Risk Adjustment Risk Sharing and Premium Regulation in Health Insurance Markets

Risk Adjustment  Risk Sharing and Premium Regulation in Health Insurance Markets
Author: Thomas G. McGuire,Richard C. Van Kleef
Publsiher: Academic Press
Total Pages: 648
Release: 2018-08-06
Genre: Business & Economics
ISBN: 9780128113264

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Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment. Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection Brings together international experience from many different countries that apply regulated competition in different ways Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness

Employment and Health Benefits

Employment and Health Benefits
Author: Institute of Medicine,Committee on Employment-Based Health Benefits
Publsiher: National Academies Press
Total Pages: 376
Release: 1993-02-01
Genre: Medical
ISBN: 9780309048279

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The United States is unique among economically advanced nations in its reliance on employers to provide health benefits voluntarily for workers and their families. Although it is well known that this system fails to reach millions of these individuals as well as others who have no connection to the work place, the system has other weaknesses. It also has many advantages. Because most proposals for health care reform assume some continued role for employers, this book makes an important contribution by describing the strength and limitations of the current system of employment-based health benefits. It provides the data and analysis needed to understand the historical, social, and economic dynamics that have shaped present-day arrangements and outlines what might be done to overcome some of the access, value, and equity problems associated with current employer, insurer, and government policies and practices. Health insurance terminology is often perplexing, and this volume defines essential concepts clearly and carefully. Using an array of primary sources, it provides a store of information on who is covered for what services at what costs, on how programs vary by employer size and industry, and on what governments do--and do not do--to oversee employment-based health programs. A case study adapted from real organizations' experiences illustrates some of the practical challenges in designing, managing, and revising benefit programs. The sometimes unintended and unwanted consequences of employer practices for workers and health care providers are explored. Understanding the concepts of risk, biased risk selection, and risk segmentation is fundamental to sound health care reform. This volume thoroughly examines these key concepts and how they complicate efforts to achieve efficiency and equity in health coverage and health care. With health care reform at the forefront of public attention, this volume will be important to policymakers and regulators, employee benefit managers and other executives, trade associations, and decisionmakers in the health insurance industry, as well as analysts, researchers, and students of health policy.

Models of Health Plan Payment and Quality Reporting

Models of Health Plan Payment and Quality Reporting
Author: Jacob Glazer,Thomas G McGuire
Publsiher: World Scientific Publishing Company
Total Pages: 208
Release: 2016-12-22
Genre: Business & Economics
ISBN: 9789813202887

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The book pulls together a series of articles by the authors that initiated the research areas of "optimal risk adjustment" and "optimal quality reporting." The papers present the basic theoretical models and link them to empirical application. Design of health insurance premiums to achieve efficient and fair outcomes is also covered. The chapters in the book also cover the intellectual development of approaches to health insurance regulation, beginning with more abstract models to those with explicit empirical and policy applications.

Epidemics and the Health of African Nations

Epidemics and the Health of African Nations
Author: MISTRA MISTRA
Publsiher: African Books Collective
Total Pages: 440
Release: 2019-07-25
Genre: Social Science
ISBN: 9780639995601

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News footage of disease in Africa is a familiar sight. Yet these outbreaks are often presented out of context, with no reference to the conditions that have triggered them. MISTRA’s new book, Epidemics and the Health of African Nations, aims to redress that. Researchers and practitioners from within the continent explore why Africa is so vulnerable to disease, and show how this vulnerability is closely linked to political and economic factors. They demonstrate how these same factors determine the way epidemics are treated. Authors extract lessons from case studies in different parts of Africa; challenge conventional frameworks about disease to argue for a ‘syndemics’ approach that takes into account the interrelationship between disease and political and socio-economic contexts; explore challenges of Africa’s future. They argue that a well-functioning health system is at the core of a country’s capacity to counter an epidemic. This volume brings African experts together to probe possible solutions to the continent’s heavy burden of disease. The insights offered will be helpful in devising policy for the control of disease and the combatting of epidemics in Africa.

The Future of Disability in America

The Future of Disability in America
Author: Institute of Medicine,Board on Health Sciences Policy,Committee on Disability in America
Publsiher: National Academies Press
Total Pages: 618
Release: 2007-10-24
Genre: Medical
ISBN: 9780309104722

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The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades. Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research. The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society.

Price Setting and Price Regulation in Health Care

Price Setting and Price Regulation in Health Care
Author: OECD,World Health Organization,Barber Sarah L,Lorenzoni Luca,Ong Paul
Publsiher: OECD Publishing
Total Pages: 298
Release: 2019-06-26
Genre: Electronic Book
ISBN: 9789264508866

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The objectives of this study are to describe experiences in price setting and how pricing has been used to attain better coverage, quality, financial protection, and health outcomes. It builds on newly commissioned case studies and lessons learned in calculating prices, negotiating with providers, and monitoring changes. Recognising that no single model is applicable to all settings, the study aimed to generate best practices and identify areas for future research, particularly in low- and middle-income settings. The report and the case studies were jointly developed by the OECD and the WHO Centre for Health Development in Kobe (Japan).

Private Health Insurance and the European Union

Private Health Insurance and the European Union
Author: Cyril Benoît,Marion Del Sol,Philippe Martin
Publsiher: Springer Nature
Total Pages: 333
Release: 2020-12-03
Genre: Political Science
ISBN: 9783030543556

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Research has paid little attention to date on how European Union law and regulation affect both the public-private mix in healthcare and the organization of private health insurance as an industry. Filling this gap, this collective book provides insights on the political economy of EU insurance regulation, its impact on private health insurers and on its interactions with domestic healthcare policy-making in four countries. Assembling original contributions drafted by a multidisciplinary team, Private Health Insurance and the European Union offers a thorough examination of a largely unrecognized source of EU influence in healthcare – and sheds a new light on the role played by private actors in social policy. Chapter 1 is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com.

The Oxford Handbook of the Welfare State

The Oxford Handbook of the Welfare State
Author: Daniel Béland,Kimberly J. Morgan,Herbert Obinger,Christopher Pierson
Publsiher: Oxford University Press
Total Pages: 1024
Release: 2021-10-22
Genre: Political Science
ISBN: 9780198828389

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This is the much anticipated revised second edition of a volume that was welcomed at its first appearance as 'the most authoritative survey and critique of the welfare state yet published'. It is an indispensable one-volume guide to what modern states spend most of their time and money doing.

Federal Register

Federal Register
Author: Anonim
Publsiher: Unknown
Total Pages: 135
Release: 2013-03
Genre: Delegated legislation
ISBN: UCR:31210024841023

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Voluntary Health Insurance in Europe

Voluntary Health Insurance in Europe
Author: Anna Sagan,Sarah Thomson
Publsiher: World Health Organization
Total Pages: 161
Release: 2016-07-21
Genre: Business & Economics
ISBN: 9789289050371

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No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved. This volume contains short, structured profiles of markets for VHI in 34 countries in Europe. These are drawn from European Union member states plus Armenia, Iceland, Georgia, Norway, the Russian Federation, Switzerland and Ukraine. The book is aimed at policy-makers and researchers interested in knowing more about how VHI works in practice in a wide range of contexts. Each profile, written by one or more local experts, identifies gaps in publicly-financed health coverage, describes the role VHI plays, outlines the way in which the market for VHI operates, summarizes public policy towards VHI, including major developments over time, and highlights national debates and challenges. The book is part of a study on VHI in Europe prepared jointly by the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe. A companion volume provides an analytical overview of VHI markets across the 34 countries.

Market Structure of the Health Insurance Industry

Market Structure of the Health Insurance Industry
Author: D. Andrew Austin
Publsiher: DIANE Publishing
Total Pages: 61
Release: 2010-04
Genre: Health care reform
ISBN: 9781437926460

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State Health Insurance Market Reform

State Health Insurance Market Reform
Author: Joel C. Cantor,Alan C. Monheit
Publsiher: Routledge
Total Pages: 192
Release: 2012-09-25
Genre: Business & Economics
ISBN: 9780415651950

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In this volume, leading American health economists provide a critical assessment of the current state of knowledge of insurance market reform that is accessible to both policy-makers and researchers.

How Adverse Selection Affects the Health Insurance Market

How Adverse Selection Affects the Health Insurance Market
Author: Paolo Belli
Publsiher: World Bank Publications
Total Pages: 31
Release: 2022
Genre: Electronic Book
ISBN: 9182736450XXX

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There may be a price to pay (in terms of inefficient coverage) if competition among health insurers is encouraged as a way to give patients greater choice and to achieve better control over insurance providers.

Health Care Utilization as a Proxy in Disability Determination

Health Care Utilization as a Proxy in Disability Determination
Author: National Academies of Sciences, Engineering, and Medicine,Health and Medicine Division,Board on Health Care Services,Committee on Health Care Utilization and Adults with Disabilities
Publsiher: National Academies Press
Total Pages: 160
Release: 2018-04-02
Genre: Medical
ISBN: 9780309469210

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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Health Insurance Market Reform

Health Insurance Market Reform
Author: United States,United States. Congress. Senate. Committee on Finance
Publsiher: Unknown
Total Pages: 138
Release: 1994
Genre: Government publications
ISBN: UCR:31210014050742

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