"title":"Long-Term Effects of Tobacco Prices Faced by Adolescents","authors":"M. Auld, M. Zarrabi","doi":"10.1515/fhep-2014-0005","DOIUrl":"https://doi.org/10.1515/fhep-2014-0005","url":null,"abstract":"Abstract Tobacco taxes in Canada varied markedly across time and across regions in the early 1990s. We exploit this variation to estimate the long reach of prices faced in adolescence on smoking behavior roughly a decade later in early to mid-adulthood. Results from a variety of econometric approaches suggest that there is a small but detectable long-run effect of price faced during adolescence. A 10% increase in prices faced during adolescence, holding contemporaneous prices constant, leads to roughly a 1% reduction in adult smoking propensity and intensity. The results are somewhat sensitive to specification and to how price during adolescence is measured.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"20 1","pages":"1 - 24"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83325692","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 The BRICS countries (Brazil, Russia, India, China, and South Africa) have experienced tremendous economic and health gains in recent decades. Two of the major health challenges faced by the BRICS and other low and middle income countries are decreasing inequity in health outcomes and increasing affordability of health insurance. One fiscally sustainable option for the BRICS governments is a public subsidy system for private health insurance plans. This essay lays out the potential applicability and impacts of public subsidies for private health insurance plans, as well as opportunities and challenges for implementation, in the BRICS countries. Overall, providing public subsidies rather than health insurance would enable the BRICS governments to avoid the open-ended financial liabilities that have plagued advanced economies, while still expanding access to health insurance and encouraging the develoment of a robust private health insurance market. We conclude by suggesting an array of pilot programs that could serve as the seeds for publicly subsidized health insurance schemes within the BRICS markets.
{"title":"Public-Private Partnership as a Path to Affordable Healthcare in Emerging Markets","authors":"J. W. Chou, D. Lakdawalla, J. Vanderpuye-Orgle","doi":"10.1515/fhep-2014-0023","DOIUrl":"https://doi.org/10.1515/fhep-2014-0023","url":null,"abstract":"Abstract The BRICS countries (Brazil, Russia, India, China, and South Africa) have experienced tremendous economic and health gains in recent decades. Two of the major health challenges faced by the BRICS and other low and middle income countries are decreasing inequity in health outcomes and increasing affordability of health insurance. One fiscally sustainable option for the BRICS governments is a public subsidy system for private health insurance plans. This essay lays out the potential applicability and impacts of public subsidies for private health insurance plans, as well as opportunities and challenges for implementation, in the BRICS countries. Overall, providing public subsidies rather than health insurance would enable the BRICS governments to avoid the open-ended financial liabilities that have plagued advanced economies, while still expanding access to health insurance and encouraging the develoment of a robust private health insurance market. We conclude by suggesting an array of pilot programs that could serve as the seeds for publicly subsidized health insurance schemes within the BRICS markets.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"44 1","pages":"65 - 74"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83011524","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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