Taxpayers reject idea of losing deduction for health insurance.
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Health Benefit Plans, Employee↗
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[Many discounts and tax deductions for student insurance].
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Economics, Hospital↗
Department of Health, Education, and Welfare. Medicare hospital insurance program; inpatient hospital deductible for 1980.
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Deductibles and Coinsurance↗
Nonparametric bounds on the effect of deductibles in health care insurance on doctor visits - Swiss evidence.
We evaluate the effect of the size of deductibles in the basic health insurance in Switzerland on the probability of a doctor visit. We employ nonparametric bounding techniques to minimise statistical assumptions. In order to tighten the bounds we consider two further assumptions: mean independence of an instrument and monotone treatment response. Under these two assumption we are able to bound the causal effect of high deductibles compared to low deductibles below zero. We conclude that the difference in health care utilisation is partly due to a reduction of moral hazard effects.
Cost Sharing↗
Optional deductibles in social health insurance systems: findings from Germany.
A fundamental aspect of the German health insurance system is the principle of solidarity. At the same time, it is possible for certain socio-economic groups to opt out of the otherwise compulsory system. To determine whether rates incorporating deductibles are compatible with the principles of solidarity and have the ability to heighten the appeal of statutory health insurance (SHI) funds compared with private health insurance companies, Germany's third largest SHI fund, Techniker Krankenkasse, implemented a pilot scheme involving the use of deductibles. Preliminary scientific evaluations of the pilot scheme indicate three main results for these deductibles: Firstly, they are compatible with the principles of solidarity in the statutory health insurance system; secondly, they provide an effective means of preventing defection to private health insurance companies and thirdly, they reduced the volume of insurance claims (moral hazard).
Adult↗
You can't buy insurance when the house is on fire. Community rating kills health insurance.
Why does health insurance cost so much? According to the vice president at the insurance company that pioneered high-deductible health insurance to go with medical savings accounts, a big factor is that insurance companies are being asked to solve social problems. Mr Hartnedy offers a solution to America's healthcare-delivery plight that includes empowerment of individuals and preservation of choice.
Actuarial Analysis↗
Socio-economic differences in general practitioner and outpatient specialist care in The Netherlands: a matter of health insurance?
Equal treatment for equal needs, irrespective of socio-economic position, is a major issue in many countries. Although in the Netherlands differences in utilization of health care between population groups are less pronounced than in most other countries, some differences by socio-economic position do exist. Controlling for health status, individuals with a high socio-economic status have a higher probability of outpatient contacts with a specialist, but a lower probability of general practitioner contacts, compared with those with a low socioeconomic status. In this cross-sectional study, we studied whether socio-economic differences in GP and outpatient specialist care utilization that exist after health status is taken into account could be explained by different aspects of health insurance. The study population, in which people with asthma and chronic obstructive pulmonary disease (COPD), diabetes mellitus, severe back complaints, and heart diseases are overrepresented, consists of 2867 respondents. Multivariate analyses show that the socio-economic differences in outpatient specialist contacts cannot be explained by differences in health insurance, whereas differences in general practitioner contacts can partially be explained by the fact that individuals with higher socio-economic status more often have a private (instead of public) insurance. This is not owing to differences in deductible or insurance coverage between public and private insurance, but is more likely to be caused by differences in regulatory aspects between these two insurance schemes (such as the stronger gate-keeper role of the general practitioner in the public insurance scheme.
Adult↗
[Tax deductable premiums of pension insurances].
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Germany, West↗
Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, Canada.
The price elasticity of demand for prescription drugs is a crucial parameter of interest in designing pharmaceutical benefit plans. Estimating the elasticity using micro-data, however, is challenging because insurance coverage that includes deductibles, co-insurance provisions and maximum expenditure limits create a non-linear price schedule, making price endogenous (a function of drug consumption). In this paper we exploit an exogenous change in cost-sharing within the Quebec (Canada) public Pharmacare program to estimate the price elasticity of expenditure for drugs using IV methods. This approach corrects for the endogeneity of price and incorporates the concept of a 'rational' consumer who factors into consumption decisions the price they expect to face at the margin given their expected needs. The IV method is adapted from an approach developed in the public finance literature used to estimate income responses to changes in tax schedules. The instrument is based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. Our preferred specification leads to expenditure elasticities that are in the low range of previous estimates (between -0.12 and -0.16). Naïve OLS estimates are between 1 and 4 times these magnitudes.
Aged↗
Problems in private psychiatric insurance.
Insurance coverage for hospitalization in a freestanding psychiatric facility faces challenging, but not insurmountable, difficulties currently and in the immediate future. Relevant issues include: possible reductions in health insurance tax deductibility, so-called "consumer choice" and "pro-competition" options, prospective financing, and cost shifting from government insurance onto private patients. Some problems more specific to private psychiatric hospitals include: misuse of insurance coverage for dubious "therapies," the effects of declining coverage, the "dental versus mental" conflict, the effect of non-physicians entering the provider pool, poor coverage for liaison and consultation psychiatry, inappropriate usage, and confidentiality concerns. Positive future possibilities include: implementation of government insurance programs through private sector contracts, continuing improvement in psychiatric scientific technology, increased accountability efforts, public education, and improvements in psychiatry's relationships with labor and management.
Cost Allocation↗
The competitive market: changing medical staff accountability.
Hospital costs are beginning to increase rapidly. The expense-control strategies employed by health insurance carriers, as well as utilization review, managed care, co-insurance, and deductibles have taken affect, and it appears that no further significant cost savings can be achieved. It is likely that new cost-containment strategies of health insurance carriers will include consolidation of hospitals and physicians into a joint program. Such combined programs will be financially driven to encourage price sensitivity through a combination of hospital and physician services. The net effect will be the development of new patterns of medical staff and hospital arrangements requiring greater accountability of hospital governance for both medical and hospital costs.
Economic Competition↗
Combining mandatory health insurance and medical savings accounts.
The American tradition of freedom of choice is mirrored exceptionally well in the health care industry. The consequences of this system are the highest health care costs in the world and 38.7 million uninsured. Implementation of mandatory, high-deductible health insurance in conjunction with a medical savings account for every resident could have several benefits, and it may engender bipartisan support.
Adolescent↗
Medicaid program; deduction of incurred medical expenses (spend down)--HCFA. Proposed rule.
These proposed rules would permit States to revise the process by which medical expenses are considered in determining Medicaid eligibility. This process is commonly referred to as "spend down." Spend down applies when an individual's income level during a budget period would ordinarily preclude eligibility, except that incurred medical expenses reduce income to the eligibility level. These proposed revisions would permit States, as allowed by law, to: (1) Consider projected institutional expenses at the Medicaid reimbursement rate as incurred medical expenses, and deduct those expenses from income in determining eligibility; (2) Combine the retroactive and prospective medically needy budget periods; (3) Except for current payments on older bills not previously deducted in any budget period, exclude from incurred medical expenses those bills for services provided more than 3 months prior to the month of application; (4) Deduct incurred medical expenses from income in the order in which the services are provided or in the order each bill is submitted to the agency; and (5) Except for health insurance premiums, deductibles and coinsurance charges, limit deductible medical expenses to services covered under the State plan.
Centers for Medicare and Medicaid Services, U.S.↗
Reference drug programs: effectiveness and policy implications.
In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs) or similar therapeutic substitution programs. This paper summarizes the mechanism and rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level can thus be established. If the evidence documents that a higher price for a given drug does not buy greater effectiveness or reduced toxicity, then under RDP such extra costs are not covered. RDPs or therapeutic substitutions based on therapeutic equivalence are seen as logical extensions of generic substitution that is based on bioequivalence of drugs. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior authorization programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles. RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit exactly into one of the two categories. Therefore, a process of medically indicated exemptions that will consider full coverage should accompany an RDP. In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs, and others are considering them. This paper summarizes the mechanism and rationale of RDPs, presents evidence of their economic effectiveness and clinical safety, and concludes with some practical implications of implementing RDP policies.
Cost Control↗
The hidden costs of cancer care: an overview with implications and referral resources for oncology nurses.
Since the 1970s, remarkable advances have been made in the early diagnosis, treatment, and survival rates of patients with cancer. This has coincided with rapid changes in the healthcare industry. As cancer has been transformed into a chronic disease that generally is treated in the outpatient setting, the financial burden on patients with cancer and their families has grown. Insurance premiums, deductibles, copayments, transportation, lost income, and miscellaneous out-of-pocket expenses are just some of the hidden, nonreimbursable costs that significantly affect the financial stability of families over time. In addition, certain populations are at greater risk of financial burden, which may affect compliance with treatment as well as patient outcomes. This article presents an overview of these hidden costs, with implications and referral resources for oncology nurses. Healthcare providers have a responsibility to assess their patients for financial need and assist them in accessing resources.
Cost Savings↗
Health savings accounts: early estimates of national take-up.
The 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA) approved tax-advantaged health savings accounts (HSAs) for certain high-deductible health insurance plans. We predict that MMA could lead to approximately 3.2 million HSA contracts among Americans ages 19-64 who are not students, not enrolled in public health insurance plans, and not eligible for group coverage as a dependent. We simulate the effect of several additional tax subsidies for HSAs. We predict that the Bush administration's refundable tax-credit proposal would double HSA take-up and reduce the number of uninsured people by 2.9 million, at an annual cost of $8.1 billion.
Adult↗
Treat the causes, not the symptoms of the health care cost problem.
The design of the American health care system is guaranteed to create an inflationary spiral. A third party payment system combined with cost-based reimbursement of hospitals, fee-for-service payments to physicians, tax deductible health insurance premiums, and a litigious society that also demands more services have created a growing sense of urgency that something must be done to control costs. Medicare's experience with prospective pricing and use of coordinated care has helped change the incentives that lead to higher costs. Greater use of such approaches shows promise but proposals to impose rigid expenditure caps could create what is tantamount to a pressure cooker unless the underlying incentives are changed.
Centers for Medicare and Medicaid Services, U.S.↗
Medical savings accounts: why do they work?
This article analyzes and reviews the cost and design characteristics of medical savings accounts (MSAs). By placing premium savings from high-deductible health insurance in medical savings accounts, individuals have an incentive to shop for medical services. A more market-oriented health insurance and delivery system results, as individuals are now both users and buyers of health care. Data show that most families would accumulate balances in their MSAs that may be used for future medical expenses or savings. Through program design, the potential problems of adverse selection and cost to risk can be greatly reduced.
Cost Sharing↗