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Results for “Insurance Selection Bias”

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At least 829 records · Page 46Linked to original sources
PubMed1996

Capitation adjustment for pediatric populations.

OBJECTIVE: The objective of this study is to assess the predictive performance of current claims-based capitation adjustment methods for pediatric populations. Medicaid programs and other insurers may increasingly use these systems for capitation rate setting, physician profiling, and other purposes. METHODS: Five leading models, a demographic model, ambulatory care groups, ambulatory diagnostic groups, diagnostic cost groups, and payment amounts for capitated systems, were tested by using use and expenditure data for children enrolled in the Maryland Medicaid program and a private nonprofit health maintenance organization in Minnesota. The models were tested at the individual level by using multiple regression methods and at the group level by using split-half validation to create both random and nonrandom groups. One of the nonrandom groups was created to represent children with chronic conditions. RESULTS: The findings indicate that although each of the alternative methods offers an improvement over a demographic model, significant underpayment remained for high-risk children, regardless of the capitation adjustment method used. CONCLUSIONS: It is concluded that children with chronic conditions would probably remain at risk for discrimination in a competitive health care market under all models tested. Limitations associated with current alternatives suggest the need for further research in the area of pediatric capitation adjustment methods.

Adolescent↗
PubMed1996

Mandatory high-risk pooling: an approach to reducing incentives for cream skimming.

Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in The Netherlands. Crude RACPs are inadequate, especially because they encourage insurers to select against people expected to be unprofitable--a practice called cream skimming. However, implementing improved RACPs does not appear to be straightforward. This paper analyzes an approach that, given a system of crude RACPs, reduces insurers' incentives for cream skimming in the market for individual health insurance, while preserving incentives for efficiency and cost containment. Under the proposed system of Mandatory High-Risk Pooling (MHRP), each insurer would be allowed to periodically predetermine a small fraction of its members whose costs would be (partially) pooled. The pool would be financed with mandatory, flat-rate contributions. The results suggest that MHRP is a promising supplement to RACPs.

Capitation Fee↗
PubMed1996

Demand for and access to institutional long-term care: the role of Medicaid in nursing home markets.

Economists long have speculated that Medicaid subsidies and related policies cause many nursing home markets to operate under conditions of permanent excess demand, resulting in access problems for Medicaid-eligible persons. If observations on nursing home use represent constrained supply instead of demand, estimation of unbiased demand parameters is difficult. In this paper, I estimate bivariate probits with partial observability on data from the National Long-Term Care Channeling Demonstration. The technique provides both unbiased demand parameters and direct tests of excess demand. The findings indicate that economic variables do not substantially affect decisions to seek nursing home care. Differential access to nursing home care by Medicaid eligibles and private payers provides empirical support for the excess demand hypothesis.

Aged↗
PubMed1995

Ethical issues in screening and testing for genetic diseases.

New analytic techniques coupled with detailed knowledge of the entire human genome soon will make possible testing of all genes in every person. Concepts of disease will change, and predisease states will be identified for genetic therapies. Patients, physicians, and laboratory personnel will be confronted with ethical and moral issues in the performance of genetic testing. The primary ethical issues will focus on who has the right to request or compel genetic testing, who has access to confidential information, and what medical or social actions may be predicated legally on genetic information.

Cardiovascular Diseases↗
PubMedDate not supplied

Marital status, spousal coverage, and the gender gap in employer-sponsored health insurance.

Not only do men who work full time earn more than women, but they are more likely to receive employer-sponsored health benefits. This paper provides evidence on the gender gap in employer-sponsored health insurance. The results indicate that the gap is driven largely by the tendency of married women to decline employer-sponsored insurance in favor of being covered through their husbands. Indeed, among single workers, women are more likely than men to be offered insurance. These findings call into question the conclusion made by previous researchers that employers discriminate against women in the provision of health insurance.

Adolescent↗
PubMed1997

Dilemmas of anonymous predictive testing for Huntington disease: privacy vs. optimal care.

Some persons at risk for Huntington disease (HD) seek predictive testing under the protection of anonymity to reduce the risk of insurance discrimination for themselves and their families. While Canadian and European health care systems seem to limit insurance discrimination to life and disability insurance, U.S. residents do not have national health insurance and are concerned about health insurance discrimination. Two persons residing outside Canada requested predictive testing anonymously. Their primary reason for doing so was to avoid the risks of medical insurance discrimination. After a detailed preparatory session and agreement to counselling and to receipt of results in person, we agreed to provide anonymous testing to these persons. One participant, whose psychological assessment was unremarkable, coped well with the predictive testing process and did not have the CAG expansion. The other participant had considerable emotional problems prior to testing, which necesitated postponement of discussion of results and referral for psychiatric assessment and support. Both participants had difficulty maintaining anonymity. The provision of anonymous predictive testing raises several problems. With anonymous testing, clinicians cooperate with participants to exclude insurance companies from information. This may invalidate the contract with insurance companies. A policy response by insurance companies or a universal health care system to protect individuals is preferable. Individuals who request anonymous testing may be precisely those most vulnerable and in need of additional support and counselling. However, the preservation of anonymity is a burden to participants and may frustrate the clinicians' ability to establish rapport in counselling and to provide appropriate follow-up typically available through genetic counselling in predictive testing programs.

Adult↗
PubMedDate not supplied

Medicare spending for elderly beneficiaries who need long-term care.

To better understand how elderly people with long-term care needs might be affected by Medicare's greater reliance on risk plans, we examine Medicare spending for this population using data from the Medicare Current Beneficiary Survey. Medicare spending for elderly people with functional limitations is substantially greater than for other beneficiaries, but highly variable. Medicare spends more, however, for community residents with moderate to severe functional limitations than for nursing home residents with similar degrees of limitation. These results raise concerns about the incentives of Medicare risk plans in caring for enrollees with long-term care needs.

Activities of Daily Living↗
PubMed1997

Genetic screening and the right not to know.

This article discusses the basic elements of genetic screening and monitoring, the Americans With Disabilities Act of 1990, the constitutional issues, and the possibility of government mandated genetic monitoring or screening. The field of genetics offers the promise of unearthing the causes of a wide range of mysterious diseases and potentially finding their cures. Genetic screening and monitoring will play a large role in the application of these new findings. While these technologies offer great promise for the future of medicine, and the eradication of certain genetically linked diseases, until there are cures for persons with the faulty genes, such knowledge can lead to anxious preoccupation with the ever present disease potential within, and discrimination by employers, insurers, governmental agencies, and health care providers without. Given these unpleasant results of genetic screening or monitoring, it is important to assert the individual's right not to know.

Persons with Disabilities↗