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Background and Aims: The United States of America and Sweden both contain a public and private component to their healthcare systems. While both countries spend a similar amount per capita on public healthcare expenditures, the United States spends significantly more in the private healthcare sector. Sweden has a social democratic model of health care, and given its identity as a welfare state, private health insurance providers have a small and nuanced role. Methods: This paper was completed after searches were queried for "Sweden," "United States," and variants of the words "insurance," "public," "private," "Medicare," "Medicaid," "public," and "costs." A preliminary search in May 2022, yielded 78 articles, of which 45 were ultimately considered relevant for this review. Inclusion criteria consisted of English language articles, topic relevance, and verification of MEDLINE‐indexed journals. These searches were performed in PubMed, Google Scholar, Embase, and Cochrane. Summary findings of these searches are compiled in this review. Results: Sweden guarantees low‐cost appropriate care to all citizens with equitable access; however, drawbacks of its system include high financial burden, lack of primary care infrastructure, as well as geographical and socioeconomic inequities. On the other hand, the United States' healthcare system is built around the private sector with public health insurance reserved only for the most vulnerable patient populations. Conclusion: Our goal is to provide an overview, compare the role of private health insurance in both countries, and highlight policies that have had beneficial effects in each nation. Possible solutions to the drawbacks of each nation's health insurance policies could be addressed by additional support to Sweden's vulnerable population by developing a program similar to the US' Medicare Advantage program. Conversely, the United States may benefit from increasing access to public health insurance, especially in instances where families face unemployment. [ABSTRACT FROM AUTHOR]

This paper presents a dynamic general equilibrium model designed to examine the macroeconomic effects and welfare implications of alternative reforms to the US health insurance system. Specifically, it scrutinizes the extent to which health care reform can mitigate inefficiencies stemming from market imperfections in the health insurance industry. The model considers a stochastic overlapping generations framework, incorporating heterogeneous agents who are subject to uncertain health shocks. These individuals make optimal decisions regarding labor supply, health insurance, and medical services. Given that the optimal levels of medical consumption and hours worked are endogenous, this setting encapsulates general equilibrium effects. The model is calibrated to US data, and numerical simulations suggest that suitable adjustments to the present health insurance system can broaden coverage and enhance welfare. This improvement is achieved by reducing adverse selection, improving overall health status, and lessening tax distortions on labor supply. [ABSTRACT FROM AUTHOR]

Objectives Patients with chronic diseases are often forced to seek emergency care for exacerbations. In the face of large predicted increases in the prevalence of chronic diseases, there is increased pressure to avoid hospitalizing these patients at the end of the ED visit, if they can obtain the care they need in the outpatient setting. We performed this scoping study to provide a broad overview of the published literature on the transition of care between ED and primary care following ED discharge. Methods We performed a MEDLINE search of English-language articles published between 1990 and March 2015. We created a data-charting form a priori of the search. Papers were organized into themes, with new themes created when none of the existing themes matched the paper. Papers with multiple themes were assigned preferentially to the theme that was consistent with their primary objectives. We created a descriptive numerical summary of the included studies. Results Of 1,138 titles, there were 252 potentially relevant abstracts, and among those 122 met criteria for full paper review. An additional 11 papers were acquired from reference review. From the 133 papers, 85 were included in the study. The papers were categorized into seven themes. These included Follow-up compliance and its predictors (38 studies), Telephone calls to discharged ED patients (15 studies), ED navigators (14 studies), The current system (nine studies), Ways to alert primary care providers ( PCPs) of the ED visit (seven studies), and Patient views and PCP information requirements (one each). In the Follow-up compliance and predictors theme, the two most frequently identified significant predictors for increasing the frequency of follow-up care were the provision of a follow-up appointment time prior to ED departure and the presence of health insurance. Follow-up telephone calls to patients resulted in better follow-up rates, but increased ED return visits in some studies. In the current system patients themselves are the conduit, and the barriers to follow-up care can be high. E-mail and/or electronic medical record alerts to the PCP are relatively new, and no studies limited the alerts to patients who had a defined need for follow-up care. Conclusions A plethora of work has been published on the transition of care from ED to primary care. To decrease hospitalizations among the upcoming wave of patients with chronic diseases, it appears that the two most efficient areas to target are a primary care follow-up appointment system and health insurance. Further research is needed in particular to identify the patients who actually need follow-up care and to develop information technology solutions that can be effectively implemented within the current emergency healthcare system. [ABSTRACT FROM AUTHOR]

The peer effect may amplify adverse selection in social networks, hampering the sustainable operation of microinsurance. This paper uses data from a micro health insurance program in Pakistan to test for the peer effect in renewal decisions and the role it plays in amplifying adverse selection within social networks. The paper finds evidence supporting that insurance renewal decisions are similar among peers in the same network, and the peer effect is stronger among households of the same risk type than households of different risk types, indicating that the heterogeneous peer effect acts as an amplifier for adverse selection. The paper provides policy implications for effective ways to mitigate the peer effect and adverse selection, based on the results of heterogeneity analyses. The policy recommendation is to enforce a minimum group enrollment rate requirement of at least 60% for large groups to mitigate the peer effect. [ABSTRACT FROM AUTHOR]

Many regulated health insurance markets include risk adjustment (aka risk equalization) to mitigate selection incentives for insurers. Empirical studies on the design and evaluation of risk‐adjustment algorithms typically focus on mandatory health insurance schemes. This paper considers risk adjustment in the context of voluntary health insurance, as found in Chile, Ireland, and Australia. In addition to the challenge of mitigating selection by insurers, regulators of these voluntary schemes have to deal with selection by consumers in and out of the market. A strategy for mitigating selection by consumers is to apply some form of risk rating. Our paper shows how risk adjustment and risk rating interact: (1) risk rating reduces the need for risk adjustment and (2) risk adjustment reduces premium variation across rating factors, thereby increasing incentives for consumers to select in and out of the market. [ABSTRACT FROM AUTHOR]

Here we highlight a neglected contribution of Alexander Sutherland (1852-1902) to Australian health economics. Sutherland read a paper on health insurance at the Melbourne Social Science Congress that was organised in the context of the International Exhibition of 1880-1881. He proposed combining life and health insurance into a single product and to require those who are insured to obtain regular medical check-ups. The aim was to provide the insurer with information on the behaviours of the insured and to promote healthy lifestyles. These proposals were not well received at the time and have been largely forgotten, but may be relevant today. [ABSTRACT FROM AUTHOR]

The U.S. health care system is often criticized for being the most expensive in the world while delivering mediocre health outcomes. While policymakers on both the right and left agree about the need for reform, they disagree strongly about whether that reform should involve a smaller role for government or a larger role. At the same time, the U.S.' high costs and mediocre health outcomes likely are at least partly attributable to lifestyle choices that occur outside of the health care system, creating another possible avenue for intervention. This introduction to the symposium on "Free Markets and Health Care" discusses how welfare economics provides a useful tool in evaluating the appropriateness of government involvement in markets related to health and health care. The papers in the symposium provide important new evidence to help inform debates about, for instance, regulations on health care providers and insurers, health insurance expansions, and policies designed to influence health behaviors. [ABSTRACT FROM AUTHOR]

Background: Limited health insurance coverage in Africa poses a significant challenge, impeding access to quality healthcare for millions of individuals. Methods: This paper synthesizes information from existing literature and research on the topic of limited health insurance coverage in Africa. The identified consequences and root causes are presented in a structured format. Results: The consequences of limited health insurance coverage in Africa include increased financial burden on households, decreased access to health services, and inadequate coverage for essential health services. These consequences contribute to reduced utilization of healthcare services and negative health outcomes, including the deterioration of existing health conditions and the development of new health problems. The financial burden is particularly significant due to high poverty rates in Africa, forcing households to pay for healthcare services out of pocket and leading to considerable financial strain and even financial ruin. Additionally, limited health insurance coverage restricts access to necessary health services, resulting in delayed treatment, missed diagnoses, and poor health outcomes. Conclusion: The root causes of limited health insurance coverage in Africa are multifaceted and include factors such as poverty, lack of government support, and limited private‐sector involvement. These systemic issues contribute to the persistence of inadequate health insurance coverage and hinder efforts to improve access to quality healthcare for African populations. [ABSTRACT FROM AUTHOR]

Using medical insurance (MI) to shift employees' health risks outside is an important risk management tool for modern firms. Existing studies usually treat firms' contributions to employees' MI only as a labor cost. However, contributing to MI also has indirect benefits, such as improved labor productivity and R&D innovation, which consequently increase corporate value. This paper studies the impact of firms' MI contributions for employees on corporate value, using social insurance collection system reform in China as a natural experiment. Results show that, first, the reform increases firms' contributions to employees' MI funds. Second, the increase has a positive impact on firms' market‐to‐book ratio. These effects can be explained by enhanced labor productivity, firm efficiency, and innovation. Heterogeneity analysis suggests that the effects are more pronounced for firms in high R&D industries, areas with high pollution, or areas with better medical and labor supplies. [ABSTRACT FROM AUTHOR]

Background: Fragmented and complex healthcare systems make it difficult to provide continuity of care for patients with advanced cancer near the end of life. Nurse‐based cross‐sectoral navigation support has the potential to increase patients' quality of life. The objective of this paper was to evaluate associations between navigation support and health care utilization, and the associated costs of care. Methods: The evaluation is based on claims data from 37 statutory health insurance funds. Non‐randomized recruitment of the intervention group (IG) took place between 2018 and 2019 in four German hospitals. The comparison group (CG) was defined ex post. It comprises nonparticipating clients of the involved health insurance funds matched on age, gender, and diagnosis in a 1:4 ratio to the IG. Healthcare resource utilization was compared using incident rate ratios (IRRs) based on negative binomial regression models. Linear mixed models were performed to compare differences in lengths of hospital stays and costs between groups. Results: A total of 717 patients were included (IG: 149, CG: 568). IG patients showed shorter average lengths of hospital stays (IG: 11 days [95% CI: 10, 13] vs. CG: 15 days [95% CI: 14, 16], p < 0.001). In the IG, 21% fewer medications were prescribed and there were on average 15% fewer outpatient doctor contacts per month. Average billed costs in the IG were 23% lower than in the CG (IG: 6754 EUR [95% CI: 5702, 8000] vs. CG: 8816 EUR [95% CI: 8153, 9533], p < 0.001). Conclusions: The intervention was associated with decreased costs mainly as a result of a non‐intended navigation effect. The social care nurses had navigated patients within the hospital early, needs‐oriented and effectively but interpreted their function less cross‐sectorally. Linkage of hospital‐based navigators with the outpatient care sector needs further exploration. [ABSTRACT FROM AUTHOR]

Risk equalization schemes, which transfer money to/from insurers that have above/below average risks, are a fundamental tool in regulated health insurance markets in many countries. Risk sharing (the transfer of some responsibility for costs from a plan to the regulator or the overall insurance market), are an additional method of insulating insurers who attract higher‐than‐average risks. This paper proposes, implements and quantifies incorporating risk sharing within a risk equalization scheme that can be applied in a data‐poor context. Using Chile's private health insurance market as case study, we show that modest amount of risk sharing greatly improves fit even in simple demographic‐based risk equalization. Expanding the model's formula to include morbidity‐based adjustors and risk sharing redirects compensations at insurer level and reduces opportunity to engage in profitable risk selection at the group level. Our emphasis on feasibility may make alternatives proposed attractive to countries facing data‐availability constraints. [ABSTRACT FROM AUTHOR]

Background: Patient satisfaction has been seen as a key criterion when evaluating hospitals and is one of the main focuses of the current health‐care reform in China. This paper aimed to explore patient‐ and hospital‐level factors associated with inpatient satisfaction, which can provide policy implications for the evaluation and development of a patient‐oriented health‐care system. Methods: The paper analyses data from the 2017 China National Patient Survey which includes 20 300 inpatients from 131 tertiary hospitals across 31 provinces. Descriptive analysis and multivariable logistic regressions are conducted to identify key factors related to satisfaction. Results: Patient sociodemographic characteristics, including gender, age, income and insurance type, are found to be strongly associated with their satisfaction of inpatient experience. In terms of institutional characteristics, hospital type, size, staffing and financial performance are also significantly correlated with inpatient satisfaction. Patients are more satisfied with specialist hospitals and large hospitals measured by the number of beds and surgeries. Hospitals with higher nurse‐to‐bed ratio also receive more satisfaction. The financial performance of hospitals, however, is negatively associated with satisfaction. Conclusion: Patient satisfaction contains unique information on service quality and thus should be incorporated into the matrix of hospital evaluation. Meanwhile, differences in patient composition must be adjusted to make fair comparisons across hospitals. Moreover, future reform needs to put greater efforts in the design of comprehensive public insurance scheme, efficient hospital structure and an overall well‐functioning health‐care delivery system in order to better serve patients in China. [ABSTRACT FROM AUTHOR]

Policy PointsPrivate health insurance (PHI) in France has been facing critical changes over the past 30 years. A complementary and voluntary scheme, it has been historically dominated by nonprofit entities. However, the share of for‐profit insurance companies in the sector has significantly increased. Nonprofit firms also changed their strategies and mimicked some for‐profit behaviors.The present paper argues that this process is a result of the conflict‐provoking coevolution of the insurance and health care sectors. Trying to improve the regulation of the insurance industry as whole, two European directives first jeopardized the business model of nonprofit entities. Then, two national reforms designed to improve health coverage significantly increased competition among insurers, notably in the area of corporate‐level contracts.Decoupling the insurance and health care sectors has become a major source of policy feedback and unexpected outcomes of reforms affecting the very organization of PHI. Context: In France, private health insurance (PHI) has an exceptionally high level of coverage and accounts for 13.7% of health expenditures. A complementary and voluntary scheme, it has been historically dominated by nonprofit, mutual benefit societies. Over the past 20 years, however, the market share of for‐profit insurance companies has increased by 47%. Financialization of the field developed, and competition based on new risk management strategies also increased. The broad aim of this paper is to characterize and to elucidate the causes of this trend. More specifically, we are interested in how and to what extent a series of supranational and national policies contributed to this situation. Method: Our data come from three sources. We first reviewed documents published by health insurers, government reports, and newspaper articles. We then conducted two semistructured interview campaigns between September 2017 and May 2018. The first mostly covered private and public actors and their involvement in European Union (EU) policymaking (n = 21). The second series of interviews was conducted with another group of actors directly involved at the French level (n = 16). Findings: Our findings support preliminary observations. PHI in France, we argue, is indeed facing a development of competition and marketlike instruments. Four major policies (two EU directives and two national reforms) played a significant role in this outcome. Surprisingly, however, it has never been the purpose of legislators and policymakers: while EU directives created a regulatory framework for insurance activities within the Single Market, policies adopted at the national level initially aimed at improving health coverage. We show that it is the interactions and the noncoordination among all of these policies that explain their unexpected outcome. Conclusions: The trend described in this paper is twofold. The first is Europeanization, as PHI in France is increasingly affected by EU legislation. Since this framework tends to favor larger firms and for‐profit companies, a reduction in statutory coverage can no longer be considered a quasi‐neutral transfer from (publicly owned) social security to nonprofit providers. At the same time, PHI is shifting toward collectivization: as competition increases, complementary health coverage is becoming gradually standardized and based at the corporate level. Together, these changes are likely to reduce freedom of choice and individual welfare, an assumption supported by studies published on the most recent period. [ABSTRACT FROM AUTHOR]

Objective: To estimate the effects of prenatal public health insurance targeting noncitizens on the health of U.S.‐born children of noncitizen mothers beyond birth outcomes. Data Sources and Study Setting: This paper uses the restricted version of the 1998–2014 National Health Interview Survey with state‐level geographic identifiers. Study Design: The empirical strategy compares outcomes in states that adopted the Children's Health Insurance Plan (CHIP) Unborn Child Option with states that never adopted or adopted it at different times, controlling for differences in the pre‐treatment period. I use a flexible event‐study analysis to quantify the effects of the Unborn Child Option on noncitizen women's health insurance coverage, health care utilization, and their children's health. Data Collection/Extraction Methods: All data are derived from pre‐existing sources. Principal Findings: The study finds that the impact of the Unborn Child Option is a 4.7%‐point increase in public health insurance coverage (p < 0.01) and 0.48 more doctor's office visits (p < 0.1) annually among noncitizens of childbearing ages. Subsequently, the reform leads to a 7%‐point rise in the rate of parents reporting their 4–6‐year‐old children are in "excellent" or "very good" health (p < 0.01). While no improvements are evident at birth and at younger ages, observed health improvements begin to appear by preschool age. Conclusions: The study contributes to the literature by providing evidence that certain benefits of in‐utero public health insurance targeting noncitizens may appear several years after birth, specifically around preschool age. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of the Affordable Care Act Medicaid expansions on marital behavior. We use data from the American Community Survey from 2008 to 2019 and estimate difference‐in‐differences models to test for effects on marriage and divorce outcomes. We find that expansions led to a 0.95% reduction in marriage stock and a 2.22% increase in divorce stock, with effects being larger among low educated individuals. We believe that two factors play a role as underlying mechanisms: (1) reduced reliance on spousal insurance coverage and (2) deciding to forego marriage or get divorced to meet eligibility restrictions. [ABSTRACT FROM AUTHOR]

This paper shows how the cost of out-of-hospital medical services and prescription drugs change as Australians enter and live through retirement. We use a sample of over 65,000 retired individuals aged forty-five and over, and extract their Medicare claims for period 2005-2014. Analysing the expenditure distribution for up to eight years after retirement, the result shows that expenditure on medical services continues to increase while pharmaceutical expenditure declines for most retirees. Partially retired individuals have higher medical service cost but lower pharmaceutical cost, while those retiring prior to Age Pension age have slower growth in medical service and pharmaceutical costs. [ABSTRACT FROM AUTHOR]

This articles features an abstract of several research papers on financial risk, insurance, and other related topics. The inventory and analysis of teaching of risk and insurance economics in Europe. The effects of bank regulation on insurance. The significance and the forms of the saving process in a national economy, the role of financial intermediaries, and the bundle of preference of moneylenders. A research study based on the "Geneva Association" issue that compares the financial benefits and contributions coupled with the various social security programs in eight countries of Europe and North-America. An argument on the effects of fluctuations in the exchange rates on the expected value and the variability of reinsurers' income streams. And others related topics are discussed in this article.

Over the last two decades, state and local governments have adopted policies requiring employers to electronically verify (E‐Verify) the work eligibility of their new hires to disrupt unauthorized immigrants' access to the formal labor market. These E‐Verify mandates previously enjoyed bipartisan support and are likely to be included in comprehensive immigration reform discussions between the Biden administration and GOP. I show in this paper that state E‐Verify mandates are associated with a 5‐percentage point reduction in the probability that likely unauthorized immigrants are employed and a 2‐percentage point reduction in the probability that they have employer‐sponsored insurance. However, these changes are limited to one period after implementation. In all remaining periods, the relationships are not distinguishable from zero. I show that this pattern can be explained by selective outmigration of otherwise unemployed and uninsured likely unauthorized immigrants. By preventing unauthorized immigrants from moving to a more favorable policy environment, a nationwide E‐Verify mandate would likely further limit unauthorized immigrants' access to private health insurance. [ABSTRACT FROM AUTHOR]

Private health insurance plays a key role in financing dental care in Australia. Having private dental insurance has been associated with higher levels of access to dental care, visiting for a check-up and receiving a favourable pattern of services. Associations with better oral health have also been reported. In the absence of any existing review, this paper aims to systematically review the relationship between dental insurance and dental service use and/or oral health outcomes in Australia. A systematic search of online databases and subsequent sifting resulted in 36 publications, 33 of which were cross sectional and three cohort analyses. Dental service outcomes were more commonly reported than oral health outcomes. There was considerable heterogeneity in the outcome measures reported, for both service use and health outcomes. Overall, the majority of the evidence was from cross sectional studies and few studies reported analyses adjusted for confounding factors. The consolidated evidence points towards a positive association between dental insurance and dental visiting. Dentally insured adults are likely to have more regular access to dental care and have a more favourable pattern of service use than the uninsured. However, evidence of associations between dental insurance and oral health are mixed. [ABSTRACT FROM AUTHOR]

Despite the growth in health insurance products that differentially cover preventive care and nonpreventive care, little is known about how preventive care utilization responds to targeted changes in coverage. Using administrative data from a large company, this paper examines the implementation of an insurance benefit design which differentially increased the price of nonpreventive care while decreasing the price of prevention. Leveraging a difference-in-differences research strategy, we find that preventive care utilization did not increase and even declined due to the differential price change. This evidence indicates a meaningful negative cross-price effect, suggesting that nonpreventive care and preventive care are complements. ( JEL I13, I11) [ABSTRACT FROM AUTHOR]

This paper develops and estimates a life‐cycle equilibrium labor search model in which heterogeneous firms determine health insurance provisions and heterogeneous workers sort themselves into jobs with different compensation packages over the life cycle. I study the optimal joint design of major policies in the Affordable Care Act (ACA) and the implications of targeting these policies to certain individuals. Compared with the health insurance system under the ACA, the optimal structure lowers the tax benefit of employer‐sponsored health insurance and makes individual insurance more attractive to younger workers. Through changes in firms' insurance provisions, a greater number of younger workers sort into individual markets, which contributes to improving the risk pool in individual insurance and lowering the uninsured risk. [ABSTRACT FROM AUTHOR]

This paper examines the introduction of premiums into the SCHIP program in Kentucky. Kentucky introduced a $20 monthly premium for SCHIP coverage for children with family incomes between 151 percent and 200 percent of the federal poverty level in December 2003. Administrative data between 2001 and 2004 is used to estimate a Cox proportional hazard model that predicts enrollment duration in this premiumpaying category. The results suggest that a premium reduces the length of enrollment, with the impact concentrated in the first three months after the introduction of the premium. Similar results are not found for the non-premium-paying category. © 2007 by the Association for Public Policy Analysis and Management [ABSTRACT FROM AUTHOR]

Aims/Introduction: To estimate the prevalence, awareness, treatment, control rate, and influence factors of type 2 diabetes in Fujian province and provide the scientific basic for prevention. Materials and Methods: A population‐based study with the analysis of binary logistic regression was carried out to estimate the odds ratios of the influencing factor on type 2 diabetes. Data of the Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE) in southeast China were used. The study sample originated from 12 counties in Fujian province and included 135,352 permanent residents aged 35–75 years in 2021. Results: The prevalence of type 2 diabetes was 18.32% (24,801/135,352). Among them, 13,921 (56.13%) were aware of their condition, 11,894 (47.96%) were receiving treatment, and 4,537 (18.29%) had achieved control of blood glucose. Multivariate logistic regression analysis showed that older age, men, low‐family income, low‐education level, urban locality, no medical insurance, and histories of myocardial infarction, stroke, dyslipidemia, hypertension, alcohol consumption, and obesity were associated with a higher prevalence of type 2 diabetes. Conclusions: The prevalence of type 2 diabetes among residents aged 35–75 years in southeast China is high, whereas the status of its low awareness, treatment and control is severe, warranting a broad‐based global strategy, including greater efforts in earlier screening, and more effective and affordable treatment is essential. [ABSTRACT FROM AUTHOR]

The high cost of medical care and its association with poverty have given rise to a growing concern for developing countries, but how insurance plans affect household income and alleviate poverty has been rarely discussed. This study aims to bridge this research gap by examining a medical insurance reform in China, a major program of the targeted poverty alleviation (TPA) strategy, which offers higher reimbursement rates and lower medical deductibles for low‐income households. We use an administrative data set on impoverished people in a Chinese county to examine how exogenous changes in the medical insurance system affect the income structure of low‐income households. We apply a two‐part model to a Difference‐in‐Differences framework, with households that received reimbursement of the insurance reform as the treatment group and others as the control group. Our results imply that the medical insurance reform could increase the overall household income diversity. The mechanism analysis suggests that the medical insurance reform improves the health conditions of patients and encourages caregivers to engage more in off‐farm work. [ABSTRACT FROM AUTHOR]

Comments on a paper which discusses privatization and bidding in the heath care sector in the United States. Description of privatization in the context of health care; Reason for favoring public production in health care; Production of health-insurance services.

This paper shows how Sharpe's measure and some financial constraints can be used to choose the best combination of risk management tools to handle a workers' compensation loss exposure. Because the sample firm data were too limited to estimate with confidence the mean of the Poisson probability distribution used in the analysis, the results were subjected to a sensitivity analysis. For the sample firm excess insurance, together with the optimum loss control efforts, was the best combination, the ex-medical plan combined with optimum loss control being a viable alternative. [ABSTRACT FROM AUTHOR]

This section presents abstracts of articles related to health care and insurance, which were published as of December 1979. Defensibility of New Health Professionals at Law: A Speculative Paper explores the way in which the principles of tort law might define primary and secondary liability for these new health professionals. Among the issues discussed in substantial detail are whether a separate standard of care is appropriate and whether the new professionals might function as independent contractors. The Antitrust Implications of Relative Value Studies in Medicine examines the status of professionally sponsored relative values studies under antitrust law and suggests several reasons why they should be held unlawful. Consequences of Increased Third-Party Payments for Health Care Services focuses on some of the adverse consequences of health insurance programs and indicates that the future or private health insurance depends upon how these problems are addressed. Characteristics and Operation of Projection Valuation Methods for Pension Plan Funding discusses several alternative approaches to projection valuation methods and also describes how costs should be computed at valuation dates after the first one. In addition, the author illustrates projected contributions and asset buildups under both traditional cost methods and projected cost methods.

This paper views the typical insurance arrangement as a transfer mechanism. In addition to the primary ‘risk transfer’ by which insurance systems can he distinguished from other financial systems, the paper identifies three secondary transfers and four other transfers that the author views as associated with insurance but incidental to it. The paper then analyzes four different insurance systems in accordance with the transfers that take place within such system, and the relative importance of each to the particular system examined. The insurance systems subjected to this analysis are (1) automobile liability insurance, (2) group medical expense insurance, (3) the private pension plan, and (4) the OASDI social insurance system. [ABSTRACT FROM AUTHOR]

In several recent papers models have been developed to explain either why particular goods have been socialized or, more generally, the 'size of government.' In this paper we develop a version of these models to explain the decision in Canada to move to a system of socialized medical insurance to the mid-1960s. Income distribution data is then used to largely confirm that the model appears consistent as an explanation of the federal-provincial structure that has arisen and of the conflicts that have resulted. [ABSTRACT FROM AUTHOR]

We conduct the first systematic review of the impact of health insurance on children and their households in low- and middle-income countries where nine-tenths of the world's child population reside. We find only 13 studies for seven countries published between 2000 and 2014 which assess the insurance impacts for children, controlling for self-selection and heterogeneity. Nine out of 10 studies reviewed provide consistent evidence that health insurance provides financial protection. The results are more mixed for health utilisation and health outcomes. Policy-makers would benefit from additional research on whether and how health insurance benefits children. [ABSTRACT FROM AUTHOR]

Purpose: Evidence of the impact of the COVID‐19 pandemic on cancer prevention and control is growing, but little is known about patient‐level factors associated with delayed care. We analyzed data from a survey focused on Iowan cancer patients' COVID‐19 experiences in the early part of the pandemic. Methods: Participants were recruited from the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden (PERCH) program. We surveyed respondents on demographic characteristics, COVID‐19 experiences and reactions, and delays in any cancer‐related health care appointment, or cancer‐related treatment appointments. Two‐sided significance tests assessed differences in COVID‐19 experiences and reactions between those who experienced delays and those who did not. Results: There were 780 respondents (26% response), with breast, prostate, kidney, skin, and colorectal cancers representing the majority of respondents. Delays in cancer care were reported by 29% of respondents. In multivariable‐adjusted models, rural residents (OR 1.47; 95% CI 1.03, 2.11) and those experiencing feelings of isolation (OR 2.18; 95% CI 1.37, 3.47) were more likely to report any delay, where experiencing financial difficulties predicted delays in treatment appointments (OR 5.72; 95% CI 1.96, 16.67). Health insurance coverage and concern about the pandemic were not statistically significantly associated with delays. Conclusion: These findings may inform cancer care delivery during periods of instability when treatment may be disrupted by informing clinicians about concerns that patients have during the treatment process. Future research should assess whether delays in cancer care impact long‐term cancer outcomes and whether delays exacerbate existing disparities in cancer outcomes. [ABSTRACT FROM AUTHOR]

Individuals with health insurance use more health care. One reason is that health care is cheaper for the insured. Additionally, having insurance can encourage unhealthy behavior via moral hazard. Previous work studying the effect of health insurance on medical utilization has mostly ignored behavioral changes due to having health insurance, and how that in turn affects medical utilization. This paper investigates the structural causal relationships among health insurance status, health behavior, and medical utilization theoretically and empirically, and separates price effects from behavioral moral hazard effects. Also distinguished are the extensive versus intensive margins of insurance effects on behavior. ( JEL C51, I12, D12) [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the influence of hospitals' organizational culture in China to the hospital influence, the impact of system organization and regulation to the health expenditures and satisfaction, and racial disparities in childhood insurance.

This paper provides an empirical analysis of the effects of employer-provided health insurance, Medicare, and Social Security on retirement behavior. Using data from the Health and Retirement Study, we estimate a dynamic programming model of retirement that accounts for both saving and uncertain medical expenses. Our results suggest that Medicare is important for understanding retirement behavior, and that uncertainty and saving are both important for understanding the labor supply responses to Medicare. Half the value placed by a typical worker on his employer-provided health insurance is the value of reduced medical expense risk. Raising the Medicare eligibility age from 65 to 67 leads individuals to work an additional 0.074 years over ages 60-69. In comparison, eliminating 2 years worth of Social Security benefits increases years of work by 0.076 years. [ABSTRACT FROM AUTHOR]

Objective. To assess the impact of the Children's Health Insurance Program (CHIP) on the distribution of health insurance coverage for low-income children. Data Source. The primary data for the study were from the 1997, 1999, and 2002 National Survey of America's Families (NSAF), which includes a total sample of 62,497 children across all 3 years, supplemented with data from other data sources. Study Design. The study uses quasi-experimental designs and tests the sensitivity of the results to using instrumental variable and difference-in-difference approaches. A detailed Medicaid and CHIP eligibility model was developed for this study. Balanced repeated replicate weights were used to account for the complex sample of the NSAF. Descriptive and multivariate analyses were conducted. Principle Findings. The results varied depending on the approach utilized but indicated that the CHIP program led to significant increases in public coverage (14–20 percentage points); and declines in employer-sponsored coverage (6–7 percentage points) and in uninsurance (7–12 percentage points). The estimated share of CHIP enrollment attributable to crowd-out ranged from 33 to 44 percent. Smaller crowd-out effects were found for Medicaid-eligible children. Conclusions. Implementation of the CHIP program resulted in large increases in public coverage with estimates of crowd-out consistent with initial projections made by the Congressional Budget Office. This paper demonstrates that public health insurance expansions can lead to substantial reductions in uninsurance without causing a large-scale erosion of employer coverage. [ABSTRACT FROM AUTHOR]

The purchase of private health insurance (PHI) as a means to partially supplement the National Health System (NHS) coverage is often regarded as a potential signal for a declining support for the NHS. Exploiting the fact that PHI is typically purchased by the most affluent, in this paper we test the so called ‘secession of the wealthy’ hypothesis whereby the likelihood of expressing ‘lack of support for the NHS’ increases with having supplementary PHI. Using empirical data from Catalonia, we draw upon an empirical strategy that circumvents an obvious simultaneity problem by estimating both a recursive bivariate probit as well as an IV probit. After controlling for insurance premium, household income and other socio-demographic determinants, we find that the purchase of PHI reduces the propensity of individuals to support the NHS. We also find evidence that PHI is a luxury good and sensitive to fiscal incentives. [ABSTRACT FROM AUTHOR]

This paper contributes to evidence regarding the effectiveness of the Medicaid expansions by focusing on a key beneficiary-the mother-who has previously been overlooked. Using the Natality Detail Files for 1989-1996, we estimate the relationship between Medicaid eligibility and maternal health outcomes for several treatment groups and a control group. Potential biases caused by improved reporting are addressed by using a "straw man" maternal complication not preventable with prenatal care. Our results indicate that increased Medicaid eligibility may have led to fewer preventable maternal complications among women most likely to have benefited from the Medicaid expansions. [ABSTRACT FROM AUTHOR]

Objective. This paper uses a unique database to examine premiums paid by beneficiaries for Medigap supplemental coverage. Average premiums charged by insurers are reported, as well as premiums by enrollee age and gender, and additional policy characteristics. Marginal prices for Medigap benefits are estimated using hedonic price regressions. In addition, the paper considers how additional policy characteristics and geographic differences in the use and cost of medical care affect premiums. Data Sources/Study Setting. A comprehensive database on premiums paid by beneficiaries for newly issued Medigap policies in the year 2000 along with state-level characteristics. Study Design. Hedonic pricing equations are used to estimate implicit prices for Medigap benefits. Data Collection/Extraction Methods. The Centers for Medicare & Medicaid Services contracted for the creation of a detailed database on Medigap premiums. Data were collected in three stages. First, letters were sent directly to insurers requesting premium data. Second, letters were directly to state insurance commissioner's offices requesting premium data. Last, each state insurance commissioner's office was visited to collect missing data. Principal Findings. With the exceptions of the part B deductible and drug benefit, Medigap supplemental insurance is priced consistent with the actuarial value of benefits offered under the standardized plans. Premiums vary substantially based on rating method, whether the policy is guaranteed issue, Medigap Select, or explicitly for smokers. Premiums increase with enrollee age, but do not vary between men and women. The relationship between premiums and enrollee age varies across rating methods. Attained-age policies show the strongest relationship between age and premiums, while community-rated premiums, by definition, do not vary with age. Medigap supplemental insurance premiums are higher in states with poorer health, greater utilization, and greater managed care penetration. Conclusions. Despite the high cost, Medigap plans are generally priced in accordance with the actuarial value of benefits. The primary exception is the drug benefit, which appears to be subject to substantial adverse selection. Benefits such as the part B deductible and at-home recovery benefit offer little value to consumers. Several states require insurers to community rate premiums. Such regulation has important implications for premiums, and research needs to consider the impact of such regulation on the Medigap market. [ABSTRACT FROM AUTHOR]

Objective: Mutual Health Organizations (MHO) emerged in Ghana in the mid-1990s. The organizational structure and financial management of private and public MHO hold important lessons for the development of national health insurance in Ghana, but there is little evidence to date on their features. This paper aims at filling this data gap, and at making recommendations to Ghanaian authorities on how to stimulate the success of MHO. Methods: Survey among 45 private and public MHO in Ghana in 2004-2005, asking questions on their structure, financial management and financial position. Results: Private MHO had more autonomy in setting premiums and benefit packages, and had higher community participation in meetings than public MHO. MHO in general had few measures in place to control moral hazard and reduce adverse selection, but more measures to control fraud and prevent cost escalation. The vast majority of schemes were managed by formally trained and paid staff. The financial results varied considerably. Conclusions: Ghanaian authorities regulate the newly established public MHO, but may do good by leaving them a certain level of autonomy in decision-making and secure community participation. The financial management of MHO is suboptimal, which indicates the need for technical assistance. [ABSTRACT FROM AUTHOR]

Objective. To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996. Data Source. 1992–1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects. Study Design. We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time-invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual-level characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility. Data Collection/Extraction Methods. We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992–1996 panels of the SIPP covering the period 1992–1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP. Principal Findings. TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance. Conclusions. An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several times larger than the previous literature implies. [ABSTRACT FROM AUTHOR]

This paper examines the incentive effects of interactions between unemployment insurance (UI) and sickness insurance (SI), two important components of Sweden's social insurance system. The main topic is how the sickness-report rate among the unemployed is affected by (i) the limit of 300 workdays for UI benefits, and (ii) the difference in maximum compensation between UI and SI benefits. Results obtained by duration analysis suggest that sick reports increase as the UI benefit expiration date approaches. There is also evidence of an incentive effect on the sick-report rate because SI offers higher compensation than UI. [ABSTRACT FROM AUTHOR]

This paper develops a model to analyse the Australian health insurance system when individuals differ in their health risk and this risk is private information. In Australia private insurance both duplicates and supplements public insurance. We show that, absent any other interventions, this results in implicit transfers of wealth from those most at risk of adverse health to those least at risk. At the social level, these transfers represent a mean preserving spread of income, creating social risk and lowering welfare – what we call anti-insurance. The recently introduced rebate on private health insurance can improve welfare by alleviating anti-insurance. [ABSTRACT FROM AUTHOR]

This paper challenges the argument that expanding private health insurance coverage in Australia will reduce the demand for public hospitals. We construct a simple model to illustrate that although a premium subsidy might expand insurance coverage, it may not reduce the demand for public health services. The reason is that, under certain conditions, government subsidies only increase insurance coverage among self–insured consumers; that is, consumers who are uninsured but purchase private health care if they fall ill. We argue that subsidising private health care rather than insurance is a more effective way of reducing the demand for public health services. [ABSTRACT FROM AUTHOR]

The impact of insurer competition on welfare, negotiated provider prices, and premiums in the U.S. private health care industry is theoretically ambiguous. Reduced competition may increase the premiums charged by insurers and their payments made to hospitals. However, it may also strengthen insurers' bargaining leverage when negotiating with hospitals, thereby generating offsetting cost decreases. To understand and measure this trade-off, we estimate a model of employer-insurer and hospital-insurer bargaining over premiums and reimbursements, household demand for insurance, and individual demand for hospitals using detailed California admissions, claims, and enrollment data. We simulate the removal of both large and small insurers from consumers' choice sets. Although consumer welfare decreases and premiums typically increase, we find that premiums can fall upon the removal of a small insurer if an employer imposes effective premium constraints through negotiations with the remaining insurers. We also document substantial heterogeneity in hospital price adjustments upon the removal of an insurer, with renegotiated price increases and decreases of as much as 10% across markets. [ABSTRACT FROM AUTHOR]

This article presents abstracts of several studies on insurance policies. Recent Experience Under the Medicare Program, by Ronald V. Gresch. The Design of Contracts of Remedies for Breach, by Steven Shavell. Two-Persons Bargaining Problems With Incomplete Information, by Roger B. Myerson. Disclosure of Pension Liabilities: The Information Content of Unfunded Vested Benefits and Unfunded Past Service Cost, by Joshua Livnat. Insurance and Saving: Some Further Results, by Georges Dionne. Preference Reversals: A Broader Perspective, by Paul Slovic and Sarah Lichtenstein. Risk Aversion and Mean-Preserving Spread: Analysis and Applications, by Marcel Boyer and Georges Dionne. Risk Attitude and Time Preference in Health, by Amiram Gafni and George W. Torrence. Modeling the Societal Impact of Fatal Accidents, by Paul Slovic, Sarah Lichtenstein and Baruch Fischhoff. Survival Versus Consumption, by Donald S. Shephard and Richard J. Zechhauser. Stochastic Dominance and Parameter Estimation: The Case of Symmetric Stable Distributions, by Moshe Ben-Horim and Haim Levy. Medical Insurance, Technological Change and Welfare, by John H. Goddeeris. Poorhouses and the Origins of the Public Old Age Home, by Michael B. Katz.

Three states (Maine, Minnesota, and Rhode Island) have had programs to assist any resident in meeting uncovered ‘catastrophic’ expenses. The annual cost of these programs after 4–6 years of experience has been only a couple of dollars per state resident. A reasonable method of forecasting a priori the cost of such a program is shown to yield a much larger cost than actually has occurred. Some of the controllable factors affecting program growth (e.g., the deductible formula) are discussed, along with a variety of influences on the policy decisions at the state level. Finally, the paper warns against extrapolating the low cost of these state programs to federal initiatives in catastrophic coverage. [ABSTRACT FROM AUTHOR]

This paper considers the primacy issue relating to automobile no-fault personal injury protection coverage where collateral sources of health insurance benefits are available. It reviews the sources of duplication of coverage and benefits and discusses the approaches to the duplication problem taken by various states in their auto no-fault laws, and in their regulations applicable to other sources of benefits. A survey of the extent of the duplication of coverage and benefits for victims of automobile accidents in Champaign, Illinois, is reported. The results show significant duplication of benefits, especially in medical payments. Although the population from which the sample was drawn is atypical, with consequently atypical results, it can be hypothesized that the aberration results in an understatement of the extent of duplication (and multiplication) of payments. The paper concludes with a discussion of the issues involved in approaches to the solution of the primacy issue. [ABSTRACT FROM AUTHOR]

Background: Existing financial hardship screening does not capture the multifaceted and dynamic nature of the problem. The use of existing health system data is a promising way to enable scalable and sustainable financial hardship screening. Methods: We used existing data from 303 adult patients with cancer at the University of Virginia Comprehensive Cancer Center (2016–2018). All received distress screening and had a valid financial assistance screening based solely on household size‐adjusted income. We constructed a composite index that integrates multiple existing health system data (Epic, distress screening, and cancer registry) to assess comprehensive financial hardship (e.g., material conditions, psychological responses, and coping behaviors). We examined differences of at‐risk patients identified by our composite index and by existing single‐dimension criterion. Dynamics of financial hardship over time, by age, and cancer type, were examined by fractional probit models. Results: At‐risk patients identified by the composite index were generally younger, better educated, and had a higher annual household income, though they had lower health insurance coverage. Identified periods to intervene for most patients are before formal diagnosis, 2 years, and 6 years after diagnosis. Within 2 years of diagnosis and more than 4 years after diagnosis appear critical for subgroups of patients who may suffer from financial hardship disparities. Conclusion: Existing health system data provides opportunities to systematically measure and track financial hardship in a systematic, scalable and sustainable way. We find that the dimensions of financial hardship can exhibit different patterns over time and across patient subgroups, which can guide targeted interventions. The scalability of the algorithm is limited by existing data availability. [ABSTRACT FROM AUTHOR]

This paper studies regulated health insurance markets known as exchanges, motivated by the increasingly important role they play in both public and private insurance provision. We develop a framework that combines data on health outcomes and insurance plan choices for a population of insured individuals with a model of a competitive insurance exchange to predict outcomes under different exchange designs. We apply this framework to examine the effects of regulations that govern insurers' ability to use health status information in pricing. We investigate the welfare implications of these regulations with an emphasis on two potential sources of inefficiency: (i) adverse selection and (ii) premium reclassification risk. We find substantial adverse selection leading to full unraveling of our simulated exchange, even when age can be priced. While the welfare cost of adverse selection is substantial when health status cannot be priced, that of reclassification risk is five times larger when insurers can price based on some health status information. We investigate several extensions including (i) contract design regulation, (ii) self-insurance through saving and borrowing, and (iii) insurer risk adjustment transfers. [ABSTRACT FROM AUTHOR]

Using credit reporting firm records on 7 million individuals in the United States, we first demonstrate that debt in collections varies significantly across the country; specifically, the South and West regions have higher shares of individuals with debt in collections than other regions. Second, we identify local factors that are strongly related to debt in collections. Results from our regression models show that neighborhoods with higher rates of debt in collections are more likely to have (1) lower health insurance coverage; (2) lower home values and homeownership rates, (3) a higher share of delinquent and underwater mortgages, (4) lower household incomes, and (5) a higher share of African Americans and Latinos. While our analysis does not identify the causal mechanisms that determine financial distress, the analyses developed here can facilitate research on such mechanisms. [ABSTRACT FROM AUTHOR]