Health Insurance

Financial and structural characteristics of the public and private programs that cover medical costs. LDI analyzes how to expand and improve coverage through insurance exchanges, employer-sponsored insurance, and public programs.

Is American Pet Health Care (Also) Uniquely Inefficient?

Jun. 29, 2017

Liran Einav, Amy Finkelstein, Atul Gupta

In American Economic Review, Liran Einav and colleagues, including Atul Gupta, examine similarities between human and pet health care in the U.S.. The authors note similarities in rapid growth in spending in both industries, with wealthier families spending significantly more on both human and pet health. They also note a rapid increase in employment of health care providers in both industries, an increase in medical technology use, and a similar propensity for high spending at the end of life. While human and pet health care share a number of similarities, they also note...

Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes

Jun. 29, 2017

Laura A. Dummit, Daver Kahvecioglu, Grecia Marrufo, Rahul Rajkumar, Jaclyn Marshall, Eleonora Tan, Matthew J. Press, Shannon Flood, L. Daniel Muldoon, Qian Gu, Andrea Hassol, David M. Bott, Amy Bassano, Patrick H. Conway

In JAMA, Laura Dummit and colleagues, including Matthew Press, evaluate whether a Centers for Medicare and Medicaid Services (CMS) bundled payment pilot program is associated with a reduction in Medicare payments. Specifically, the authors assess if Bundled Payments for Care Improvement (BPCI) reduced Medicare payments and maintained quality in lower extremity joint replacement. This CMS program was launched in 2013 to test whether linking payments for services provided during an episode of care can reduce Medicare payments and maintain quality. The authors used a difference-in-...

The Economics of Medicaid Reform and Block Grants

Jun. 27, 2017

Paula Chatterjee, Benjamin D. Sommers

In The JAMA Forum, Paula Chatterjee and colleagues explore the rationale for and potential effects of repealing the Affordable Care Act (ACA). The authors argue that Medicaid will be disproportionately affected, as 12 of the 20 million individuals who gained coverage through the ACA are on Medicaid. They assess arguments for Medicaid reform, examine policy implications, and explore potential effects on patients. They examine how these changes would affect current Medicaid payment models, and posit that providers may be more limited in services they can offer to Medicaid recipients...

‘A Giant Step in the Wrong Direction’

Jun. 26, 2017

Forty economists and health policy experts, including Dan Polsky and Zeke Emanuel, have signed a strongly worded letter opposing the Better Care Reconciliation Act (BCRA), the Senate proposal to repeal the Affordable Care Act.

Exit, Voice or Loyalty? An Investigation into Mandated Portability of Front-Loaded Private Health Plans

Jun. 15, 2017

Juan Pablo Atal, Hanming Fang, Martin Karlsson, and Nicholas R. Zieberth

In a National Bureau of Economic Research Working Paper, Juan Pablo Atal and colleagues, including Hanming Fang, study how a mandate designed to increase competition in the German private health care market influences rates of consumers switching insurers or switching plans within an insurer. In the German system, those who opt into private insurance are required to front-load premium costs, so that younger, healthier consumers pay disproportionately into old-age provisions to offset increased costs for older enrollees. Before a 2009 mandate, consumers who switched insurers could...

Market environment and Medicaid acceptance: What influences the access gap?

May. 1, 2017

Amy Bond, William Pajerowski, Dan Polsky, and Michael R. Richards

In Health Economics, LDI Fellow Amelia Bond and colleagues raise important questions about potential positive effects of provider and insurer concentration on primary care appointment availability for new Medicaid patients. The study assesses whether the two health care industry trends of expanding Medicaid and greater integration and consolidation among insurers and providers may have implications for each other.

Using “secret shopper” data on primary care physicians' real-world behavior, the authors observed provider willingness to accept new privately insured and...

Taking Subsidies Off the Exchanges

Apr. 26, 2017

The Affordable Care Act (ACA) has an “empty shelf” problem: consumers can use their premium subsidies only on the public health insurance exchanges, but insurers are not required to offer any plans on these exchanges.

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