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Risk Adjustment Risk Sharing And Premium Regulation In Health Insurance Markets

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Risk Adjustment Risk Sharing and Premium Regulation in Health Insurance Markets

Risk Adjustment  Risk Sharing and Premium Regulation in Health Insurance Markets Book
Author : Thomas G. McGuire,Richard C. Van Kleef
Publisher : Academic Press
Release : 2018-08-06
ISBN : 012811326X
Language : En, Es, Fr & De

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Book Description :

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

Epidemics and the Health of African Nations

Epidemics and the Health of African Nations Book
Author : MISTRA
Publisher : The Mapungubwe Institute for Strategic Reflection (MISTRA)
Release : 2019-07-25
ISBN : 0639995594
Language : En, Es, Fr & De

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Book Description :

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.

Private Health Insurance and the European Union

Private Health Insurance and the European Union Book
Author : Cyril Benoît,Marion Del Sol,Philippe Martin
Publisher : Springer Nature
Release : 2020-12-03
ISBN : 3030543552
Language : En, Es, Fr & De

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Book Description :

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.

Models of Health Plan Payment and Quality Reporting

Models of Health Plan Payment and Quality Reporting Book
Author : Jacob Glazer,Thomas G McGuire
Publisher : World Scientific Publishing Company
Release : 2016-12-22
ISBN : 9813202882
Language : En, Es, Fr & De

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Book Description :

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.

The Oxford Handbook of the Welfare State

The Oxford Handbook of the Welfare State Book
Author : Daniel Béland,Kimberly J. Morgan,Herbert Obinger,Christopher Pierson
Publisher : Oxford University Press
Release : 2021-10-22
ISBN : 0198828381
Language : En, Es, Fr & De

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Book Description :

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.

Handbook of Health Economics

Handbook of Health Economics Book
Author : Mark V. Pauly,Thomas G. McGuire,Pedro Pita Barros
Publisher : Elsevier
Release : 2012-01
ISBN : 0444535926
Language : En, Es, Fr & De

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Book Description :

What new theories, evidence, and policies have shaped health economics in the 21st century? Editors Mark Pauly, Thomas McGuire, and Pedro Pita Barros assemble the expertise of leading authorities in this survey of substantive issues. In 16 chapters they cover recent developments in health economics, from medical spending growth to the demand for health care, the markets for pharmaceutical products, the medical workforce, and equity in health and health care. Its global perspective, including an emphasis on low and middle-income countries, will result in the same high citations that made Volume 1 (2000) a foundational text. Presents coherent summaries of major subjects and methodologies, marking important advances and revisions. Serves as a frequently used non-journal reference. Introduces non-economists to the best research in health economics.

Patient Protection and Affordable Care ACT HHS Notice of Benefit and Payment Parameters for 2014 Us Department of Health and Human Services Regulation Hhs 2018 Edition

Patient Protection and Affordable Care ACT   HHS Notice of Benefit and Payment Parameters for 2014  Us Department of Health and Human Services Regulation   Hhs   2018 Edition  Book
Author : The Law The Law Library
Publisher : Createspace Independent Publishing Platform
Release : 2018-11-10
ISBN : 9781729722640
Language : En, Es, Fr & De

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Book Description :

Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. Cost-sharing reductions and advance payments of the premium tax credit, combined with new insurance market reforms, are expected to significantly increase the number of individuals with health insurance coverage, particularly in the individual market. In addition, we expect the premium stabilization programs-risk adjustment, reinsurance, and risk corridors-to protect against the effects of adverse selection. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance. This book contains: - The complete text of the Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Health Insurance Market Reform

Health Insurance Market Reform Book
Author : United States,United States. Congress. Senate. Committee on Finance
Publisher : Unknown
Release : 1994
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

Download Health Insurance Market Reform book written by United States,United States. Congress. Senate. Committee on Finance, available in PDF, EPUB, and Kindle, or read full book online anywhere and anytime. Compatible with any devices.

Federal Register

Federal Register Book
Author : Anonim
Publisher : Unknown
Release : 2013-08
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

Download Federal Register book written by , available in PDF, EPUB, and Kindle, or read full book online anywhere and anytime. Compatible with any devices.

State Health Insurance Market Reform

State Health Insurance Market Reform Book
Author : Joel C. Cantor,Alan C. Monheit
Publisher : Routledge
Release : 2012-09-25
ISBN : 0415651956
Language : En, Es, Fr & De

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Book Description :

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.

Health Care Financing and Insurance

Health Care Financing and Insurance Book
Author : Francesco Paolucci
Publisher : Springer Science & Business Media
Release : 2010-10-28
ISBN : 364210794X
Language : En, Es, Fr & De

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Book Description :

As a contribution to the search for suitable and sustainable solutions to finance rising medical care expenditures, the book proposes a typology of healthcare financing and insurance schemes, based on the dimensions of basic vs. supplementary services and mandatory vs. voluntary coverage, to analyse the design and the complex interactions between various financing and insurance arrangements in several OECD countries. This study provides a better understanding of the strengths and weaknesses of the financial and organisational structures of different countries’ healthcare financing and insurance schemes. Its main contributions are the development of a novel and rigorous theoretical framework analysing the economic rationales for the optimal design of healthcare financing and insurance schemes, and an empirical and institutional analysis investigating the consequences for efficiency and affordability of the complex interactions between basic and supplementary sources of financing.

Patient Protection and Affordable Care ACT HHS Notice of Benefit and Payment Parameters for 2014 Us Centers for Medicare and Medicaid Services Regulation Cms 2018 Edition

Patient Protection and Affordable Care ACT   HHS Notice of Benefit and Payment Parameters for 2014  Us Centers for Medicare and Medicaid Services Regulation   Cms   2018 Edition  Book
Author : The Law The Law Library
Publisher : Createspace Independent Publishing Platform
Release : 2018-07-05
ISBN : 9781722602680
Language : En, Es, Fr & De

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Book Description :

Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. Cost-sharing reductions and advance payments of the premium tax credit, combined with new insurance market reforms, are expected to significantly increase the number of individuals with health insurance coverage, particularly in the individual market. In addition, we expect the premium stabilization programs-risk adjustment, reinsurance, and risk corridors-to protect against the effects of adverse selection. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance. This book contains: - The complete text of the Patient Protection and Affordable Care Act - HHS Notice of Benefit and Payment Parameters for 2014 (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section

How Adverse Selection Affects the Health Insurance Market

How Adverse Selection Affects the Health Insurance Market Book
Author : Paolo Belli
Publisher : World Bank Publications
Release : 2021-12-08
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

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.

Encyclopedia of Health Economics

Encyclopedia of Health Economics Book
Author : Anonim
Publisher : Newnes
Release : 2014-02-21
ISBN : 0123756790
Language : En, Es, Fr & De

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Book Description :

The Encyclopedia of Health Economics offers students, researchers and policymakers objective and detailed empirical analysis and clear reviews of current theories and polices. It helps practitioners such as health care managers and planners by providing accessible overviews into the broad field of health economics, including the economics of designing health service finance and delivery and the economics of public and population health. This encyclopedia provides an organized overview of this diverse field, providing one trusted source for up-to-date research and analysis of this highly charged and fast-moving subject area. Features research-driven articles that are objective, better-crafted, and more detailed than is currently available in journals and handbooks Combines insights and scholarship across the breadth of health economics, where theory and empirical work increasingly come from non-economists Provides overviews of key policies, theories and programs in easy-to-understand language

Expanding Access to Health Care

Expanding Access to Health Care Book
Author : Terry F. Buss,Paul N. Van de Water
Publisher : Routledge
Release : 2014-12-18
ISBN : 1317470842
Language : En, Es, Fr & De

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Book Description :

The U.S. health care system faces well-known problems: 47 million people without health insurance, rapidly rising costs that consume 16 percent of the country's economic output, and widely uneven quality of care. Even many people with coverage are experiencing serious problems paying for the rapidly rising costs of health care and insurance.This book - a joint product of the National Academy of Public Administration and the National Academy of Social Science - undertakes a sweeping analysis of the management and administrative issues that arise in expanding health care coverage. The book identifies the core administrative functions that need to be performed in assuring access to health coverage, describes how these functions are performed at present and under proposed alternatives, draws lessons from experience in the U.S. and abroad, and assesses suggested administrative approaches designed to facilitate the improvement and expansion of health care coverage.Adequate health care is one of today's most crucial domestic policy concerns. "Expanding Access to Health Care" is designed to bring together in one place some of the best thinking on the subject, not as an exercise in advocacy, but rather to lay out the issues in a balanced way so that policymakers, researchers, and citizens can better understand the complex details of health care reform.

International Encyclopedia of Public Health

International Encyclopedia of Public Health Book
Author : William C Cockerham
Publisher : Academic Press
Release : 2016-10-06
ISBN : 0128037083
Language : En, Es, Fr & De

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Book Description :

International Encyclopedia of Public Health, Second Edition is an authoritative and comprehensive guide to the major issues, challenges, methods, and approaches of global public health. Taking a multidisciplinary approach, this new edition combines complementary scientific fields of inquiry, linking biomedical research with the social and life sciences to address the three major themes of public health research, disease, health processes, and disciplines. This book helps readers solve real-world problems in global and local health through a multidisciplinary and comprehensive approach. Covering all dimensions of the field, from the details of specific diseases, to the organization of social insurance agencies, the articles included cover the fundamental research areas of health promotion, economics, and epidemiology, as well as specific diseases, such as cancer, cardiovascular diseases, diabetes, and reproductive health. Additional articles on the history of public health, global issues, research priorities, and health and human rights make this work an indispensable resource for students, health researchers, and practitioners alike. Provides the most comprehensive, high-level, internationally focused reference work available on public health Presents an invaluable resource for both researchers familiar with the field and non-experts requiring easy-to-find, relevant, global information and a greater understanding of the wider issues Contains interdisciplinary coverage across all aspects of public health Incorporates biomedical and health social science issues and perspectives Includes an international focus with contributions from global domain experts, providing a complete picture of public health issues

Insurance Economics

Insurance Economics Book
Author : Peter Zweifel,Roland Eisen
Publisher : Springer Science & Business Media
Release : 2012-02-24
ISBN : 3642205488
Language : En, Es, Fr & De

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Book Description :

"Winner of the 2014 Kulp-Wright Book Award Presented by the American Risk and Insurance Association". More information can be found here: http://www.aria.org/awards/bookawards.htm Insurance Economics brings together the economic analysis of decision making under risk, risk management and demand for insurance by individuals and corporations, objectives pursued and management tools used by insurance companies, the regulation of insurance, and the division of labor between private and social insurance. Appropriete both for advanced undergraduate and graduate students of economics, management, and finance, this text provides the background required to understand current research. Predictions derived from theoretical argument are not only stated but confronted with empirical evidence. Throughout the book, conclusions summarize results, helping readers to check their knowledge and understanding. Issues discussed include paradoxa in decision making under risk, selection of favorable risks by insurers, the possibility of a "death spiral" in insurance markets, and future challenges such as re-regulation in the wake of the 2007-09 financial crisis and the increasing availability of generic information.

Health Economics Worldwide

Health Economics Worldwide Book
Author : Peter Zweifel,H. E. Frech
Publisher : Springer Science & Business Media
Release : 2012-12-06
ISBN : 9401123926
Language : En, Es, Fr & De

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Book Description :

This volume reflects both the main issues confronting health economics and the state of the art in health economics a decade before the end of the twentieth century. It contains a selection from almost 150 papers presented at the Second World Congress on Health Economics, held at the University of ZUrich, Switzerland, 10-14 September 1990. This is ten years after the last Congress (held in Leiden, The Netherlands) and more than 17 years after the Tokyo meeting organized by the International Economic Associ ation (which might be called the First World Congress were it not for its small size and symposium-like character). Out of the 16 papers appearing in this book, only four were invited, and they were refereed like all the others. The remaining contributions are survivors of stiff competition. However, in spite of the large sample of papers we were able to draw from, certain gaps of coverage persist. In particular, environmental impacts on health were designated as a field of priority interest in the call for papers to this Congress. Yet, not even half a dozen contribu tions were submitted, which is remarkable in view of the intense interest of the public in the health effects of environmental degradation, ranging from noise level to ozone concentration. Another specially designed field was the political economy of health, dealing with the behavior of policy makers when deciding about changes in the health care systems. It did not attract as many contributions as we had hoped for or expected.

Assessing Alternative Modifications to the Affordable Care Act

Assessing Alternative Modifications to the Affordable Care Act Book
Author : Christine Eibner,Evan Saltzman
Publisher : Rand Corporation
Release : 2014-10-21
ISBN : 0833089641
Language : En, Es, Fr & De

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Book Description :

This report summarizes analysis in which the COMPARE microsimulation model was used to estimate how several potential changes to the Affordable Care Act, including eliminating the individual mandate and eliminating the law’s tax-credit subsidies, might affect 2015 individual market premiums and overall insurance coverage. The report also presents estimate how changes in young adult enrollment might affect 2015 individual market premiums.

Annual Report to Congress

Annual Report to Congress Book
Author : United States. Physician Payment Review Commission
Publisher : Unknown
Release : 1994
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

Download Annual Report to Congress book written by United States. Physician Payment Review Commission, available in PDF, EPUB, and Kindle, or read full book online anywhere and anytime. Compatible with any devices.