International journal of health care finance and economics最新文献

The health insurance loading fee represents the portion of the premium above the expected amount of medical care expenditures paid by the insurance company. The size of the loading fees and how they vary by employer group size have important implications for health policy given the recent passage of the Patient Protection and Affordable Care Act. Despite their policy relevance, there is surprisingly little empirical evidence on the magnitude and the determinants of health insurance loading fees. This paper provides estimates of the loading fees by firm size using data from the confidential Medical Expenditure Panel Survey Household Component-Insurance Component Linked File. Overall, we find an inverse relationship between employer group size and loading fees. Firms of up to 100 employees face similar loading fees of approximately 34%. Loads decline with firm size and are estimated to be on average 15% for firms with more than 100 employees, but less than 10,000 employees, and 4% for firms with more than 10,000 workers.

We examine how the market power of physician groups affects the form of their contracts with health insurers. We develop a simple model of physician contracting based on 'behavioral economics' and test it with data from two sources: a survey of physician group practices in Minnesota; and the physician component of the Community Tracking Survey. In both data sets we find that increases in groups' market power are associated with proportionately more fee-for-service revenue and less revenue from capitation.

This paper analyzes the welfare gain from replacing the tax exclusion of employer-provided health insurance with a lump-sum tax credit. It differs from earlier studies in that we look at the welfare cost of health insurance tax exclusion as coming directly from excessive health insurance rather than from overconsumption of medical care and that we account for the labor market effect of the tax exclusion on welfare. Both differences work to produce a smaller tax reform welfare gain. For a set of mid-range parameter values, the welfare gain is about 21% of current health insurance tax expenditures. In addition, government tax expenditures would fall by 38%, and health insurance spending would fall by 77% after the reform.

Between 1993 and 1995 Medicare increased the coverage of immunosuppression medication for kidney transplant recipients from 1 to 3 years following transplantation. The universal Medicare eligibility among kidney transplant patients provides a unique opportunity to explore labor supply responses to public insurance provision among a large number of men and women of prime working age and of all income levels. Although these patients are likely to be less healthy than the general population, upon receiving a kidney transplant, the main health problem of an individual with kidney failure, the lack of functioning kidneys, is removed. The income effects associated with the large transfer payment may discourage labor supply, while the potential health benefits of the coverage extension may promote labor supply. Results indicate that Medicare's increased medication coverage led to decreases in labor force participation among part time workers. These results suggest that potential labor supply reducing income effects should be taken into account when discussing the possibility of expanded public health insurance coverage, particularly for other groups of individuals with high expected medical expenditures, such as the elderly, or those with chronic conditions, such as diabetes. These results are useful considering the forthcoming expansion of government aid to purchase health insurance.

This study tests whether the low-income population in Bogota not insured under the General Social Security Health System is able to economically handle unexpected health problems or not. It used data from the Health Services Use and Expenditure Study conducted in Colombia in 2001, for which each household recorded its monthly out-of-pocket health expenditure during the year and the household income was measured as the sum of each member's contribution to the household. Payment capacity or available income and catastrophic health spending were based on the latest methodology proposed by the World Health Organization (WHO) in 2005. A probit model was adjusted to determine the factors that significantly influence the likelihood of a household having catastrophic health spending. The percentage of households with catastrophic health spending in Bogota was 4.9%; incidence was higher in low-income households where none of the members were affiliated to social security, where there had been an in-patient event, and where the heads of household were over 60 years of age. There is no statistical evidence for rejecting the hypothesis under study, which states that low-income households that have no health insurance are more likely to have catastrophic health spending than higher-income households with health insurance.

We use variation in premium inflation and general inflation across geographic areas to identify the effects of downward nominal wage rigidity on employers' health insurance decisions. Using employer level data from the 2000 to 2005 Medical Expenditure Panel Survey-Insurance Component, we examine the effect of premium growth on the likelihood that an employer offers insurance, eligibility rates among employees, continuous measures of employee premium contributions for both single and family coverage, and deductibles. We find that small, low-wage employers are less likely to offer health insurance in response to increased premium inflation, and if they do offer coverage they increase employee contributions and deductible levels. In contrast, larger, low-wage employers maintain their offers of coverage, but reduce eligibility for such coverage. They also increase employee contributions for single and family coverage, but not deductibles. Among high-wage employers, all but the largest increase deductibles in response to cost pressures.

The rate of increase of longevity has varied considerably across U.S. states since 1991. This paper examines the effect of the quality of medical care, behavioral risk factors (obesity, smoking, and AIDS incidence), and other variables (education, income, and health insurance coverage) on life expectancy and medical expenditure using longitudinal state-level data. We examine the effects of three different measures of the quality of medical care. The first is the average quality of diagnostic imaging procedures, defined as the fraction of procedures that are advanced procedures. The second is the average quality of practicing physicians, defined as the fraction of physicians that were trained at top-ranked medical schools. The third is the mean vintage (FDA approval year) of outpatient and inpatient prescription drugs. Life expectancy increased more rapidly in states where (1) the fraction of Medicare diagnostic imaging procedures that were advanced procedures increased more rapidly; (2) the vintage of self- and provider-administered drugs increased more rapidly; and (3) the quality of medical schools previously attended by physicians increased more rapidly. States with larger increases in the quality of diagnostic procedures, drugs, and physicians did not have larger increases in per capita medical expenditure. We perform several tests of the robustness of the life expectancy model. Controlling for per capita health expenditure (the "quantity" of healthcare), and eliminating the influence of infant mortality, has virtually no effect on the healthcare quality coefficients. Controlling for the adoption of an important nonmedical innovation also has little influence on the estimated effects of medical innovation adoption on life expectancy.

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

Cancer is the second leading cause of death in the U.S. and its economic cost is very high. The objective of this study is to analyze the socioeconomic and demographic factors that are related to the willingness to pay (WTP) for cancer prevention. Data from an experimental module in the 2002 Health and Retirement Study (HRS) were used to identify WTP differences across different population subgroups. Respondents were asked whether they were willing and able to pay different dollar amounts per month for a new cancer prevention drug. Years of age were negatively related to WTP whereas income and the probability of developing cancer were positively related to WTP. Risk-relevant numeracy skills were positively related to self-assessed cancer risk, which may suggest that adults with poor numeracy skills underestimate their cancer risk. This has consequences not only on the relative perceived value of different cancer treatments across different population subgroups but also on perceived value as captured by WTP.