scholarly journals Oil and Water: Mixing Individual Mandates, Fragmented Markets, and Health Reform

2010 ◽  
Vol 36 (1) ◽  
pp. 7-78 ◽  
Author(s):  
Allison K. Hoffman
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Health Reform ◽  
Care Delivery ◽  
Market Competition ◽  
Insurance Market ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
Individual Mandate ◽  
Policy Objectives

AbstractThe 2010 federal health insurance reform act includes an individual mandate that will require Americans to carry health insurance. This article argues that even if the mandate were to catalyze universal health insurance coverage, it will fall short on some of the policy objectives many hope to achieve through a mandate if implemented in a fragmented insurance market. To uncover this problem, this article sets forth a novel framework that disentangles three different policy objectives the individual mandate can serve. Namely, supporters of the mandate might hope for it to: (1) facilitate greater health and financial security for the uninsured (“paternalism”); (2) eliminate inefficiencies in health care delivery and financing (“efficiency”); and/or (3) require the healthy to buy insurance to help fund medical care for the sick (“health redistribution”). Health redistribution — the primary focus of this article — is a shifting of wealth from the healthy to the sick through the mechanism of risk pooling. Many see health redistribution as a means to enable all Americans to more equitably access medical care on the basis of need, rather than on the basis of ability or willingness to pay.Drawing on evidence from the implementation of an individual mandate in Massachusetts's health reform in 2006, this article reveals that the fragmented American health insurance market will thwart the mandate's ability to achieve these objectives— in particular the goal of health redistribution. Fragmentation is an atomization of the insurance market into numerous risk pools that has been driven by market competition and regulation. It prevents Americans from sharing broadly in the risk of poor health and, in doing so, entrenches a system where access to medical care remains tied to ability to pay and individualized characteristics. The final section of this article examines how various policies, including some in the new law (e.g., insurance regulation and exchanges) and others not (e.g., expanded public insurance), can reduce fragmentation so that the mandate can successfully serve all desired objectives and in the process gain greater legitimacy over time.

Protect the Sick: Health Insurance Reform in One Easy Lesson

2008 ◽  
Vol 36 (4) ◽  
pp. 652-659 ◽  
Author(s):  
Deborah Stone
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Low Income ◽  
The Elderly ◽  
The United States ◽  
Government Programs ◽  
Insurance Reform ◽  
Sick People ◽  
Health Insurance Reform ◽  
Inducing Factors

In most other nations, insurance for medical care is called sickness insurance, and it covers sick people. In the United States, we have “health insurance,” and its major carriers — commercial insurers, large employers, and increasingly government programs — strive to avoid sick people and cover only the healthy. This perverse logic at the heart of the American health insurance system is the key to reform debates.Focusing on sick people versus healthy people might seem a strange way to view the coverage issue. Most discussions of insurance categorize people into other groupings: the insured versus the uninsured; Caucasian whites versus other racial and ethnic groups; men versus women; poor and low-income people versus everybody else; children, adults, and the elderly; or citizens versus immigrants and undocumented aliens. More recently, health researchers have begun talking about “vulnerable populations,” using most of the same demographic groupings and adding other illness-inducing factors such as social isolation, stress, and impoverished neighborhoods. But as I will show, insurance plans now use premiums, cost-sharing, and other design features in ways that indirectly divide each of these groups into the sick and the healthy, to the detriment of the sick. By shifting the costs of illness onto people who use medical care — that is, sick people — market-oriented reforms of the last few decades have eroded insurance in the name of strengthening it.

scholarly journals Benefit of China’s Social Health Insurance Schemes: Trend Analysis and Associated Factors Since Health Reform

2021 ◽  
Vol 18 (11) ◽  
pp. 5672
Author(s):  
Wanyue Dong ◽  
Anthony B. Zwi ◽  
Ruhai Bai ◽  
Chi Shen ◽  
Jianmin Gao
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Social Health Insurance ◽  
Medical Insurance ◽  
Social Health ◽  
Inpatient Service ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
Basic Medical Insurance ◽  
Basic Medical

With the deepening of health insurance reform in China, the integration of social health insurance schemes was put on the agenda. This paper aims to illustrate the achievements and the gaps in integration by demonstrating the trends in benefits available from the three social health insurance schemes, as well as the influencing factors. Data were drawn from the three waves of the China Health and Nutrition Survey (2009, 2011, 2015) undertaken since health reforms commenced. χ2, Kruskal–Wallis test, and the Two-Part model were employed in the analysis. The overall reimbursement rate of the Urban Employee Basic Medical Insurance (UEBMI) is higher than that of Urban Resident Basic Medical Insurance (URBMI) or the New Rural Cooperative Medical Scheme (NRCMS) (p < 0.001), but the gap has narrowed since health reform began in 2009. Both the outpatient and inpatient reimbursement amounts have increased through the URBMI and NRCMS. Illness severity, higher institutional level, and inpatient service were associated with significant increases in the amount of reimbursement received across the three survey waves. The health reform improved benefits covered by the URBMI and NRCMS, but gaps with the UEBMI still exist. The government should consider more the release of health benefits and how to lead toward healthcare equity.

scholarly journals Health Reform: What's Insurance Got to Do with It? Recognizing Health Insurance as a Separate Species of Insurance

2010 ◽  
Vol 36 (2-3) ◽  
pp. 436-451 ◽  
Author(s):  
Wendy K. Mariner
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Access To Health Care ◽  
The United States ◽  
Separate Species ◽  
Insurance Law ◽  
Insurance Reform ◽  
Patient Protection ◽  
Health Insurance Reform ◽  
Actuarial Fairness

Health reform debates in the United States are typically conducted using the language of insurance. President Barack Obama described his hopes for expanding access to care as “health insurance reform.” Both proponents and opponents of reform debated the merits of reform proposals leading to the Patient Protection and Affordable Care Act of 2010 in insurance terms. Yet, disagreements over the structure of reform reveal deep differences in what proponents and opponents of reform mean by insurance and the role it should play in mediating access to health care. Scholars of insurance law are likely to describe insurance somewhat narrowly as a risk spreading device. Industry representatives, among others, often view conventional indemnity insurance as the norm. From this perspective, reforms that move too far beyond underwriting risks can be seen as undermining actuarial fairness, threatening the very idea of insurance and possibly the industry itself.

scholarly journals Health Insurance Reform and HMO Penetration in the Small Group Market

2005 ◽  
Vol 42 (4) ◽  
pp. 367-380 ◽  
Author(s):  
Thomas C. Buchmueller ◽  
Su Liu
Keyword(s):  
Health Insurance ◽  
Small Group ◽  
State Level ◽  
Insurance Market ◽  
State Control ◽  
Factors Affecting ◽  
Insurance Reform ◽  
Reform Legislation ◽  
Health Insurance Reform ◽  
State Variation

This study uses data from several national employer surveys conducted between the late 1980s and the mid-1990s to investigate the effect of state-level underwriting reforms on HMO penetration in the small group health insurance market. We identify reform effects by exploiting cross-state variation in the timing and content of reform legislation and by using mid-sized and large employers, which were not affected by the legislation, as within-state control groups. While it is difficult to disentangle the effect of state reforms from other factors affecting HMO penetration in the small group markets, the results suggest a positive relationship between insurance market regulations and HMO penetration.

scholarly journals Dental Expenditure by Household Income in Korea over the Period 2008–2017: A Review of the National Dental Insurance Reform

2021 ◽  
Vol 18 (8) ◽  
pp. 3859
Author(s):  
Hosung Shin ◽  
Han-A Cho ◽  
Bo-Ra Kim
Keyword(s):  
Health Insurance ◽  
Concentration Index ◽  
Dental Health ◽  
Age Groups ◽  
The Elderly ◽  
Dental Service ◽  
Delta Method ◽  
Dental Services ◽  
Insurance Reform ◽  
Health Insurance Reform

Since 2009, the National Health Insurance in Korea (NHI) has been implementing a series of policies to expand the scope of dental benefits. This study reviewed the changes in co-payments and dental use patterns before (2008 to 2012) and after (2013 to 2017) the NHI’s dental health insurance reform. The study used Korea Health Panel data of 7681 households (16,493 household members) from a 10-year period (2008–2017). Dental expenditures and equivalent income using square root of household size were analyzed. Dental services were categorized into 13 types and a concentration index and 95% confidence interval using the delta method was calculated to identify income-related inequalities by a dental service. Dental expenditures and the number of dental services used increased significantly, while the proportion of out-of-pocket spending by the elderly decreased. The expenditure ratio for implant services to total dental expenditures increased substantially in all age groups, but the ratio of expenditures for dentures and fixed bridges decreased relatively. The concentration index of implant services was basically in favor of the rich, but there was no longer a significant bias favoring the better-off after the reforms. The dental health insurance reform in Korea appears to contribute not only to lowering the ratio of out-of-pocket to total dental expenses per episode in the elderly but also to improving the inequality of dental expenses.

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