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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)
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: 14)
Geneva Risk and Insurance Review     Hybrid Journal   (Followers: 8)
Health Affairs     Full-text available via subscription   (Followers: 83)
Insurance Markets and Companies     Open Access   (Followers: 1)
Insurance: Mathematics and Economics     Hybrid Journal   (Followers: 10)
International Journal of Business Continuity and Risk Management     Hybrid Journal   (Followers: 28)
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: 12)
International Social Security Review     Hybrid Journal   (Followers: 9)
Journal for Labour Market Research     Open Access   (Followers: 11)
Journal of Derivatives & Hedge Funds     Hybrid Journal   (Followers: 9)
Journal of Risk and Insurance     Hybrid Journal   (Followers: 17)
Journal of Risk Finance     Hybrid Journal   (Followers: 6)
Risk Management     Hybrid Journal   (Followers: 14)
Risk Management & Insurance Review     Hybrid Journal   (Followers: 11)
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: 12  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2199-9023 - ISSN (Online) 2199-9031
Published by Springer-Verlag Homepage  [2658 journals]
  • Predicting diagnostic coding in hospitals: individual level effects of
           price incentives

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      Abstract: The purpose of this paper is to test if implicit price incentives influence the diagnostic coding of hospital discharges. We estimate if the probability of being coded as a complicated patient was related to a specific price incentive. This paper tests empirically if upcoding can be linked to shifts in patient composition through proxy measures such as age composition, length of stay, readmission rates, mortality- and morbidity of patients. Data about inpatient episodes in Norway in all specialized hospitals in the years 1999–2012 were collected, N = 11 065 330. We examined incentives present in part of the hospital funding system. First, we analyse trends in the proxy measures of diagnostic upcoding: can hospital behavioural changes be seen over time with regards to age composition, readmission rates, length of stay, comorbidity and mortality' Secondly, we examine specific patient groups to see if variations in the price incentive are related to probability of being coded as complicated. In the first years (1999–2003) there was an observed increase in the share of episodes coded as complicated, while the level has become more stable in the years 2004–2012. The analysis showed some indications of upcoding. However, we found no evidence of widespread upcoding fuelled by implicit price incentive, as other issues such as patient characteristics seem to be more important than the price differences. This study adds to previous research by testing individual level predictions. The added value of such analysis is to have better case mix control. We observe the presence of price effects even at individual level.
      PubDate: 2021-10-06
       
  • State minimum wages and health insurance coverage in the United States:
           2008–2018

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      Abstract: This study examines the effect of minimum wage hikes on the shares of uninsured people during the period 2008–2018. Despite some concern that higher minimum wages would lead to higher uninsured rates by (1) reducing employment, (2) inducing employers to stop offering health insurance to their employees, and (3) making minimum wage workers ineligible for Medicaid by increasing their earnings, the findings indicate that the uninsured rate tends to decrease with higher minimum wages, suggesting that minimum wage hikes might encourage minimum-wage workers to obtain health insurance. The effects appear to come from minimum wage hikes that occurred after the Affordable Care Act (ACA) took effect in 2014, suggesting that higher minimum wages combined with federal subsidies for the ACA marketplace and the individual mandate might have contributed to a reduction in the uninsured rate. However, Medicaid expansions seem to mitigate the effect of the minimum wage on the uninsured rate among low-income households.
      PubDate: 2021-09-08
      DOI: 10.1007/s10754-021-09313-6
       
  • The sensitivity of hospital coding to prices: evidence from Indonesia

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      Abstract: This study examines a newly introduced DRG system in Indonesia. We use secondary data for 2015 and 2017 from Jaminan Kesehatan Nasional (JKN), a patient level dataset for Indonesia created in 2014 to record public and private hospitals’ claims to the national health insurance system to investigate whether there is an association between changes in tariffs paid and the severity of inpatient activity recorded in hospitals. We find a consistent small, positive and statistically significant correlation between changes in tariffs and changes in concentration of activity, indicating discretionary but limited coding behaviour by hospitals. The results indicate that reducing price differentials may mitigate discretionary coding, but that the benefits of this are limited and need to be compared to the potential risk of having to rebase all prices upwards.
      PubDate: 2021-09-07
      DOI: 10.1007/s10754-021-09312-7
       
  • Cost-efficiency in the patient centered medical home model: New evidence
           from federally qualified health centers

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      Abstract: This research analyzes the cost-efficiency of the Patient Centered Medical Home (PCMH) model vis-à-vis the traditional care delivery model in the Federally Qualified Health Centers (FQHC). We apply the three-stage least squares modeling approach on 2014 UDS data on all FQHCs to estimate per-visit and per-patient cost functions. Log-quadratic and linear-quadratic functional forms of cost are used for the analysis. The estimated models reveal substantial scale economies and cost advantages associated with PCMH status. Aggregate cost-saving impact of PCMH across all FQHCs in 2014 is estimated to be $1.05 billion. Simulations reveal that the PCMH impact on cost savings grows with the size of the patient population. Reaching the full cost-saving potential in PCMH-recognized FQHCs hinges on expanding the health workforce at all levels of care to meet the need of the growing patient population due to aging and Medicaid expansion. For FQHCs that are not PCMH-recognized, capacity/infrastructural expansion appears to be the immediate policy choice.
      PubDate: 2021-09-01
      DOI: 10.1007/s10754-021-09295-5
       
  • Racial disparities in health care utilization, the affordable care act and
           racial concordance preference

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      Abstract: The Affordable Care Act was implemented with the aim of increasing coverage and affordable access with hopes of improving health outcomes and reducing costs. Yet, disparities persist. Coverage and affordable access alone cannot explain the health care gap between racial/ethnic minorities and white patients. Instead, the focus has turned to other factors affecting utilization rates such as the patient-provider relationship. Data from nationally represented U.S. households in 2009–2017 were used to study the association between patient-provider social distance as measured by “racial/ethnic concordance” and health care utilization rates for periods covering pre- and post-ACA. Despite the reduction in financial barriers to health access with the implementation of the ACA, the correlation between racial/ethnic concordance and utilization remains positive and significant. The results suggest that while the ACA may have improved coverage and affordability, other dimensions of access, particularly acceptability, as measured by patient-provider clinical interaction experience, remains a factor in the decision to utilize care.
      PubDate: 2021-08-24
      DOI: 10.1007/s10754-021-09311-8
       
  • Does an upward intergenerational educational spillover effect exist'
           The effect of children’s education on Chinese parents’ health

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      Abstract: Background Research on the presence of an upward spillover effect of children’s education on parental health is rapidly developing. However, there are certain differences in the conclusions of relevant studies, and no consistent viewpoint has been reached. Methods Using the exogenous differences in education generated by the expansion of higher education enrollment that China implemented as a reform in 1999, we analyze this issue by studying the effect of children’s higher education on their parents’ health. Results The instrumental variable (IV) estimation results show that children who received higher education have a significant and positive effect on the physical health of their parents. Compared with the ordinary least squares (OLS) estimation results, the coefficient of the effect of children receiving higher education is larger in the IV estimation. Conclusions Children’s education can generate a significant active effect on parental health, affecting parental physical health via its effect on parental health cognition and health behaviors. Based on heterogeneity analyses, the effect of a son’s education on parental health is more significant than the effect of a daughter’s education, and among rural children, higher education has a more significant effect on parental health.
      PubDate: 2021-08-20
      DOI: 10.1007/s10754-021-09308-3
       
  • Impact of implementation of the Dependency Act on the Spanish economy: an
           analysis after the 2008 financial crisis

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      Abstract: The aim of this paper is to assess the industry-wide impact of Long-Term Care (LTC) spending on the Spanish economy. LTC spending includes beneficiaries’ copayment and the impact is quantified in terms of output, employment and value added. To this purpose, we use an input–output model of the Spanish economy that allows us to further describe how the value added generated is distributed throughout the economy according to the existing benefit-mix (in kind services, cash benefit for informal care and cash benefit for personal assistance). Additionally, the model provides results on how the return on LTC spending would improve by using only in-kind services instead of the benefit mix currently in place. The 2012 Spanish Input–Output Table at current prices was extracted from the WIOD Database’s 2016 Release. Consumption data for dependent, employed, and unemployed households were collected from the Spanish Household Budget Survey for 2012. The findings reveal that the total annual costs are 7,205.43 million €, with total costs from in-kind services being almost 71% higher than total costs from cash benefits. Each million euros invested in in-kind services and CBPA would create 41.91 jobs (68.41% direct, 9.16% indirect and 22.43% induced). However, each million euros spent on cash benefits would result in 16.88 jobs overall (53.02% direct, 24.53% indirect and 22.45% induced). The total number of jobs is 151,353 at the aggregate level, being 46,840 depending on cash-benefits and 104,513 on in-kind services.
      PubDate: 2021-08-04
      DOI: 10.1007/s10754-021-09310-9
       
  • Willingness to give amid pandemics: a contingent valuation of anticipated
           nongovernmental immunization programs

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      Abstract: Given that altruism is crucial in assisting impoverished households to cope with health and economic crises, it is important to improve our understanding of how preferences and motives for giving differ during a pandemic. We implemented a web-based, contingent valuation survey to estimate Americans’ willingness to give for nongovernmental immunization programs in the context of the COVID-19 pandemic. Our results indicate that the median person is willing to give a one-time donation of $26, or at least $13 when willingness-to-give estimates are corrected for uncertainty regarding future donations. We find that willingness to give is related to income, concern levels, vaccine usage, and sociodemographic characteristics. Our findings also shed light on purely and impurely altruistic motives underlying the willingness to fund immunization programs.
      PubDate: 2021-06-11
      DOI: 10.1007/s10754-021-09309-2
       
  • Providers preferences towards greater patient health benefit is associated
           with higher quality of care

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      Abstract: Standard theories of health provider behavior suggest that providers are motivated by both profit and an altruistic interest in patient health benefit. Detailed empirical data are seldom available to measure relative preferences between profit and patient health outcomes. Furthermore, it is difficult to empirically assess how these relative preferences affect quality of care. This study uses a unique dataset from rural Myanmar to assess heterogeneous preferences toward treatment efficacy relative to provider profit and the impact of these preferences on the quality of provider diagnosis and treatment. Using conjoint survey data from 187 providers, we estimated the marginal utilities of higher treatment efficacy and of higher profit, and the marginal rate of substitution between these outcomes. We also measured the quality of diagnosis and treatment for malaria among these providers using a previously validated observed patient simulation. There is substantial heterogeneity in providers’ utility from treatment efficacy versus utility from higher profits. Higher marginal utility from treatment efficacy is positively associated with the quality of treatment among providers, and higher marginal utility from profit are negatively associated with quality of diagnosis. We found no consistent effect of the ratio of marginal utility of efficacy vs marginal utility of profit on quality of care. Our findings suggest that providers vary in their preferences towards profit and treatment efficacy, with those providers that place greater weight on treatment efficacy providing higher quality of care.
      PubDate: 2021-06-04
      DOI: 10.1007/s10754-021-09298-2
       
  • Socioeconomic inequality in tobacco use in Kenya: a concentration analysis

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      Abstract: This paper aims at assessing and exploring socioeconomic inequalities in tobacco use in Kenya. Using the theory of fundamental causes, and concentration index, we investigate the determinants of tobacco use, and whether it disproportionately affects the poor. All data used in this study emanated from the 2014 Global Adult Tobacco Survey implemented in Kenya on a nationally representative sample of men and women aged 15 years and older. Our results suggest a link between tobacco use and socioeconomic inequality. Overall, poorer households are more affected by tobacco use than richer households. This socioeconomic inequality is more evident among men and households living in urban areas. The decomposition of the concentration index indicates that the overall socioeconomic inequality for current tobacco smokers is explained by 69.11% of household wealth. To reduce the prevalence rate of smoking in Kenya, policymakers could design and implement tobacco control programs through the equity lens. Community health workers could be used to promote non-smoking behaviors among the poor.
      PubDate: 2021-06-01
      DOI: 10.1007/s10754-020-09292-0
       
  • Opioid and non-opioid analgesic prescribing before and after the
           CDC’s 2016 opioid guideline

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      Abstract: The U.S. has addressed the opioid crisis using a two-front approach: state regulations limiting opioid prescriptions for acute pain patients, and voluntary federal CDC guidelines on shifting chronic pain patients to lower opioid doses and non-opioids. No opioid policy research to date has accounted for this two-pronged approach in their research design. We develop a theory of physician prescribing behavior under this two-pronged incentive structure. Using the Medical Expenditure Panel Survey, we empirically corroborate the theory: regulations and guidelines have the intended effects of reducing opioid prescriptions for acute and chronic pain, respectively, as well as the predicted unintended effects—income effects cause regulations on acute pain treatment to increase chronic pain opioid prescriptions and the chronic pain treatment guidelines spillover to reduce opioids for acute pain. Moreover, we find that the guidelines worked as intended in terms of the reduced usage, with chronic pain patients shifting to non-opioids and also tapering opioid doses. For those who discontinued opioids under regulations and guidelines, we find no harm in terms of increased work limitations due to pain a year after discontinuing opioids. Finally, we observe an unexplained dichotomy—regulations reduce opioid use by causing fewer new starts, whereas guidelines reduce opioid use by discontinuing current users, with no impact on new starts.
      PubDate: 2021-05-08
      DOI: 10.1007/s10754-021-09307-4
       
  • The incidence of the healthcare costs of chronic conditions

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      Abstract: Who pays for the costs of chronic conditions' In this paper, we examine whether 50–64-year old workers covered by employer-sponsored insurance bear healthcare costs of chronic conditions in the form of lower wages. Using a difference-in-differences approach with data from the Health and Retirement Study, we find that workers with chronic diseases receive significantly lower wages than healthy workers when they are covered by employer-sponsored insurance. Our findings suggest that higher healthcare costs of chronic conditions can explain the substantial part of the wage gap between workers with and without chronic diseases.
      PubDate: 2021-05-04
      DOI: 10.1007/s10754-021-09305-6
       
  • Impacts of insurance expansion on health cost, health access, and health
           behaviors: evidence from the medicaid expansion in the US

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      Abstract: Expansion of subsidized health insurance may result in both safer and riskier health behavior and outcomes. While having insurance lowers cost barriers to receive both usual and preventive care, the lower potential cost from adverse health events may also promote risky behavior. In this paper, I exploit expansion in the Medicaid program under the Affordable Care Act to estimate the impact of insurance expansion on health outcomes and behaviors for low-income individuals in the US. I find that expansion of coverage has significantly lowered cost and increased access, particularly among minority populations, but has had no significant impact on preventive health behaviors. At the same time, I also find no evidence of moral hazard or increase risky behavior like smoking and drinking among residents of expansion states.
      PubDate: 2021-05-02
      DOI: 10.1007/s10754-021-09306-5
       
  • Determinants of prepaid systems of healthcare financing: a worldwide
           country-level perspective

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      Abstract: In this paper we examine determinants of prepaid modes of health care financing in a worldwide cross-country perspective. We use three different indicators to capture the role of prepaid modes in health care financing: (i) the share of total prepaid financing as percent of total current health expenditures, (ii) the share of voluntary prepaid financing as percent of total prepaid financing, and (iii) the share of compulsory health insurance as percent of total compulsory prepaid financing. In the econometric analysis, we refer to a panel data set comprising 154 countries and covering the time period 2000–2015. We apply a static as well as a dynamic panel data model. We find that the current structure of prepaid financing is significantly determined by its different forms in the past. The significant influence of GDP per capita, governmental revenues, the agricultural value added, development assistance for health, degree of urbanization and regulatory quality varies depending on the financing structure we look at. The share of the elderly and the education level are only of minor importance for explaining the variation in a country’s share of prepaid health care financing. The importance of the mentioned variables as determinants for prepaid health care financing also varies depending on the countries’ socio-economic development. From our analysis we conclude that more detailed information on indicators which reflect the distribution of individual characteristics (such as income, family size and structure and health risks) within a country’s population would be needed to gain deeper insight into the decisive determinants for prepaid health care financing.
      PubDate: 2021-03-31
      DOI: 10.1007/s10754-021-09301-w
       
  • Wealth and the utilization of long-term care services: evidence from the
           United States

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      Abstract: Long-term care (LTC) provision and financing has become a major challenge for policymakers in the United States and worldwide. To inform associated policies and more efficiently allocate LTC resources, it is important to understand how demand for different types of LTC services responds to increased wealth. We use data from the United States Health and Retirement Study to examine the use of LTC services following plausibly exogenous positive shocks to wealth. We further account for time-invariant household-level characteristics, including the expectation of a wealth shock at an unknown future time, by employing household fixed effects. We find that large positive wealth shocks lead to a greater probability of purchase of paid home care but not of nursing home care. Our results imply that expanding home and community-based services and insurance coverage of home care for people without sufficient wealth is likely to be efficient and welfare improving and should be considered by policymakers.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 4 Given name: [R. Tamara] Last name: [Konetzka]. Also, kindly confirm the details in the metadata are correct.confirmedPlease confirm the city are correct and amend if necessary in Affiliations 1, 2, 3, 4.confirmed
      PubDate: 2021-03-30
      DOI: 10.1007/s10754-021-09299-1
       
  • Public–private differentials in health care delivery: the case of
           cesarean deliveries in Algeria

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      Abstract: Akin to other developing countries, Algeria has witnessed an increasing role of the private health sector in the past two decades. Our study sheds light on the public–private overlap and the phenomenon of physician dual practice in the provision of health care services using the particular case of cesarean deliveries in Algeria. Existing studies have reported that, compared to the public sector, delivering in a private health facility increases the risk of enduring a cesarean section. While confirming this result for the case of Algeria, our study also reveals the existence of public–private differentials in the effect of medical variables on the probability of cesarean delivery. After controlling for selection in both sectors, we show that cesarean deliveries in the private sector tend to be less medically justified compared with those taking place in the public sector, thus, potentially leading to maternal and neonatal health problems. As elsewhere, the contribution of the private health sector to the unmet need for health care in Algeria hinges on an appropriate legal framework that better coordinates the activities of the two sectors and reinforces their complementarity.
      PubDate: 2021-03-30
      DOI: 10.1007/s10754-021-09300-x
       
  • Geographic variation in Part B reimbursement and physician offsetting
           behavior: a physician matching approach

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      Abstract: Historically, Medicare has operated under the assumption that providers respond to reductions in reimbursement through increased provision of services in an effort to offset declining practice revenue; however, some recent empirical work examining fee reductions has found evidence of either small offsetting effects or reductions in the quantity supplied. Using a distance matching approach that matches practices to nearby practices that are subject to different reimbursement rates, we find overall evidence in support of Medicare’s offsetting assumption collectively for all services and for evaluation and management services. We also find evidence consistent with a traditional volume response for imaging and testing services.
      PubDate: 2021-03-18
      DOI: 10.1007/s10754-021-09297-3
       
  • The association of insurance plan characteristics with physician
           patient-sharing network structure

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      Abstract: Professional and social connections among physicians impact patient outcomes, but little is known about how characteristics of insurance plans are associated with physician patient-sharing network structure. We use information from commercially insured enrollees in the 2011 Massachusetts All Payer Claims Database to construct and examine the structure of the physician patient-sharing network using standard and novel social network measures. Using regression analysis, we examine the association of physician patient-sharing network measures with an indicator of whether a patient is enrolled in a health maintenance organization (HMO) or preferred provider organization (PPO), controlling for patient and insurer characteristics and observed health status. We find patients enrolled in HMOs see physicians who are more central and densely embedded in the patient-sharing network. We find HMO patients see PCPs who refer to specialists who are less globally central, even as these specialists are more locally central. Our analysis shows there are small but significant differences in physician patient-sharing network as experienced by patients with HMO versus PPO insurance. Understanding connections between physicians is essential and, similar to previous findings, our results suggest policy choices in the insurance and delivery system that change physician connectivity may have important implications for healthcare delivery, utilization and costs.
      PubDate: 2021-02-26
      DOI: 10.1007/s10754-021-09296-4
       
  • Impact of community-based health insurance on utilisation of preventive
           health services in rural Uganda: a propensity score matching approach

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      Abstract: The effect of voluntary health insurance on preventive health has received limited research attention in developing countries, even when they suffer immensely from easily preventable illnesses. This paper surveys households in rural south-western Uganda, which are geographically serviced by a voluntary Community-based health insurance scheme, and applied propensity score matching to assess the effect of enrolment on using mosquito nets and deworming under-five children. We find that enrolment in the scheme increased the probability of using a mosquito net by 26% and deworming by 18%. We postulate that these findings are partly mediated by information diffusion and social networks, financial protection, which gives households the capacity to save and use service more, especially curative services that are delivered alongside preventive services. This paper provides more insight into the broader effects of health insurance in developing countries, beyond financial protection and utilisation of hospital-based services.
      PubDate: 2021-02-10
      DOI: 10.1007/s10754-021-09294-6
       
  • Choice, quality and patients’ experience: evidence from a Finnish
           physiotherapy service

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      Abstract: We study the relationship between patient choices and provider quality in a rehabilitation service for disabled patients who receive the service frequently but do not have access to quality information. Previous research has found a positive relationship between patient choices and provider quality in health services that patients typically do not have previous experience or use frequently. We contribute by examining choices of new patients and experienced patients who were either forced to switch or actively switched their provider. In the analysis, we combine register data on patients’ choices and switches with provider quality data from a competitive bidding, and estimate conditional logit choice models. The results show that all patients prefer high-quality providers within short distances. We find that the willingness to travel for quality is highest among new patients and active switchers. These results suggest that new patients and active switchers compare different alternatives more thoroughly, whereas forced switchers choose their new provider in limited time leading into poorer choices.
      PubDate: 2021-01-19
      DOI: 10.1007/s10754-020-09293-z
       
 
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