PREVENTIVE CARE AND INSURANCE COVERAGE

This article examines how having a choice of health plans, HMO enrollment, and health status affect the use of preventive services. For preventive services use, HMO enrollment is endogenous for workers with a choice of plans, but is exogenous for workers who do not have a choice. Relative to a model that ignores the effect of a choice of plans, the effect of HMO enrollment on the use of preventive treatments is reduced. Individuals who do not have a choice of plans but are enrolled in HMOs are more likely to use preventive services than are individuals who choose HMOs. (JEL I10 , I11 , I12 )     

Nash bargaining model of HMO premiums

This paper estimates a model of commercial HMO premiums based on Nash's axiomatic approach to bargaining between HMOs and employers. The bargaining models incorporate variables that measure the?‘power’?of the parties to affect the division of potential gains from a contract. It is found that an increase in the number of competing HMOs increases the employer's bargaining power and leads to lower premiums, especially for for-profit HMOs. It is also found that employers’?bargaining power over non-profit HMOs is positively related to the ratio of the HMO's administrative expenses/total expenses.     

HMO plans,self-selection and utilization of health care services

This study examines the effect of health maintenance organizations (HMOs) on the use of health care services among the privately insured, nonelderly population. To consider jointly the possible self-selection bias and high frequency of zero observations in the applied utilization measures, we accommodate the endogeneity of health plan choice decisions in the censored regression model. Using data from the 2000 Medical Expenditure Panel Survey, we find strong evidence for favourable self-selection into HMO plans. Health maintenance organization enrollment is found to encourage greater use of office-based and hospital outpatient services. Overall satisfaction with the quality of care among HMO members is relatively low compared to that among nonHMO members. These findings suggest that more effort is needed to develop management strategies in HMOs in order to contain the moral hazard in utilization and assure the quality of service provided within the network of HMO providers.     

The welfare economics of a health plan merger

Recently, two large health maintenance organizations (HMOs) in Minneapolis merged to form a single company with over half of the total Twin Cities HMO enrollment. This paper strongly suggests that the merger will have adverse consequences for consumers. I use a model of health plan rivalry and empirical demand functions to predict that health insurance premiums in 6 Twin Cities firms will rise by as much as 19 percent after the merger. Next, I show how to calculate the loss in consumer surplus in a discrete choice model and predict that the merger will reduce surplus by 4.4% on average. Several objections to these conclusions are considered but, on the whole, the analysis raises serious concerns for public policy toward HMO mergers.     

Does contracting out increase the efficiency of government programs? Evidence from Medicaid HMOs

State governments contract with health maintenance organizations (HMOs) to coordinate medical care for nearly 20 million Medicaid recipients. Identifying the causal effect of HMO enrollment on government spending and health care quality is difficult if, as is often the case, recipients have the option to enroll in a plan. To estimate the average effect of HMO enrollment, this paper exploits county-level mandates introduced during the last several years in the state of California that required most Medicaid recipients to enroll in a managed care plan. The empirical results demonstrate that the resulting switch from fee-for-service to managed care was associated with a substantial increase in government spending but no corresponding improvement in infant health outcomes. The findings cast doubt on the hypothesis that HMO contracting has reduced the strain on government budgets.     

HMO coverage of cosmetic procedures: Response to market competition

Theory suggests that insurance policies should not cover purely cosmetic procedures. This paper attempts to explain empirical variation in coverage of a purely cosmetic procedure. Health maintenance organizations (HMOs) are modeled in a Cournot competition with two decisions—the number of policies and the limits placed on medical care utilization. Comparative statics for an individual market suggest, first, that restrictiveness is positively associated with the number of HMOs. Second, restrictiveness is positively associated with the predisposition to demand managed care products. Third, each effect is strengthened by increasing the other parameter. Restriction of tattoo ablation, a purely cosmetic procedure, is examined empirically. The first and second predictions are supported at low levels of predisposition and numbers of HMOs, while the third prediction is not supported. The data were obtained under a grant from the Office of Technology Assessment (HMO Laser Procedure Coverage) and a University of Michigan Rackham Pre-Doctoral Fellowship (InterStudy and County Business Patterns).     

Expanded role of nursing in ambulatory managed care. Part I: Literature, role development, and justification

New expanded roles in nursing are developing in response to the health system switch from private, episodic care of individuals to health maintenance organizations (HMO's) focusing on disease prevention and promotion of health for populations of persons with chronic illness. This evaluation project explored the role of the nurse clinician in population and case management at a large HMO in the Northwest United States. In Part I of this two-part series, a literature review, is presented on chronic illness, ambulatory nursing, expanded role nursing, and nursing in HMOs. The development of the expanded role nurse clinician at the managed care organization is also described. Results could be used by HMOs to attract and retain nurses, improve care processes, and decrease costs in ambulatory care.     

WHAT ARE EMPLOYERS DOING TO CREATE A COMPETITIVE MARKET FOR HEALTH CARE IN THE TWIN CITIES?

Employers' willingness to control costs is a critical aspect of pro-competition strategies for the health-care market. Here, we present some of the first quantitative evidence of what employers do to control health-care costs. Our sample is 44 large private and public employers in Minnesota.
We develop a theoretical model in which the employer chooses cost-control "innovations"—along with wages, fringe benefits, and labor-force size—to maximize profits. The role of innovations is to reduce unit costs of offering fringe benefits.
Our data are from a 1982 survey. Eighty percent of the surveyed employers, representing nearly 200,000 employees, responded. Most respondents offer both indemnity insurance plans and health-maintenance organizations (HMOs). Many firms and individual health-insurance plans conduct cost-control activities, but less than half of the firms which offer HMOs have adopted level-dollar premium contributions for their family health-insurance policies. Few plans have increased their coinsurance and deductible requirements in the past five years.
We use probit equations to estimate the probability that a firm or a health plan will adopt cost-control activities. Our analysis suggests that many firms may soon make major plan-design changes to control health-care costs, although they have not yet done so.     

SOCIALLY OPTIMAL SUBSIDIES FOR ENTRY: THE CASE OF MEDICARE PAYMENTS TO HMOs*

The U.S. Medicare program has increased its spending on private Medicare plans in anticipation of larger consumer surplus and higher efficiency. To evaluate the welfare consequences of such policy interventions, I develop an empirical model with endogenous entry. Counterfactual simulation reveals the following: subsidizing HMO entry can be justified to enhance national welfare (no excessive entry); the level of price subsidies in 2008, however, is far beyond the optimal level; and the geographic inconsistency between the subsidies and the Medicare fee‐for‐service costs is another source of inefficiency. Resolving this geographic inconsistency significantly raises national welfare by restructuring entry.     

Account-based retiree medical plans: what's good for your pension plan may be good for your retiree medical plan

Many of the same forces that caused employers to gravitate toward account-based pension plans are beginning to spark similar changes in retiree medical plans. As medical costs continue to escalate, account-based retiree medical plans offer a new way to manage company outlays, while preserving an important benefit for retirees.     

Managed care and the near-elderly: effects of plan enrollment on functionality

This paper examines the effects of enrollment in a health maintenance organization (HMO) or a preferred provider organization (PPO) on the functional status of near-elderly adults (aged 55–64), compared to traditional fee-for-service (FFS) plans. A sample of 1306 near-elderly adults with employer-sponsored health insurance are drawn from the 2000–2002 waves of the Health and Retirement Study, a nationally representative panel survey of community-dwelling adults. Regression models are estimated to assess the effects of different types of insurance plans on functionality, as measured by whether or not the individual has any functional limitations. The potential influence of selection bias into alternative types of plans is addressed by limiting the sample to near-elders without a choice of health plans. The effects of HMOs on functionality are shown to be comparable to those of FFS plans among the general near-elderly population. However, significant adverse effects of HMO enrollment on functional status are observed among near-elders with chronic conditions. PPO enrollees have similar functional outcome to FFS enrollees, even among those with chronic conditions. The observed differences in functional outcome across plans have important implications for the practicality of managed care plans serving older adults.     

Controlling utilization through a selective participation PPO

A selective participation PPO, which blends the fee-for-service payment system with the HMO concept, may offer an effective approach to controlling dental care costs.     

The impact of horizontal mergers and acquisitions on cost and quality in health care

Mergers and acquisitions among HMOs, hospitals and other health care providers can be disconcerting to benefits staff and employees, but they can be successfully managed. They may offer an employer the opportunity to improve the quality of care provided and to do so at reduced costs.     

有针对性地做好高校离退休工作

我国已逐渐步入老龄化社会,高校离退休人员队伍越来越庞大,并呈不断增长的态势.笔者通过对高校离退休人员群体特征、高校离退休工作特点及对高校离退休工作一般规律的分析,阐述了高校离退休工作的重点及对策,强调应坚持"以人为本"的科学发展观,结合实际,把握规律,真正做到管理到位、待遇到位、感情到位、服务到位.     

Long‐term care and pay‐for‐performance programs

Pay‐for‐performance programs are gradually spreading across Asia. This paper builds on the longer experience in the United States to offer lessons for Asia. The Center for Medicare and Medicaid Services has introduced several pay‐for‐performance programs since 2012 to encourage hospitals to improve quality of care and reduce costs. Some state Medicaid programs have also introduced pay‐for‐performance for nursing homes. Long‐term care providers play an important role in hospital pay‐for‐performance programs because they can affect the readmission rate and also total episode payments. A good pay‐for‐performance program will focus on improving quality of care that affects health outcomes. In addition, that quality must vary across providers and be measurable. Furthermore, it is important that the measures be reported in a timely way, that both demand and supply respond to the measures, and that the measures be risk adjusted. Empirical data from Medicare beneficiaries in the state of Michigan show that mean episode payments and readmission rates in skilled nursing facilities vary widely and are sensitive to the number of observations. These practical matters create challenges for implementing pay‐for‐performance in practice. There is an extensive literature review of pay‐for‐performance in long‐term care in the United States and in Asia.     

HR customer service--FedEx.com or BUST!

As the "customers" of the benefits department, employees, beneficiaries and retirees deserve best practice service delivery. This article describes a benefits administration operating model that can deliver high levels of customer service by furnishing accurate, consistent and timely information. Performance measurement is a key element in this type of customer satisfaction, particularly when outsourcing vendors are involved in the provision of benefits.     

A DHMO (Dental HMO) value checker and understanding drivers of dentists' behavior

Although the majority of employees enrolled in dental HMOs (DHMOs) are pleased with the services they provide, some plan sponsors have experienced difficulties with them. Understanding the balance of risks and incentives DHMO participation presents to dentists may help plan sponsors avoid pitfalls and obtain better value from these plans. This article includes a "value checker" to be used in assessing a DHMO.     

What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending

We study the impact of the introduction of one of the major pillars of the social insurance system in the United States: the introduction of Medicare in 1965. Our results suggest that, in its first 10 years, the establishment of universal health insurance for the elderly had no discernible impact on elderly mortality. However, we find a substantial reduction in the elderly's exposure to out of pocket medical expenditure risk. Specifically, we estimate that the introduction of Medicare was associated with a 40% decline in out of pocket spending for the top quartile of the out of pocket spending distribution. A stylized expected utility framework suggests that the welfare gains from such reductions in risk exposure alone may be sufficient to cover almost two-fifths of the costs of Medicare. These findings underscore the importance of considering the direct insurance benefits from public health insurance programs, in addition to any indirect benefits from an effect on health.     

Cardiovascular event costs in patients with Type 2 diabetes mellitus

Abstract

Objective:

To quantify the cost of acute major adverse cardiac events (MACE; myocardial infarction [MI] and stroke) stratified by cardiovascular disease (CVD) risk factors in commercially, Medicare Supplemental-, and Medicaid-insured patients with type 2 diabetes mellitus (T2DM).     

Should you pay off your mortgage or invest?

The mortgage payoff dilemma affects many retirees that have enough financial assets to pay off their mortgage. I find that, on average, retirees with less than $300,000 in non-housing financial wealth are better off keeping the mortgage and investing.