Inquiry J Health Car
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Inquiry J Health Car · Jan 2009
Risk selection and risk adjustment: improving insurance in the individual and small group markets.
Insurance market reforms face the key challenge of addressing the threat that risk selection poses to the availability, of stable, high-value insurance policies that provide long-term risk protection. Many of the strategies in use today fail to address this breakdown in risk pooling, and some even exacerbate it. Flexible risk adjustment schemes are a promising avenue for promoting market stability and limiting insurer cream-skimming, potentially providing greater benefits at lower cost. Reforms intended to increase insurance coverage and the value of care delivered will be much more effective if implemented in conjunction with policies that address these fundamental selection issues.
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We obtained patient-level cost data from one hospice to explore variation in hospice costs across patients. We found that average per day costs decreased as duration of hospice stay increased. ⋯ We identify possible alterations to the Medicare per diem payment system that could address these issues, including higher per diems for the first and last days and an adjuster for nursing home residence. However, replicating these results using data from a broader, more representative sample of hospices is needed before making changes to the per diem system.
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This study examined length of service use among U. S. adult hospice patients based on data from the 1992-2000 National Home and Hospice Care Surveys. ⋯ Findings show that length of service use decreased significantly among adult patients who had Medicare as their only payment source. Although overall length of service use declined significantly in 1996, 1998, and 2000 compared to 1992, it was similar between 1996 and 2000.
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This paper presents several options designed to help the Commonwealth of Massachusetts move to universal health insurance coverage. The alternatives all build upon a common base that includes an expansion of the Medicaid program, income-related tax credits, a purchasing pool, and government-sponsored reinsurance. ⋯ The cost of an employer mandate--with a "pay or play" design--is sensitive to the payroll tax rate and base, the number and kind of exemptions, and whether workers whose employers "pay" receive discounts when they purchase health insurance. The development of these alternatives and their analyses contributed to the eventual health care compromise that emerged in Massachusetts in April 2006.
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This paper estimated the effects of tort law and insurer investment returns on physician malpractice insurance premiums. Data were collected on tort law from 1991 through 2004, and multivariate regression models, including fixed effects for state and year, were used to estimate the effect of changes in tort law on medical malpractice premiums. The premium consequences of national policy changes were simulated. ⋯ Simulation results indicate that a national cap of dollar 250,000 on awards for noneconomic damages in all states would imply premium savings of dollar 16.9 billion. Extending a dollar 250,000 cap to all states that do not currently have them would save dollar 1.4 billion annually, or about 8% of the total. A negative effect on malpractice premiums was found for the Dow Jones industrial average, but not for bond prices; effects of the Nasdaq index were not significant for internal medicine, but were marginally significant for surgery and obstetrics premiums.