scholarly journals Patient Cost-Sharing and Hospitalization Offsets in the Elderly

2010 ◽  
Vol 100 (1) ◽  
pp. 193-213 ◽  
Author(s):  
Amitabh Chandra ◽  
Jonathan Gruber ◽  
Robin McKnight
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
The Elderly ◽  
Hospital Utilization ◽  
Public Employees ◽  
Drug Usage ◽  
Patient Cost ◽  
Physician Visits ◽  
Medicare Program ◽  
Rand Health Insurance Experiment

In the Medicare program, increases in cost sharing by a supplemental insurer can exert financial externalities. We study a policy change that raised patient cost sharing for the supplemental insurer for retired public employees in California. We find that physician visits and prescription drug usage have elasticities that are similar to those of the RAND Health Insurance Experiment (HIE). Unlike the HIE, however, we find substantial “offset” effects in terms of increased hospital utilization. The savings from increased cost sharing accrue mostly to the supplemental insurer, while the costs of increased hospitalization accrue mostly to Medicare. (JEL G22, I12, I18, J14)

scholarly journals Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review

2018 ◽  
Vol 44 (5) ◽  
pp. E6 ◽  
Author(s):  
Seungwon Yoon ◽  
Michael A. Mooney ◽  
Michael A. Bohl ◽  
John P. Sheehy ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Financial Burden ◽  
Vascular Lesions ◽  
Annual Growth Rate ◽  
Model Case ◽  
Patient Cost ◽  
Neurosurgical Patients ◽  
The Mean ◽  
Insured Patients

OBJECTIVEWith drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth.METHODSFor 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors’ institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time.RESULTSIn the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016).CONCLUSIONSEven after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

Health Insurance, Medical Care, and Children's Health

PEDIATRICS ◽  
1986 ◽  
Vol 77 (1) ◽  
pp. 124-128
Author(s):  
R. BURCIAGA VALDEZ ◽  
ARLEEN LEIBOWITZ ◽  
JOHN E. WARE ◽  
NAIHUA DUAN ◽  
GEORGE A. GOLDBERG ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Status ◽  
Medical Care ◽  
Cost Sharing ◽  
Medical Services ◽  
Randomized Experiment ◽  
Opportunity To Respond ◽  
Insurance Policies ◽  
Rand Health Insurance Experiment ◽  
Use Of Medical Services

We welcome this opportunity to respond to previously published commentaries by Drs Haggerty, Starfield, and Dutton on our discussions of how cost sharing affects the use of medical services and health status.1,2 Our purpose in responding is threefold: to reiterate succinctly the major conclusions of the Rand Health Insurance Experiment, to respond to issues raised by the commentators, and to emphasize certain points of agreement with them. Our goal is to promote a better understanding of the experiment and spur further discussion about the structure of health insurance for children. WHAT DID WE SHOW? In the Rand Health Insurance Experiment, a total of 1,844 children from six areas participated in a randomized experiment on the effects of cost sharing in health insurance policies.

Health Insurance and the Demand for Healthcare

2019 ◽  
Author(s):  
Michael Gerfin
Keyword(s):  
Health Insurance ◽  
Moral Hazard ◽  
Cost Sharing ◽  
Healthcare Providers ◽  
Healthcare Spending ◽  
Point Of View ◽  
Demand Side ◽  
Economic Point ◽  
Rand Health Insurance Experiment

Health insurance increases the demand for healthcare. Since the RAND Health Insurance Experiment in the 1970s this has been demonstrated in many contexts and many countries. From an economic point of view this fact raises the concern that individuals demand too much healthcare if insured, which generates a welfare loss to society. This so-called moral hazard effect arises because individuals demand healthcare that has less value to them than it costs to provide it. For that reason, modern health insurance plans include demand side cost-sharing instruments like deductibles and copayments. There is a large and growing literature analyzing the effects of these cost-sharing instruments on healthcare demand. Three issues have recently received increasing attention. First, cost-sharing instruments such as yearly deductibles combined with stop losses create nonlinear price schedules and dynamic incentives. This generates the question of whether patients understand the incentives and what price individuals use to determine their healthcare demand. Second, it appears implausible that patients know the benefits of healthcare (which is crucial for the moral hazard argument). If patients systematically underestimated these benefits they would demand too little healthcare without health insurance. Providing health insurance and increasing healthcare demand in this case may increase social welfare. Finally, what is the role of healthcare providers? They have been completely absent in the majority of the literature analyzing the demand for healthcare, but there is striking evidence that the physicians often determine large parts of healthcare spending.

scholarly journals The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection

2014 ◽  
Vol 104 (7) ◽  
pp. 2152-2184 ◽  
Author(s):  
Hitoshi Shigeoka
Keyword(s):  
Cost Sharing ◽  
Financial Risk ◽  
National Policy ◽  
The Elderly ◽  
Regression Discontinuity Design ◽  
Sharp Reduction ◽  
Patient Cost ◽  
Policy Cost ◽  
Risk Protection ◽  
The Right

This paper exploits a sharp reduction in patient cost sharing at age 70 in Japan, using a regression discontinuity design to examine its effect on utilization, health, and financial risk arising from out-of-pocket expenditures. Due to the national policy, cost sharing is 60–80 percent lower at age 70 than at age 69. I find that both outpatient and inpatient care are price sensitive among the elderly. While I find little impact on mortality and other health outcomes, the results show that reduced cost sharing is associated with lower out-of-pocket expenditures, especially at the right tail of the distribution. (JEL G22, I11, I12, I13, I18, J14)

The Effect of a Redistribution System for Health Care for the Elderly on the Financial Performance of Health Insurance Societies in Japan

1998 ◽  
Vol 14 (3) ◽  
pp. 458-466 ◽  
Author(s):  
Akira Babazono ◽  
Janet Weiner ◽  
Toshihide Tsuda ◽  
Yoshio Mino ◽  
Alan L. Hillman
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Financial Performance ◽  
Health Care Costs ◽  
Cost Sharing ◽  
The Elderly ◽  
Financial Data ◽  
Care For The Elderly ◽  
Elderly Health ◽  
Care Costs

AbstractHealth care for the elderly in Japan is financed through a pool to which all insurers contribute. We analyzed insurers' financial data to evaluate this redistribution system. Cost sharing affected financial performance substantially. The current formula for cost-sharing redistributes elderly health care costs unequally and should be changed.

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