Health insurers' operations in the face of health care reform: An analysis of the Supplemental Health Care Exhibit

The Patient Protection and Affordable Care Act (ACA) introduced significant changes to the health insurance marketplace in the United States. The act also imposed reporting requirements on insurers. The law has required insurers since 2010 to file yearly the Supplemental Health Care Exhibit (SHCE). The SHCE provides unique information on how health insurers operate. We analyze data in the SCHE to understand how insurers have complied with one of the major new regulations affecting health insurers' operations arising from the ACA—the Medical Loss Ratio (MLR) Provision. This requires that insurers spend a minimum percentage of their premium revenue on medical claims, quality improvement expenses, and deductible fraud and abuse detection and recovery expenses. Our analysis of the 2010–2017 SHCE indicates that insurers' underwriting performance worsened in the early years of the ACA as they worked to increase MLRs to become ACA‐compliant. Analysis of the SHCE further reveals that insurers' profits from managing uninsured plans grew as the profitability of underwriting insured plans decreased. Future research on health insurer operations is warranted. The currently underutilized and data‐rich SHCE provides unique information that makes future research possible.     

Health insurance and its impact on the survival rates of breast cancer patients in Synthea

The goal of this project was to build policy modules in a synthetic health system to analyze how healthcare policy impacts breast cancer survival rates. To do any inference regarding healthcare policy, researchers need secure and protected health data, which are restricted by privacy laws and interoperability issues. Synthetic health systems generate and help investigate health data without concerns of violating legal restrictions (HIPAA). In this research, we programmed health insurance and loss‐of‐care modules into a synthetic health system simulator (Synthea) to simulate and analyze the impact of health insurance on breast cancer survival rates. Our goal was for our health insurance and loss‐of‐care implementations to be realistic and reflective of the real world, in which we were successful.     

The effects of hospital ownership on medical productivity

To develop new evidence on how hospital ownership and other aspects of hospital market composition affect health care productivity, we analyze longitudinal data on the medical expenditures and health outcomes of the vast majority of nonrural elderly Medicare beneficiaries hospitalized for new heart attacks over the period 1985-1996. We find that the effects of ownership status are quantitatively important. Areas with a presence of for-profit hospitals have approximately 2.4% lower levels of hospital expenditures, but virtually the same patient health outcomes. We conclude that for-profit hospitals have important spillover benefits for medical productivity.     

Shifting reactions to risks: a case study

Social science research in the field of risk analysis has emphasised evaluating the magnitude of individuals’ reactions to risks (e.g. strength and salience of concerns, frequency and forcefulness of behaviours that respond to risks). Fewer studies assess the factors that contribute to risk reactions or the types of risks to which reactions are directed (e.g. human health, wildlife health or ecosystem health risks; economic or aesthetic concerns). Theoretical and empirical research on amplification and attenuation of risk (e.g. the Social Amplification of Risk Framework) reveals that the strength of people’s reaction to risks can change markedly over time, as a function of new stimuli. We expand on this foundation to consider here how the types of risks members of the public react to may also shift over the course of their exposure to a hazard, particularly as more information about the hazard becomes available. This case study of risk reactions related to an outbreak of type E botulism in north-western Michigan, USA, demonstrates that the types of risks people react to can change substantially over time. We identify factors that contributed to changes in types of risk reactions, and then consider how these factors potentially distinguish the botulism outbreak from other outbreaks. This case study suggests that, under certain conditions, risk communication can meaningfully alter the types of risks that people react to in response to an environmental hazard. We discuss implications of these findings for risk research, risk communication and environmental conservation.     

Retirement behavior and retirement plan designs: strategies to retain an aging workforce

Certain retirement and retiree health plan design features trigger different retirement behaviors among top performers and low performers and among workers of different wage levels. However, previous research has revealed little of these effects. Using a unique data set, this article shows how specific design features affect workers' retirement behavior, allowing employers to focus on those most likely to influence the most productive workers to delay retirement.     

医疗保险、健康异质性与精准脱贫——基于贫困脆弱性的分析

医疗保险能否有效减少贫困,尚未达成共识。本文利用CHARLS全国调查数据,基于资产度量个体的贫困脆弱性(即陷贫概率),实证分析医疗保险参保行为及其保障水平对贫困脆弱性的影响。研究表明,参与医疗保险和提高医疗保险保障水平的减贫效果都存在健康异质性,对健康状况差的群体有显著的减贫效果,而对健康状况好的群体减贫效果不显著。此外,本文证实了改善劳动供给是医疗保险减贫的重要中介渠道之一。     

数字普惠金融与未预期风险应对:理论与实证

本文构建理论模型刻画数字普惠金融对居民未预期风险应对的影响,并基于世界银行2014年和2017年中国普惠金融微观数据进行实证检验。研究表明,数字普惠金融能够有效提高居民风险应对能力,增强贫困人口抵抗风险冲击的韧性。但考虑个体多重借贷行为后发现,适度借贷有益于改善居民风险分担,过度借贷则会损害其风险防御能力,进而弱化数字普惠金融的风险平滑效应,这意味着数字普惠金融增强居民风险应对能力是建立在理性借贷基础之上。进一步分析发现,数字普惠金融还能帮助遭受风险冲击的家庭平稳消费,这一影响主要来源于对非耐用品支出的促进作用。此外,机制检验表明数字普惠金融能在扩大风险分担网络、增进信任机制、培养金融习惯以及提升服务效率等方面带来重要影响。本文为我国推进数字技术与普惠金融融合创新,营造健康数字普惠金融生态圈提供了一定启示。     

THE EFFECT OF TAX PREFERENCES ON HEALTH SPENDING

In this paper, we estimate the effect of the tax preference for health insurance on health care spending using data from the Medical Expenditure Panel Surveys from 1996-2005. We use the fact that Social Security taxes are only levied on earnings below a statutory threshold to identify the impact of the tax preference. Because employer-sponsored health insurance premiums are excluded from Social Security payroll taxes, workers who earn just below the Social Security tax threshold receive a larger tax preference for health insurance than workers who earn just above it. We find a significant effect of the tax preference, consistent with previous research.     

Is Investor Attention for Sale? The Role of Advertising in Financial Markets

Prior research documents capital market benefits of increased investor attention to accounting disclosures and media coverage; however, little is known about how investors and markets respond to attention‐grabbing events that reveal little nonpublic information. We use daily firm advertising data to test how advertisements, which are designed to attract consumers' attention, influence investors' attention and financial markets (i.e., spillover effects). Exploiting the fact that firms often advertise at weekly intervals, we use an instrumental variables approach to provide evidence that print ads, especially in business publications, trigger temporary spikes in investor attention. We further find that trading volume and quoted dollar depths increase on days with ads in a business publication. We contribute to research on how management choices influence firms' information environments, determinants and consequences of investor attention, and consequences of advertising for financial markets.     

The role of the PBM in total health management strategies for individuals with chronic conditions

In this article, we examine the multiple data sources and outcomes surrounding the management of both pharmacy and medical cost spending for chronic health care in one pharmacy benefit manager (PBM). We offer examples of how the complex relationship between interventions and spending is utilized in order to bring value to PBMs' clients above and beyond the scope of traditional pharmacy trend analytics. Additionally, we demonstrate how the implementation of disease management programs can effectively impact the largest component of total health care costs.     

Health trend assessment in Indonesia Futures studies at the provincial level

Health trend assessment studies have been carried out in Indonesia at the national and provincial levels, to provide input into long-term national development plans and to build up the capacity for local health planning in anticipation of decentralization. Provincial health trend assessment studies have been done in five provinces by teams from local health and planning authorities and the local school of public health. These provincial teams have all used background documents and standard procedures developed by a national team and have gone through the same methodological training. Out of the experience have come specific ideas about how trend assessment and similar activities can be strengthened. Among the recommendations are the establishment of national research centres for trend analysis, efforts to improve availability and reliability of relevant data, the training of a cadre of health professionals familiar with futures methods, and continued promotion by WHO and other agencies of long-term health planning and health futures.     

The Role of Unhealthy Behaviors on an Individual's Self-Reported Perceived Health Status

Many health plans and employers gather information about their enrollees in the form of self-reported surveys. This information is useful in assessing the risk pool of the population, targeting disease or case management programs to affected personnel, and developing/assessing wellness/incentive programs to lower medical costs and improve quality of life. The purpose of our study is to explore the role of individual-level unhealthy behaviors in influencing self-reported perceived health status. We extend prior research to estimate the effects of unhealthy behaviors on subsequent perceived health status using longitudinal data for the noninstitutional civilian adult population in the United States. We link data from two sources, the National Health Interview Survey (NHIS) and the longitudinal form of the Medical Expenditure Panel Survey (MEPS). Both the NHIS and MEPS data were collected using a complex survey design, enabling our results to be representative of the U.S. noninstitutionalized civilian population. We find that an increase in the number of unhealthy behaviors reduces the likelihood of individuals perceiving their health status as Excellent. In contrast, the likelihood of individuals perceiving their health status as Poor increases as the number of unhealthy behaviors increases, with a more pronounced effect for individuals with medically diagnosed conditions or perceived functional limitations.     

WHO''s health futures consultation

The World Health Organization's 1993 consultation on health futures examined the field from perspectives of the macro-environment, health status, health resources, emerging health technology, alternative care systems, and tools for health futures research. The consultation produced numerous suggestions about how WHO could promote and support health futures work. Among the ideas now being implemented are new efforts in global surveillance of infectious diseases, the publication of health futures articles, the establishment of an electronic health futures bulletin board, and preparation of a handbook for health futures studies.     

Moral hazard,adverse selection,and health expenditures: A semiparametric analysis

Theoretical models predict asymmetric information in health insurance markets may generate inefficient outcomes due to adverse selection and moral hazard. However, previous empirical research has found it difficult to disentangle adverse selection from moral hazard in health care consumption. We propose a two‐step semiparametric estimation strategy to identify and estimate a canonical model of asymmetric information in health care markets. With this method, we can estimate a structural model of demand for health care. We illustrate this method using a claims‐level data set with confidential information from a large self‐insured employer. We find significant evidence of moral hazard and adverse selection.     

Does prestigious board membership matter? Evidence from New Zealand

This study investigates whether ‘prestigious’ multiple board membership is positively associated with firm performance. We employ Resource Dependency theory to explain why performance outcomes may be improved by the presence of ‘prestigious’ multiple directorships. Our analysis relies on extensive hand‐collected data on New Zealand company directorships. The results support the contention that ‘prestigious’ multiple directorships are related to better accounting and market performance. Conclusions reflect upon how Resource Dependency theory informs this phenomenon and how ‘prestigious’ board members may be a valuable resource for firms. We also reveal how these findings expose a new avenue for board governance research.     

Went Fundholding, Going Commissioning? Some Evidence-Based Reflections on the Prospects for Primary Care Groups

Following the publication of the White Paper, 'The New NHS: Modern, Dependable' (Cm 3807), the Labour Government has abolished GP fundholding. Family doctors retain a lead role for primary care in planning health care with the creation of Primary Care Groups (PCGs). In due course, it is expected that health authorities will relinquish direct commissioning of care to PCGs. Although fundholding is ending, its operation provides useful evidence about how GPs approach participation in the planning of health care. This article reflects on the prospects for PCGs, drawing on original research into the reasons why practices volunteered to 'go fundholding' and how those practices selected their 'lead' partner, on whom much of the fundholding burden fell.     

Owning and testing smoke alarms: findings from a qualitative study

Reducing injury and death in house fires is an important public health intervention activity with the presence of an operating smoke alarm widely considered an important way of reducing harm from fire. Yet despite a number of initiatives and fire-safety campaigns, a number of households at greater risk of domestic fire fail to have a functioning alarm. This paper provides empirical insight into everyday experiences of owning, maintaining and testing smoke alarms among a purposive sample of individuals identified as being less likely to own a functioning smoke alarm. Analysis from focus group data identifies a number of reasons why individuals may not own or test an alarm, and provides new insight into how fire risk is understood in the context of a range of competing, and potentially more prominent, individual and household risks. We suggest that while initiatives that aim to reduce fire injury and death should be continued, their success, and indeed future research on fire risk, should pay attention to the mundane and everyday contexts within which individuals currently rarely reflect on their risk of experiencing a domestic fire.     

A symposium on Understanding Society,the UK Household Longitudinal Study: introduction

Understanding Society, the UK Household Longitudinal Study began in 2009, and built on and incorporated its predecessor the British Household Panel Survey. It is the largest survey of its kind in the world and provides rich opportunities for economic research and policy analysis. In this introduction to a symposium on Understanding Society, we review the main features of the study, how it is conducted, and evidence on data quality. We also discuss past and potential uses in economic research.     

Systematic Mortality Improvement Trends and Mortality Heterogeneity: Insights from Individual-Level HRS Data

Providers of life annuities and pensions need to consider both systematic mortality improvement trends and mortality heterogeneity. Although how mortality improvement varies with age and gender at the population level is well studied, how trends vary with risk factors remains relatively unexplored. This article assesses how systematic mortality improvement trends vary with individual risk characteristics using individual-level longitudinal data from the U.S. Health and Retirement Study between 1994 and 2009. Initially a Lee-Carter model is used to assess mortality improvement trends by grouping individuals with similar risk characteristics of gender, education, and race. We then fit a longitudinal mortality model to individual-level data allowing for heterogeneity and time trends in individual-level risk factors. Our results show how survey data can provide valuable insights into both mortality heterogeneity and improvement trends more effectively than commonly used aggregate models. We show how mortality improvement differs across individuals with different risk factors. Significantly, at an individual level, mortality improvement trends have been driven by changes in health history such as high blood pressure, cancer, and heart problems rather than risk factors such as education, marital status, body mass index, and smoker status.     

Housing returns,precautionary savings and consumption: Micro evidence from China

We investigate how changes in home prices affect consumption in China via a wealth channel. Examining a panel of 7955 households via fixed effects and instrumental variable methods, we find a marginal propensity to consume out of housing wealth (home-price MPC) that is concentrated on goods consumed for pleasure rather than necessity. This trend is driven by the value of second homes rather than that of primary residences, suggesting a wealth channel. We further examine whether returns on housing investment, including rental income and home appreciation, fund the wealth channel; however, we find little supporting evidence. In contrast, a reduction in health risk increases the home-price MPC, but a reduction in income risk that also relieves precautionary saving motives does not. Our results are robust to alternative data, common-factor progress, expenditure shocks and bequest motives. We contribute by examining second homes, which carry little of the dual nature of housing that primary residences do, to identify a controversial wealth channel, and by studying the relative effects of health and income risks on the wealth channel.