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.     

The public sector and health care

This paper specifies a model of the determinans of total expenditure on health care. The model shows how this expenditure is divided between the public and private sectors when public expenditures are chosen by majority rule.From the theoretical model I derive two equations determining the private and public expenditures on health care as shares of GDP. The equations are estimated using OECD panel data with two-way fixed effects and with simultaneous correction for heteroeskedasticity and serial correlation. The results include estimates of the price and income elasticities of public and private demands for health care as well as estimates of the crowdingout effects of public on private expenditures.Paper presented at the 51st Congress of the International Institute of Public Finance.     

Researching accounting in health care: considering the nature of academic contribution

As academics we naturally seek to address interesting and important questions. Our concerns for rigour drive us to work from generally accessible preoccupations towards more narrowly and precisely defined questions however. Such specialisation is properly understood as a source of strength in our knowledge. The growing impact of governance mechanisms surrounding journal rankings threatens this strength by attacking our abilities to produce, but also to integrate, the specialised contributions that we make however. This article will expand upon this basic argument and further elaborate it through a discussion of the academic literature around costing in health care.     

论商业健康保险在新医疗保障体系中的地位

国务院新公布的《关于深化医药卫生体制改革的意见(征求意见稿)》引发了社会各界的高度关注,方案中明确提出在新的医疗保障制度构建中要积极发展商业健康保险。国际经验表明,要建立一个高效率运行和可持续发展的医疗保障体系,商业健康保险是不可或缺的重要组成部分。本文从经济学理论和医疗保障的实践结果两个角度出发,论述商业健康保险与社会医疗保险合理配合的必要性,以及商业健康保险在医疗保障体系中的优势和特殊作用,并对进一步确保我国商业健康保险发展提出相应的政策建议。     

Health care reform and reform for health: creating a health system for communities in the 21st century

If we are to improve the health of the population and reduce the inequalities in health that plague our communities and our planet, we will have to give greater attention to the determinants of health. The reform of the health care system, necessary though it is, will never be sufficient; we need to reform our whole society and in particular to focus on human rather than economic development. At the community level we need to create healthy communities that are “health-creating systems” of environmental, social and human development, as well as health care systems that focus first on improving and maintaining health. Such a “bottom-down” health care system would see the hospital become once again the place of last resort (but still a potentially important partner in creating healthier communities) and would focus instead on how to provide health promotion and health care from the household level up.     

Innovation and the trade elasticity

The reaction of trade volumes to tariffs is far larger than what current models predict. One reason for this is that they abstract from endogenous productivity choices (“innovation”), which amplify this reaction. To show this, I develop a model of international trade with innovation, and calibrate it to Canada and United States before the Free Trade Agreement. Feeding in the tariff drops observed during the agreement, the increase in the trade volumes is within the empirical estimates. Without innovation, the change in trade volumes is too low, and similar to what current models without innovation have found.     

Information-sharing in health and social care: Lessons from a socio-technical initiative

Advances in information technology have led to new and innovative approaches in data-sharing, analysis, interpretation, and the potential for real-time responses to changes in health and social care status. However, health and social care information is not only complex but often socially and personally sensitive in ways that do not apply in other domains. This requires adoption of a tailored interdisciplinary (social, ethical, legal, technical and data science) and intersectoral (health and social care, academic and commercial institutions and citizens) approach to technology development. The authors present some important lessons to date from ongoing development of an innovative infrastructure for sharing health and social care data.     

Developing time-driven activity-based costing at the national level to support policy recommendations for radiation oncology in Belgium

We use time-driven activity-based costing (TDABC) to estimate the cost of radiation treatments at the national level. Although TDABC has mostly been applied at the hospital level, we demonstrate its potential to estimate costs at the national level, which can provide health policy recommendations. Contrary to work on reimbursement or charges representing the health care system perspective, we focus on resource costs from the perspective of health care service providers. Using the example of Belgian inputs and results, we discuss development of a TDABC model. We also present insights into the challenges that arose during model design and implementation. Finally, we discuss recent examples of policy implications in Belgium as well as some caveats that should be considered when developing resource allocation models at the national level.     

After the tide: Commodity currencies and global trade

The decade prior to the Great Recession saw a boom in global trade and rising transportation costs. High-yielding commodity exporters׳ currencies appreciated, boosting carry trade profits. The Global Recession sharply reversed these trends. We interpret these facts with a two-country general equilibrium model that features specialization in production and endogenous fluctuations in trade costs. Slow adjustment in the shipping sector generates boom–bust cycles in freight rates and, as a consequence, in currency risk premia. We validate these predictions using global shipping data. Our calibrated model explains about 57% of the narrowing of interest rate differentials post-crisis.     

Accounting and the emergence of care pathways in the National Health Service

This paper examines the effects of New Public Management reforms on the information infrastructure underpinning the work of public service professionals. Focussing on the case of the British National Health Service (NHS), the paper argues that hospital accounting reforms played a significant role in the emergence of standardised models of clinical practice. The paper moreover argues that, under the label ‘care pathways’, such standardised models of clinical practice became embedded in the information infrastructure of the NHS and concludes by discussing their implications for the work of doctors and hospital accountants.     

全球价值链的发展改变了什么

全球价值链的发展改变了国际贸易的性质,并对收入的形成、竞争力的衡量和贸易政策的制定产生了重要影响。全球价值链创造了财富,但不同国家的财富增长速度是不同的;全球价值链也改变了竞争力的意义,使得竞争力的衡量更加侧重于企业的跨境生产;全球价值链加深了国家之间的依赖,政策合作更加重要。     

Tax-tariff reform with costs of tax administration

As is broadly recognised, the straightforward application of the Diamond–Mirrlees (1971) production efficiency theorem implies that when lump-sum taxation is not available, then it is optimal for the government in a small open economy to rely on taxes on the net demand of households rather than on border taxes to finance its resource requirements. However, the theorem does not hold when taxation is associated with administrative costs. The present paper explores the implications for optimal taxation and for desirable directions of tax-tariff reform of taking into account the costs of tax administration in countries at different levels of economic development. The paper clarifies the reasons for, and lends support to, the criticism by Stiglitz (Presentation to Congress of International Institute of Public Finance, Prague, 2003) of the IMF and the World Bank’s recommendation to developing countries to adopt VAT to replace border taxes.      

我国人力资本国际流动分析

随着科技创新全球一体化进程提速,我国高端人力资本流失严重、人力资本"暗流"频繁、人力资本开始出现较大的回流趋势,这为我国创新体系建设带来机遇的同时也提出了更为严峻的挑战.及早建立科学有效的人力资本激励机制、回流机制、"暗流"引导机制,是全面建设创新型国家,实现创新全球化的必然选择.     

The impact of health care reform on older workers, retirees and employers

The Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 impacts everyone who uses or pays for the health care system. Among the new law's effects will be changes in older workers' health care choices as they transition from full-time employees to part-time work or other jobs and, ultimately, to retirement, and the retiree health benefit choices facing their employers. This article reviews the major issues surrounding these changes, including those affecting retiree health benefits, benefits for Medicare-eligible retirees and health care options for older Americans not yet eligible for Medicare. The authors conclude that although employers will be reacting in 2010 and 2011 with regard to some issues surrounding FASB ASC 715-60 and the early retiree reinsurance program, employers should consider waiting to make major changes until regulations are issued and the health plans for active employees have been fully vetted.     

Defining the road ahead: thinking strategically in the new era of health care reform

Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.     

全球低通胀的表现、原因和政策挑战

股价崩盘会严重损害股东的利益,对资本市场的健康发展产生极大的负面影响。 交叉持股是否会延缓股票崩盘的风险？本文以2008至2014年沪深两市A股上市公司为研究样 本,考察交叉持股与股价崩盘风险的关系。研究发现,交叉持股对上市公司股价崩盘风险有显 著抑制作用。同时,在盈利性较差、成长性较差的上市公司,交叉持股现象对其股价崩盘风险 有显著抑制作用。本文为交叉持股在资本市场的作用做出了新的解释,也为交叉持股产生的经 济后果提供了新的证据。