How does managed care do it?

Integrating the health services and insurance industries, as health maintenance organizations (HMOs) do, could lower expenditure by reducing either the quantity of services or unit price or both. We compare the treatment of heart disease in HMOs and traditional insurance plans using two datasets from Massachusetts. The nature of these health problems should minimize selection. HMOs have 30% to 40% lower expenditures than traditional plans. Both actual treatments and health outcomes differ little; virtually all the difference in spending comes from lower unit prices. Managed care may yield substantial increases in measured productivity relative to traditional insurance.     

地方政府财政支出的民生化进程与农村居民消费——基于总量和分类支出视角下的理论分析与实证检验

基于总量和分类支出的视角,从宏观层面对地方政府民生财政支出与农村居民消费进行理论分析,并采用1998~2011年中国大陆31个省市面板数据加以实证检验,研究结果表明：地方政府民生财政支出确实有效地促进了农村居民消费,尤其是对以教育文化娱乐、医疗保健等为主的发展享受性消费的挤入程度要大于以衣食住为主的基本生存性消费;但在民生财政具体分类支出方面影响却存在着差异,即教育和医疗卫生支出对农村居民消费产生显著的挤入效应,而文化和社会保障等支出影响微弱。因此,在稳步扩大民生财政支出比重的同时,应注重优化民生财政支出结构,增加农村居民收入等,全面提高农村居民消费水平。     

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.     

Potential “Savings” of Medicare: The Analysis of Medicare Advantage and Accountable Care Organizations

Medicare faces significant financial challenges because of rising health care costs. In response, Medicare reform efforts have been testing various payment and service delivery models, including accountable care organizations (ACOs), aiming to reduce expenditures while preserving or enhancing the coordination of quality care. The idea behind ACOs is to form an organizational network to coordinate all care for Medicare beneficiaries and in so doing, at least theoretically, improve quality of care and hopefully reduce medical costs. The purpose of this research is to apply Data Envelopment Analysis (DEA) to assess the potential savings of Medicare obtainable through optimally efficient implementation of ACOs and Medicare Advantage plans. DEA comparisons across plans achieve this purpose by identifying which Medicare plans operate relatively more efficiently and which are inefficient, and additionally, for inefficient plans, the DEA analysis generates target levels of “inputs” and “outputs” required to bring the plan into efficient operation. Knowing sources of inefficiency can also provide insights into Medicare reform, such as Medicare privatization and innovation models. Our results show that Medicare Advantage plans are more efficient in reducing health expenditures but incur higher administrative costs. Health expenditure savings can also be achievable by promoting government-sponsored managed Medicare such as ACOs. Finally, compared to the profit efficiency of Medicaid managed care plans, Medicare Advantage should have the potential for more Medicare market penetration from the supply (insurer) side.     

人口老龄化对住院费用增长的贡献——基于CFPS数据的分析

在中国,许多人认为,人口老龄化是医疗费用增长的主要驱动力,极度担忧人口老龄化带来医疗费用的快速膨胀。本文首先利用CFPS 2010年和2012年的调查数据,计算了2009-2011年间中国(老年)人口年龄结构变动和(老年)人口数量变动对住院总费用增长的贡献。接下来,利用2009年和2011年全国人口抽样调查数据进行了校正。结果发现,(老年)人口年龄结构变动不是住院医疗费用增长的主要原因,(老年)人口数量剧烈变动可能对住院医疗费用增长产生较大的影响。但是,就中国现实而言,不论是人口老龄化还是老年人口数量变动,对中国住院费用增长的贡献均极其有限。这既是因为人口老龄化本身的速度很慢,老年人相对于非老年人的平均住院费用较低,并且老年人平均住院费用随年龄升高而下降,也是因为中国年龄别平均住院费用增长过快。为此,未来应进一步提高老年人医疗保障水平,加强慢性病预防和康复体系建设,关注医疗保险支付方式改革,遏制医疗技术快速发展和医师诱导需求现象,以控制医疗费用快速上涨。     

Prospects for account-based health plans under the Patient Protection and Affordable Care Act

Account-based health plans (ABHPs), which combine high-deductible plans with either health reimbursement arrangements (HRAs) or health savings accounts (HSAs), have gained popularity in recent years. Because there is growing evidence these plans are indeed engaging consumers and moderating cost increases, employers will need ABHP design options as they strive to bring costs under control in coming years. Some observers, however, are now concerned that benefits standards introduced by federal health care reform will undermine these plans, and many in the business community anticipate new health benefits mandates will drive up employers' total health care costs. The authors show that although the Patient Protection and Affordable Care Act (PPACA) of 2010 includes numerous provisions that will likely increase costs for employers, the law also accommodates, and may even foster, HSAs and HRAs.     

Consumerism and wellness: rising tide, falling cost

Annual employer-sponsored health plan cost increases have been slowing incrementally due to slowing health care utilization--a phenomenon very likely tied to the proliferation of health management activities, wellness programs and other consumerism strategies. This article describes the sharp rise in recent years of consumer-directed health plans (CDHPs) and explains what developments must happen for genuine consumer-directed health care to realize its full potential. These developments include gathering transparent health care information, increasing consumer demand for that information and creating truly intuitive data solutions that allow consumers to easily access information in order to make better health care decisions.     

Auswirkungen der steigenden Lebenserwartung auf die Gesundheitsausgaben

In the literature there are controversial discussions about the influence of the increasing live expectancy on the expenditure for health care. In the first part of this paper, I analyse the adaptability of the hypotheses of compression or extension of morbidity on the health care expenditure. On a theoretic basis, I transfer the hypotheses from the level of physical life quality to the level of monetary spending. I define a monetary version of the compression of morbidity hypothesis and of the expansion of morbidity hypothesis (the so called monetary medicalisation). In a further definition the influence of inflation is included. In the second part of the paper, I verify the hypotheses based on data from a large German private insurance company. The data include average health care expenditure per capita in the ambulant and stationary sectors for each age and gender. The availability of ten years of data allows the identification of a trend in the expenditure under increased life expectancy. As the spending shows a growth for each age and sex an ?inflation adjusted monetary medicalisation“ can be stated.     

The savings potential of 24-hour coverage

In summary, there are costs to maintaining separate systems to cover both work- and non-work-related injuries and illnesses; there are also significant costs associated with achieving coordination--if not integration--of the two plans. Overall, the financial data do not indicate that the overlap between workers' compensation and health benefits is of such magnitude as to justify integration regardless of cost; however, the data do suggest that judicious exploitation of opportunities to coordinate the two programs, especially in regard to managing health care providers, may generate significant savings.     

Intergenerational Transfers and Insurance Policy Design

Abstract

Group health insurance policies offering an identical benefit package to every member of the group result in lower expected health benefits for younger cohorts than older cohorts. The dispersion in insurance benefits across age groups differs among insurance policies. Simulation results presented in this paper demonstrate that a shift from comprehensive health insurance to high-deductible health insurance decreases the share of expected benefits going to younger cohorts. An estimated 81.5% of the 23-to-32-year-old cohort is expected to receive less than $500 in health benefits during a year for one prototypical high-deductible health plan. Low expected benefits for younger relatively healthy cohorts could increase the number of younger individuals who eschew health coverage. Age-rated premiums are probably the most straightforward way to stimulate demand for high-deductible health plans among younger healthier individuals.     

Portfolio choice in retirement: Health risk and the demand for annuities,housing, and risky assets

In a life-cycle model, a retiree faces stochastic health depreciation and chooses consumption, health expenditure, and the allocation of wealth between bonds, stocks, and housing. The model explains key facts about asset allocation and health expenditure across health status and age. The portfolio share in stocks is low overall and is positively related to health, especially for younger retirees. The portfolio share in housing is negatively related to health for younger retirees and falls significantly in age. Finally, out-of-pocket health expenditure as a share of income is negatively related to health and rises in age.     

More preventive care, and fewer emergency room visits and prescription drugs--health care utilization in a consumer-driven health plan

Although consumer-driven health plans (CDHPs) have grown dramatically, the question of whether CDHPs have reduced health care costs has not been answered definitively. This article presents what the authors believe to be the first study to analyze a large sample of claims data and to look in detail at different types of utilization among enrollees in a CDHP and those in a traditional comprehensive major medical (CMM) plan. After adjusting for the finding that CDHP enrollees are both younger and healthier than those in CMM plans, the authors found that CDHP enrollees show no consistent or significant utilization differences for measures over which consumers have little control (e.g., inpatient stays); lower utilization for measures over which consumers have greater control (e.g., emergency room visits); and higher utilization of preventive services.     

Account-based plans curb costs and engage employees

A growing number of organizations are combining consumer-driven health plans with account-based approaches in order to limit health benefit costs, reinforce key consumerist messages and provide meaningful benefits to both actives and retirees. This article describes how account-based approaches work and can be used to motivate employees to invest in their health today and salt away funds for tomorrow. The author describes what employers can do to ensure that consumer-driven health plans and account-based approaches help employees accomplish their goals.     

医院物价管理中自律管理的思考

医疗费是人们生活中最重要的开支之一,而随着人们对身体健康的日益关注,医疗费在人们生活开支中所占的比例也逐年增多.“看病贵”依然是我国面临的重要民生问题,而加强医院物价管理,推行自律管理,能减少或避免医院乱收费的现象,对规范医院收费行为有着重要的作用,可有效解决人们“看病贵”等民生问题,切实地维护广大医疗消费者的利益.本文深入医院物价管理的实践中,从自律管理角度探讨新形势下医院如何更好地开展物价管理工作,为我国医疗事业的健康、稳定发展提供一定的参考借鉴价值.     

Here it comes: defined contribution health care

The Patient Protection and Affordable Care Act includes provisions to make the individual health insurance marketplace one where all Americans, including those with preexisting health conditions, can obtain affordable coverage. At the same time, the act has failed to address, in any significant way, many of the underlying flaws in the current U.S. health care system that have caused costs to spiral out of control. The combination of persistent U.S. health care cost increases and a viable individual health insurance marketplace will cause a sea change in employer-sponsored health care offerings that is similar to that seen among employer-sponsored retirement benefit plans: movement away from defined benefit approaches and toward defined contribution designs. Although the authors show parallels between the evolution of employers' health care and retirement offerings, they explain why certain key developments will need to occur before defined contribution approaches become as prevalent in employer-sponsored health care plans as they are in today's employer-sponsored retirement plans.     

Flypaper Effect and Sluggishness: Evidence from Regional Health Expenditure in Italy

In Italy, public expenditure reduction is achieved through a revision of social security and health care programs. In particular, public health expenditure control has been implemented through a reform that imposes more stringent budget rules to local governments and a considerable reduction in grants-in-aid from the central government. This paper investigates empirically whether the response to this decrease in categorical lump-sum grants from the central to local governments results in an asymmetric response to intergovernmental grants. Hard budget and soft budget constraint hypotheses are estimated by using a sample of cross-sectional and time observations covering the 20 Italian regions over the period 1989–1993. The main finding is the existence of a standard and a super flypaper effect in both models. The introduction of the soft-budget constraint hypothesis results in a stronger effect of grants and a lower response of own resources which shows that local governments prefer to incur some deficit instead of reducing health care expenditure.     

全民健保战略目标下的医疗救助理念研究——浙江省新型社会救助体系的启示

在全民健保的战略目标下,医疗救助的地位被弱化,只是对因病致贫人员和特殊群体实行的临时性救助。然而,以缴费型保险为主的医疗保障体系不能从根本上解决贫困人口的医疗费用问题。因此,从目前过渡到全民健保阶段,医疗救助的地位不应该被削弱。目前我国医疗救助的理念定位不清,没有充分化解贫困人口的疾病风险。本文以全民健保的战略目标和医改为背景,对基本风险、最低需求、政府责任这几个基本概念加以界定;并从医疗救助化解的社会风险出发,分析全民健保战略目标下仍需医疗救助处理的基本风险;再以浙江省分层分类的覆盖城乡的新型社会救助体系为例,阐述医疗救助理念定位需要重点解决的两个关键问题,反思医疗救助与社会医疗保险的关系和医疗救助水平,促进公平和效率。     

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.     

论公共卫生最优支出策略

公共卫生支出具有极强的正外部性.如果由地方政府或私人选择公共卫生支出的水平,那么他们的最优选择是较低的公共卫生支出和较高的个人消费(内含个人医疗支出),整个社会的福利将会处于较低的水平状态.本文在一个动态的框架下分析了发生这种现象的经济学原因,说明中央政府而非地方政府或私人应该对公共卫生的建设承担更大的责任,应由中央政府负责全国公共卫生体系的建设.     

Redefining competition in health care

The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning competitive markets--think computers, mobile communications, and banking--these outcomes would be inconceivable. In health care, these results are intolerable, with life and quality of life at stake. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must end, the authors argue, and must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.