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Copyright of Çalışma ve Toplum is the property of Calisma ve Toplum and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Studia Historica Brunensia is the property of Masaryk University, Faculty of Arts and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The prices that insurers pay physicians ultimately affect beneficiaries' health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare's fee-for-service (FFS) program would pay for the same service. MA prices paid by those insurers were close to Medicare FFS prices, varied minimally, and were similar in and out of network. In contrast, commercial prices paid by the same insurers were substantially higher than FFS, varied widely, and were up to three times higher out of network than in network. Those results suggest that insurers can use statutory limits on out-of-network charges in MA to negotiate lower in-network prices in those plans. In contrast, without those limits on out-of-network prices, in-network prices in commercial plans are much higher. [ABSTRACT FROM AUTHOR]

India is one of the important countries in world trade as far as the service sector is concerned. The health insurance sector continues to be one of the most dynamic and fast-evolving constituents of the Indian Insurance Industry. This paper makes an attempt to examine the expectations and perceptions of policyholders regarding health insurance service quality of public and private sector general insurance companies. The data is collected from 800 health insurance policyholders in Greater Mumbai region, Maharashtra, India using simple random sampling technique. Structured questionnaire is used for collecting primary data. Secondary data is collected from journals, books, websites etc. The top 8 general insurance companies including the public and private sector, operating in India, was selected. The study is based on the SERQUAL model developed by Parasuraman et al. The study is based on five factors of health insurance service quality viz; Reliability, Empathy, Access, Responsiveness and Tangibles. Statistical tools used in the study are Parametric Paired 't' test, mean and standard deviation. The study revealed that there is a significant difference in the expectations and perceptions of policyholders regarding Health Insurance Service Quality factors (Reliability, Empathy, Access, Responsiveness and Tangibles) in both public and private sector general insurance companies. Also, all differences are positive, which denotes that customer's expectations exceed customer's perception. The general insurance company should try to bridge the gap between expectations and perceptions of the customers to satisfy the customers and to retain them. Customer satisfaction depends on the agreement between expectations and perceptions of service quality. [ABSTRACT FROM AUTHOR]

This article considers the extent to which Affordable Care Act state Medicaid expansions alleviated the burden of out-of-pocket costs associated with obtaining health insurance and medical care using data from the 2011 to 2016 Current Population Survey Annual Social and Economic Supplement. Using a difference-in-differences framework, the analysis examines effects of the Medicaid expansions on out-of-pocket expenditures for health insurance premiums and medical care, comparing expenditures across expansion and nonexpansion states before and after the expansions were implemented, performing separate analyses for individuals with family income at various eligibility cutoff levels in the first and second years of expansion implementation. The findings suggest that the expansions were associated with a relatively larger likelihood of having zero premium expenditures and of having zero nonpremium medical out-of-pocket expenditures for low-income individuals. These findings suggest that the expansions were effective in reducing medical out-of-pocket expenditures. [ABSTRACT FROM AUTHOR]

A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012-13 Ghana Living Standards Survey (n = 72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (-5 p.p. vs -9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (-10 p.p. vs. -6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between insurer market structure, health plan quality, and health insurance premiums in the Medicare Advantage (MA) program.Data Sources/study Setting: Administrative data files from the Centers for Medicare and Medicaid Services, along with other secondary data sources.Study Design: Trends in MA market concentration from 2008 to 2017 are presented, alongside logistic and linear regression models examining MA plan quality and premiums as a function of insurer market structure for 2011.Data Collection/extraction Methods: Data are publicly available.Principal Findings: MA plans that tend to operate in more concentrated MA markets have a higher predicted probability of receiving a high-quality health plan rating. Operating in more concentrated MA markets was also found to be associated with higher premiums. Among plans that tend to operate in very concentrated MA markets, high-quality MA plans were associated with premiums as much as two times higher than premiums associated with lower-quality plans.Conclusions: Any policies directed at enhancing insurer competition should consider implications for health plan quality, which may be very different than the implications for enrollee premiums. [ABSTRACT FROM AUTHOR]

The current research aimed to advance the psychological reactance theory literature by extending this framework to older adults (N = 525) age 55 or older. In doing so, this project tests two principles of reactance theory as well as exploring the relationship between reactance and a behavioral outcome. Results demonstrated that the threat of additional driver's license requirements, issue involvement, and the personal relevance of the threatened freedom increased freedom threat perceptions. In turn, freedom threat perceptions were positively associated with reactance. Reactance was positively associated with agreeing to sign a petition protesting the proposed requirements. The same pattern of findings was replicated within the context of maintaining low cost health insurance premiums. In addition to these main effects, two interactions (additional test requirements * issue involvement and additional test requirements * personal 2 relevance) were explored. Results are discussed with an emphasis on the theoretical and practical implications for psychological reactance theory among older adults. [ABSTRACT FROM AUTHOR]

Background: The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households’ decisions to enrol and renew membership in these schemes. Methods: We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively. Results: Results revealed that household’s socioeconomic status, husband’s employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. Conclusion: While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing. [ABSTRACT FROM AUTHOR]

Ghana implemented the National Health Insurance Scheme (NHIS) in 2005 with the intention of providing residents with quality affordable healthcare. Over the past few years, concerns have been raised about the quality of healthcare clients receive. This study assesses the experiences of NHIS subscribers with the quality of care they receive under the scheme by both private and public hospitals. The results from the 56 interviews show that the majority of the subscribers were dissatisfied with the overall quality of healthcare they received in both private and public hospital because of the long waiting hours, the poor attitude of nurses and the demand for payment of additional money. Even though clients who visited the private hospital paid for all services, excluding consultation, their level of satisfaction with the quality of healthcare was relatively higher than those who visited the public hospital. The paper concludes that NHIS clients do not receive the quality of healthcare the scheme promised, and this has implications for premium renewals and health-seeking behaviour. [ABSTRACT FROM AUTHOR]

social and health insurance premiums) which in short- and long-term affect entrepreneurial decisions. The analysis pinpoints the structural elements of taxes which enable various tax strategies. On the basis of the empirical data collected the authors determine as well the average amount of income tax, the scale of use of stimulus instruments, the level of impact of the discussed burdens on the financial results of enterprises, and costs related to property taxes and social insurance. [ABSTRACT FROM AUTHOR]

One goal of the Affordable Care Act (ACA) was to enable entrepreneurship by increasing access to non-employer-based health insurance. We evaluate the extent to which the ACA was successful at this, providing some of the first estimates of the effect of the main provisions of the ACA on entrepreneurship. We are the first to focus specifically on older adults, whose higher average health costs and health insurance premiums make health insurance more salient to their labor market decisions. We do so using data from the American Community Survey and a difference-in-difference strategy, taking advantage of Medicare-eligibles as a control group less affected by the ACA. We find that the ACA led to a 3-4% increase in self-employment. We find similar increases in the likelihood of being self-employed in an incorporated business and of generating at least $5000 in business income, as well as a 9% increase in the likelihood of being self-employed full time. By lowering the cost of non-employer health insurance policies to older adults, the ACA appears to have eased their transition from employment to self-employment. [ABSTRACT FROM AUTHOR]

Since 2014, average premiums for health plans available in the Affordable Care Act marketplaces have increased. We examine how premium price changes affected the amount consumers pay after subsidies for the lowest-cost bronze and silver plans available by age in the federally facilitated exchanges. Between 2015 and 2016, benchmark plan premiums increased in 83.3% of counties. Overall, rising benchmark premiums were associated with lower average after-subsidy premiums for the lowest-cost bronze and silver plans for older subsidy-eligible adults, but with higher after-subsidy premiums for younger adults purchasing the same plans, regardless of income. With recent discussions to replace or overhaul the Affordable Care Act, it is critical that we learn from the successes and failures of the current policy. Our findings suggest that the subsidy design, which makes rising premiums costlier for younger adults looking to purchase an entry-level plan, may be contributing to adverse selection and instability in the marketplace. [ABSTRACT FROM AUTHOR]

Health insurance policy is a current topic of concern for the United States. The classroom game discussed here provides students with a thorough understanding of some of the policy options under debate, in addition to demonstrating the classic problem of adverse selection. Students received probabilities of encountering a variety of medical expenses, based on their randomly assigned fictitious person's age and health status. In each round, students made insurance decisions and then rolled dice to determine outcomes for each possible medical expense. The experiment considered insurance with an individual mandate, insurance without an individual mandate, insurance where students could purchase à la carte coverage mimicking proposed insurance riders for certain coverage, and insurance where pre-existing conditions were not covered. [ABSTRACT FROM AUTHOR]

In 1991, Dannon employees had the choice to stay with their current health care plan or switch to a new plan which offered a lower premium and less hospital cost coverage that better fit the needs of most employees. Both plans were the same in all other respects. Only 25% of employees chose the new lower-premium plan over the old plan. This article reports a collaborative effort between The Dannon Company and Cornell University's Center for Advanced HR Studies to identify the patterns of employee choices, and the effects of those choices on the actual costs that employees incurred. The actual decisions of 287 Dannon employees were examined, and the out-of-pocket costs that they actually incurred in the two years after the plan was introduced were calculated. [ABSTRACT FROM AUTHOR]