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INSURANCE (26 journals)

Showing 1 - 26 of 26 Journals sorted alphabetically
Annals of Actuarial Science     Full-text available via subscription   (Followers: 2)
Asia-Pacific Journal of Risk and Insurance     Hybrid Journal   (Followers: 7)
Assurances et gestion des risques     Full-text available via subscription  
Astin Bulletin     Full-text available via subscription   (Followers: 1)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Blätter der DGVFM     Hybrid Journal   (Followers: 2)
British Actuarial Journal     Full-text available via subscription   (Followers: 1)
Geneva Papers on Risk and Insurance - Issues and Practice     Hybrid Journal   (Followers: 13)
Geneva Risk and Insurance Review     Hybrid Journal   (Followers: 7)
Health Affairs     Full-text available via subscription   (Followers: 80)
Insurance Markets and Companies     Open Access  
Insurance: Mathematics and Economics     Hybrid Journal   (Followers: 10)
International Journal of Business Continuity and Risk Management     Hybrid Journal   (Followers: 17)
International Journal of Forensic Engineering     Hybrid Journal   (Followers: 3)
International Journal of Forensic Engineering and Management     Hybrid Journal   (Followers: 3)
International Journal of Health Economics and Management     Hybrid Journal   (Followers: 13)
International Social Security Review     Hybrid Journal   (Followers: 8)
Journal for Labour Market Research     Open Access   (Followers: 9)
Journal of Derivatives & Hedge Funds     Hybrid Journal   (Followers: 9)
Journal of Risk and Insurance     Hybrid Journal   (Followers: 17)
Risk Management     Hybrid Journal   (Followers: 15)
Risk Management & Insurance Review     Hybrid Journal   (Followers: 10)
Scandinavian Actuarial Journal     Hybrid Journal   (Followers: 2)
SourceOECD Finance & Investment/Insurance & Pensions     Full-text available via subscription   (Followers: 3)
The Geneva Reports     Free   (Followers: 2)
Zeitschrift für die gesamte Versicherungswissenschaft     Hybrid Journal   (Followers: 1)
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International Journal of Health Economics and Management
Number of Followers: 13  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2199-9023 - ISSN (Online) 2199-9031
Published by Springer-Verlag Homepage  [2626 journals]
  • Implementation of personalized medicine in a context of moral hazard and
           uncertainty about treatment efficacy
    • Abstract: This paper analyzes the decision of a health authority to implement personalized medicine. We consider a model in which the health authority has three possibilities. It can apply either the same treatment (a standard or a new treatment) to the whole population or implement personalized medicine, i.e., use genetic information to offer the most suitable treatment to each patient. We first characterize the drug reimbursement contract of a firm producing a new treatment with a companion genetic test when the firm can undertake an effort to improve drug quality. Then, we determine the conditions under which personalized medicine should be implemented when this effort is observable and when it is not. Finally, we show how the unobservability of effort affects the conditions under which the health authority implements personalized medicine.
      PubDate: 2020-11-17
       
  • Growth and welfare in mixed health system financing with physician dual
           practice in a developing economy: a case of Indonesia
    • Abstract: Based on Indonesia’s hybrid BPJS Kesehatan health system, we analyze for welfare-optimal government financing strategy in an economy with a mixed health system using an endogenous growth framework with physician dual practice. We find the model solution to produce two vastly different regimes in terms of policy implications: a “high” public-sector congestion regime as in the benchmark case of Indonesia, and a “low” public-sector congestion, high capacity regime. In the former, welfare-optimal health financing strategy appears to be promoting private health service. In contrast, in the low-congestion, high capacity regime, a welfare-optimal strategy is to do the opposite of increasing government physician wage at the expense of private health subsidy. These results highlight the importance of developing a benchmarking system that measures the actual degree of congestion faced by the public health service in a developing economy, as it ultimately would influence the optimal health financing strategy to be pursued.
      PubDate: 2020-11-07
       
  • From downcoding to upcoding: DRG based payment in hospitals
    • Abstract: A prospective disease group-based payment is a reimbursement rule used in a wide array of countries. It turns to be the hospital’s payment rule to imply. The secret of this payment is a fee payment as well as a hospital’s activity based payment. There is a consensus to consider this rule of payment as the least likely to be manipulated by the actors. However, the defined fee per group depends on recorded information that is then processed using complex algorithms. What if the data itself can be manipulated' The result would be a fee per group based on manipulated factors that would lead to an inefficient budget allocation between hospitals. Using a unique French longitudinal database with 145 million stays, I unambiguously demonstrate that the implementation of a finer classification led to an upcoding-learning effect. The end result has been a budget transfer from public non-research hospitals to for-profit hospitals. The 2009 policy lead to upcoding disconnected from any changes in the trend of production of care.
      PubDate: 2020-10-31
       
  • National health insurance and the choice of delivery facility among
           expectant mothers in Ghana
    • Abstract: The effectiveness of health insurance in removing barriers to the utilisation of maternal healthcare in order to curb maternal mortality especially in developing countries is gaining ground. However, in assessing the effects of health insurance on choice of delivery facilities, previous studies either put all delivery services together and used binary techniques or failed to address endogeneity problem. Moreover, the age of data used for such analysis in Ghana may not tell a convincing story. This study used data from the 2014 to 2008 Ghana Demographic and Health Surveys with a sample of 6319 women and employed multinomial endogenous treatment effects models with Conditional Mixed Process estimator to examine the effects of national health insurance scheme (NHIS) on the choice delivery facility in Ghana. We found that NHIS has varied effects on the use of delivery services across service providers in the health system. Relative to home delivery services, being insured increases the probability of using public hospitals, public clinics and private health facilities for delivery by 20.3 percent, 9.1 percent and 2.3 percent respectively. Moreover, relative to an insured woman who gave birth before 2008, her counterpart who gave birth after 2008 is 6.3 percent, 4.9 percent and 0.77 percent more likely to use public hospitals, public clinics and private health facilities respectively for delivery.
      PubDate: 2020-10-30
       
  • Asymmetric behavior of tobacco consumption in Spain across the business
           cycle: a long-term regional analysis
    • Abstract: Many theoretical and empirical studies have analyzed the relationship between the economic cycle and tobacco consumption using the GDP and unemployment rates as the key variables for measuring economic phases. However, few studies focus on the pathways that cause tobacco consumption to be linked with the economic cycle, and there are no studies analyzing the heterogeneous effects underlying this relationship across nations and regions. This article explores the relationship and its pathways in 16 Spanish regions for the period 1989–2018. To this end, we apply a Granger causality analysis based on the augmented vector autoregressive (VAR) model in levels and extra lags. This method provides more efficient and robust results than the standard VAR model, which can lead to biased results with limited samples, especially in a region-by-region analysis. The empirical results suggest that the impact of the business cycle on tobacco consumption is heterogeneous and specific to each region. In addition, although recession phases cause a decline in tobacco consumption in Spain, in line with the literature, this procyclical relationship does not occur for expansion phases in all regions. One of the main findings of this article is that in expansion phases, tobacco consumption is sensitive to GDP, while in recession phases, tobacco consumption is affected by unemployment. National and regional governments should consider these results when they develop smoking control policies because homogeneous strategies can lead to heterogeneous results. Thus, the results can be useful for policymakers dealing with tobacco control strategies.
      PubDate: 2020-10-06
       
  • Aging out of dependent coverage and the effects on the use of inpatient
           medical care
    • Abstract: We investigate the impact of losing health insurance coverage at age 26 due to aging out of the Affordable Care Act’s dependent coverage on health insurance coverage rates and various indicators of inpatient medical care. We find that the probability of being covered under any type of health insurance plan decreases by 2.5–6.2 percentage points at age 26. However, the effects of this discrete change in health insurance coverage on inpatient medical care and related costs are insignificant.
      PubDate: 2020-09-17
       
  • Efficiency and profitability in US not-for-profit hospitals
    • Abstract: This article examines the relationship between hospital profitability and efficiency. A cross-section of 1317 U.S. metropolitan, acute care, not-for-profit hospitals for the year 2015 was employed. We use a frontier method, stochastic frontier analysis, to estimate hospital efficiency. Total margin and operating margin were used as profit variables in OLS regressions that were corrected for heteroskedacity. In addition to estimated efficiency, control variables for internal and external correlates of profitability were included in the regression models. We found that more efficient hospitals were also more profitable. The results show a positive relationship between profitability and size, concentration of output, occupancy rate and membership in a multi-hospital system. An inverse relationship was found between profits and academic medical centers, average length of stay, location in a Medicaid expansion state, Medicaid and Medicare share of admissions, and unemployment rate. The results of a Hausman test indicates that efficiency is exogenous in the profit equations. The findings suggest that not-for-profit hospitals will be responsive to incentives for increasing efficiency and use market power to increase surplus to pursue their objectives.
      PubDate: 2020-08-20
       
  • Value of new performance information in healthcare: evidence from Japan
    • Abstract: Mandatory measurement and disclosure of outcome measures are commonly used policy tools in healthcare. The effectiveness of such disclosures relies on the extent to which the new information produced by the mandatory system is internalized by the healthcare organization and influences its operations and decision-making processes. We use panel data from the Japanese National Hospital Organization to analyze performance improvements following regulation mandating standardized measurement and peer disclosure of patient satisfaction performance. Drawing on value of information theory, we document the absolute value and the benchmarking value of new information for future performance. Controlling for ceiling effects in the opportunities for improvement, we find that the new patient satisfaction measurement system introduced positive, significant, and persistent mean shifts in performance (absolute value of information) with larger improvements for poorly performing hospitals (benchmarking value of information). Our setting allows us to explore these effects in the absence of confounding factors such as incentive compensation or demand pressures. The largest positive effects occur in the initial period, and improvements diminish over time, especially for hospitals with poorer baseline performance. Our study provides empirical evidence that disclosure of patient satisfaction performance information has value to hospital decision makers.
      PubDate: 2020-08-18
       
  • Health expenditure, human capital, and economic growth: an empirical study
           of developing countries
    • Abstract: Social security systems were successively established in most developing countries in the 1980s and 1990s. To ensure the long-term sustainability of these newly established systems it is essential to carefully monitor the economic impact. Based on the panel data of 21 developing countries from 2000 to 2016, this paper is the first to apply the panel threshold model to empirically analyze the relationship between national health expenditures and economic growth under different levels of human capital. The results show that health expenditure and economic growth have significant interval effects because of the different levels of human capital. Specifically, when human capital levels are low, health expenditure is significantly negatively correlated with economic growth. When human capital is at a medium level, health expenditure has a positive but not significant impact on economic growth. When the level of human capital is high, the positive economic impact of the health expenditure is significantly enhanced. In addition, subgroup analyses indicate that population aging and low fertility aggravate the negative impact of health expenditures on economic growth. This study provides reliable analysis and can be used by developing countries to maintain a long-term sustainable social security system.
      PubDate: 2020-06-01
       
  • The individual welfare effects of the Affordable Care Act for previously
           uninsured adults
    • Abstract: The Affordable Care Act (ACA) improved welfare by expanding, subsidizing, and standardizing healthcare coverage. At the same time, the law also penalizes the remaining uninsured and establishes a benchmark private policy that charges premiums and cost-sharing expenses in the non-group market. This paper introduces a conceptual and empirical framework for evaluating the net effects of ACA coverage expansions for the individual welfare of previously uninsured adults. Using restricted-access data from the 2010–2012 Medical Expenditure Panel Survey, I evaluate the short-term welfare effect as a function of health and non-medical consumption. I simulate post-ACA insurance status then evaluate the change in expected medical consumption and the utility of consumption by estimating parameter values for a generalized gamma distribution of the ex-ante spread of healthcare and medical spending for each person. The ACA generates a modest net improvement in individual welfare on average (+ $91). While low-income individuals realize gains (+ $539), all other income-groups realize increasingly large losses. The uninsured majority (65%) realize average losses (− $158). Medicaid beneficiaries realize substantial gains (+ $1309). While in most specifications, exchange enrollees realize average gains (+ $146), just under a quarter (24%) realizes any improvement. The chronically-ill realize substantial gains (+ $1065). The non-chronically-ill majority (71%) realize average losses (− $312). Despite weakly lower risk premiums (− $28), medical spending increases in catastrophic scenarios on average. The ACA improves the welfare of some, especially the low-income and chronically-ill. Medicaid generates unequivocal gains for beneficiaries. Most previously uninsured adults remain uninsured, some of whom pay a penalty. The subsidized cost of ACA private insurance outweighs its benefits for most exchange enrollees.
      PubDate: 2020-06-01
       
  • Quality information disclosure and health insurance demand: evidence from
           VA hospital report cards
    • Abstract: This study examines the effect of public reporting of quality information on the demand for public insurance. In particular, we examine the effect of the introduction of Veterans Affairs (VA) hospital quality report cards in 2008. Using data from the Current Population Survey in 2005–2015, we find that new information about the quality of a VA hospital had a significant effect on VA coverage among veterans living in the same Metropolitan Statistical Area (MSA). Despite the significant effect on VA coverage, the quality report did not have a spillover effect on veterans’ labor supply. Moreover, updated quality information released in later years, which was presented in a less straightforward form, led to no additional changes in VA coverage. These findings suggest that quality reports for public insurance programs can be used as a policy lever to facilitate take up decision among potential beneficiaries.
      PubDate: 2020-06-01
       
  • Consolidation in the dental industry: a closer look at dental payers and
           providers
    • Abstract: We examine the effect of commercial dental insurance concentration on the size of dental practices, the decision of dentists to own a practice, and the choice of dentists to work at a dental management service organization—a type of corporate group practice that has become more prevalent in the United States in recent years. Using 2013–2015 dentist-level data from the American Dental Association, county-level data on firms and employment from the United States Census, and commercial dental insurance market concentration data from FAIR Health®, we find a modest effect of dental insurance market concentration on the size of dental practices. We also find that a higher level of commercial dental insurance market concentration is associated with a dentist’s decision not to own a practice. There is inconclusive evidence that higher levels of dental insurance market concentration impact a dentist’s decision to affiliate with a dental management service organization. Overall, our findings imply that dentists consolidate in response to increases in concentration among commercial dental insurers.
      PubDate: 2020-06-01
       
  • Patient and provider-level factors associated with changes in utilization
           of treatments in response to evidence on ineffectiveness or harm
    • Abstract: High-quality health care not only includes timely access to effective new therapies but timely abandonment of therapies when they are found to be ineffective or unsafe. Little is known about changes in use of medications after they are shown to be ineffective or unsafe. In this study, we examine changes in use of two medications: fenofibrate, which was found to be ineffective when used with statins among patients with Type 2 diabetes (ACCORD lipid trial); and dronedarone, which was found to be unsafe in patients with permanent atrial fibrillation (PALLAS trial). We examine the patient and provider characteristics associated with a decline in use of these medications. Using Medicare fee-for-service claims from 2008 to 2013, we identified two cohorts: patients with Type 2 diabetes using statins (7 million patient-quarters), and patients with permanent atrial fibrillation (83 thousand patient-quarters). We used interrupted time-series regression models to identify the patient- and provider-level characteristics associated with changes in medication use after new evidence emerged for each case. After new evidence of ineffectiveness emerged, fenofibrate use declined by 0.01 percentage points per quarter (95% CI − 0.02 to − 0.01) from a baseline of 6.9 percent of all diabetes patients receiving fenofibrate; dronedarone use declined by 0.13 percentage points per quarter (95% CI − 0.15 to − 0.10) from a baseline of 3.8 percent of permanent atrial fibrillation patients receiving dronedarone. For dronedarone, use declined more quickly among patients dually-enrolled in Medicare and Medicaid compared to Medicare-only patients (P < 0.001), among patients seen by male providers compared to female providers (P = 0.01), and among patients seen by cardiologists compared to primary care providers (P < 0.001).
      PubDate: 2020-04-30
       
  • Effects of macroeconomic fluctuations on mental health and psychotropic
           medicine consumption
    • Abstract: Our aim in this paper is to understand the impact of macroeconomic fluctuations on mental health and psychotropic medicine consumption. In order to do that we exploit differences in the fluctuations of business cycle conditions across regional units in Catalonia. Our findings suggest that, in general, economic fluctuations at the local level had no significant effect on the consumption of psychotropic medicines. However, we show that a deterioration in local labour market conditions is associated with a reduction in the consumption of anxiolytics medicines. We also report an increase in the consumption of anxiolytics in regions with a softer deterioration in the economic situation. Although we report mild improvements in both mental and physical health for some sub-groups of the population, we also find significant reductions on the probability of sleeping 6 h or more. Thus, these elements point towards potential negative effects of local labour market conditions on health in the medium/long term.
      PubDate: 2020-04-19
       
  • Do the uninsured demand less care' Evidence from Maryland’s
           hospitals
    • Abstract: Uninsured individuals receive fewer healthcare services for at least three reasons: responsibility for the entire bill, higher prices, and potential provider reductions for concern of nonpayment. I isolate reductions when uninsured patients are solely financially responsible by capitalizing on Maryland’s highly regulated health care system. Prices are set by the state, are uniform across all patients, and hospitals are compensated for free care and bad debt. I use a unique feature of the data, multiple readmissions for patients who gain or lose insurance between visits, to isolate the reductions in quantity demanded when individuals are faced with paying the full price without an insurance contribution. A Blinder–Oaxaca decomposition estimates uninsured individuals receive 6% fewer services after accounting for differences in patient, illness, and hospital characteristics than when these same individuals are insured.
      PubDate: 2020-03-06
       
  • Public satisfaction with health system coverage, empirical evidence from
           SHARE data
    • Abstract: People’s satisfaction with the health system, including the coverage provided, has been a concern for some years now but research into the main explanatory factors is in progress. This work focuses on European countries plus Israel, using the SHARE database to find what determines people’s satisfaction with the basic coverage provided by the health system of each country. On top of the usual individual socioeconomic characteristics, other explanatory factors were also considered. These include, at individual level, trust in others, political positioning, and risk aversion; at country level, they include access to specialist care and the type of health system financing. Estimation of an ordered logistic model found that the main predictors for satisfaction with a health system’s basic coverage include trust in others, unmet health needs, self-assessed health, free access to specialists, health system financed through social insurance, and out-of-pocket payments. These results provide the basis for possible policies designed to improve people’s satisfaction.
      PubDate: 2020-02-14
       
  • Effects of pay-for-performance on prescription of hypertension drugs among
           public and private primary care providers in Sweden
    • Abstract: This study exploits policy reforms in Swedish primary care to examine the effect of pay-for-performance (P4P) on compliance with hypertension drug guidelines among public and private health care providers. Using provider-level outcome data for 2005–2013 from the Swedish Prescription Register, providers in regions using P4P were compared to providers in other regions in a difference-in-differences analysis. The results indicate that P4P improved guideline compliance regarding prescription of angiotensin converting enzyme inhibitors and angiotensin receptor blockers. The effect was mainly driven by private providers, suggesting that policy makers should take ownership into account when designing incentives for health care providers.
      PubDate: 2020-01-20
       
  • Competition and market structure in the dental industry
    • Abstract: We use Survey of Dental Practice data from 1983 to 2012 to examine market power of dentists and hygienists in private practice. Our findings are consistent with a dental market wherein practices use hygienist services as a “loss leader” in order to steer patients into more lucrative dental services, which exhibit the ability to markup price above marginal cost. Both dental care exhibits an elasticity of demand of roughly − 0.2, while hygienist care exhibits and elasticity of demand of nearly − 0.6. Another theme that emerged from our findings is the evidence for significant economies of scale in the dental market. The overall returns to scale parameter of 2.1 suggests significant increasing returns to scale are available to the typical dental practice. Given that the typical practice has 1.5 dentists, the finding is not surprising. While returns to scale diminishes with visit volume, the largest quartile of practices still has meaningful increasing returns to scale of roughly 1.75.
      PubDate: 2020-01-08
       
  • Health expenditure, longevity, and child mortality: dynamic panel data
           approach with global data
    • Abstract: In this study, effects of public and private health expenditures on life expectancy at birth and infant mortality are analysed on a global scale with 195 countries in the years 1995–2014. The global data set is divided into country categories according to growth in life expectancy, decrease in infant mortality rate, and level of gross national income per capita. Some new dynamic panel model estimators, argued to be more efficient with high persistence series and predetermination compared to popular but complex GMM estimators, show that public health expenditures are generally more health-promoting than private expenditures. However, the health effects are not as great as primary education effects. Although the new estimators provide some new and valuable information on health expenditure effects on life expectancy and infant mortality on a global scale, they do not show desired robustness.
      PubDate: 2019-09-06
       
  • Health expenditure and gross domestic product: causality analysis by
           income level
    • Abstract: The empirical findings on the relationship between gross domestic product (GDP) and health expenditure are diverse. The influence of income levels on this causal relationship is unclear. This study examines if the direction of causality and income elasticity of health expenditure varies with income level. It uses the 1995–2014 panel data of 161 countries divided into four income groups. Unit root, cointegration and causality tests were employed to examine the relationship between GDP and health expenditure. Impulse-response functions and forecast-error variance decomposition tests were conducted to measure the responsiveness of health expenditure to changes in GDP. Finally, the common correlated effects mean group method was used to examine the income elasticity of health expenditure. Findings show that no long-term cointegration exists, and the growth in health expenditure and GDP across income levels has a different causal relationship when cross-sectional dependence in the panel is accounted for. About 43% of the variation in global health expenditure growth can be explained by economic growth. Income shocks affect health expenditure of high-income countries more than lower-income countries. Lastly, the income elasticity of health expenditure is less than one for all income levels. Therefore, healthcare is a necessity. In comparison with markets, governments have greater obligation to provide essential health care services. Such results have noticeable policy implications, especially for low-income countries where GDP growth does not cause increased health expenditure.
      PubDate: 2019-07-16
       
 
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