Mitigating Risk Selection in Healthcare Entitlement Programs: A Beneficiary-Level Competitive Bidding Approach

2021 ◽  
Author(s):  
Daniel Montanera ◽  
Abhay Nath Mishra ◽  
T. S. Raghu
Keyword(s):  
Private Insurance ◽  
Developed Countries ◽  
Healthcare Systems ◽  
Competitive Bidding ◽  
Great Promise ◽  
Risk Selection ◽  
Health Plans ◽  
Vulnerable Patients ◽  
Quality Health ◽  
Research Findings

Many developed countries rely, to varying degrees, on competition among private health plans to obtain affordable and high-quality health insurance for their residents. Incorporating beneficiary-level competitive bidding into these healthcare systems can better align the incentives of these health plans, increase their willingness to enroll, and serve the sickest and most vulnerable patients while keeping costs manageable. We identify two digitally enabled program designs that allow private insurance plans to competitively bid to enroll individual beneficiaries. Compared with those used in existing entitlement programs, these designs always make a larger share of the beneficiary population profitable to enroll, thereby increasing willingness of the plans to enroll the most costly beneficiaries and improving access to care. On simulating the conditions of existing real-word healthcare entitlement programs, we found that these new designs actually tend to lower the tax burden in up to 83% of simulations. The research findings suggest that these new designs hold great promise in achieving the dual aim of improved access and lower costs. We believe that findings from this research can guide policymakers implement policies that will enroll more beneficiaries and cost the taxpayers less.

OUR CHALLENGES FOR THE 70'S President's Address, 1970

PEDIATRICS ◽  
1971 ◽  
Vol 47 (2) ◽  
pp. 465-469
Author(s):  
Russell W. Mapes
Keyword(s):  
American Academy ◽  
General Medicine ◽  
Vice President ◽  
Medical Community ◽  
Great Promise ◽  
Quality Health Care ◽  
American Academy Of Pediatrics ◽  
Quality Health ◽  
History Of ◽  
Organized Medicine

For any national organization striving to keep pace with increasingly diverse responsibilities and objectives, there are appropriate times when that organization must pause, reflect, and project before moving forward to meet the goals to which it has dedicated its programs and priorities. This year marks the 40th anniversary of the American Academy of Pediatrics. It was June 23, 1930 that 35 pediatricians met in Harper Hospital in Detroit to establish the Academy as the organization to speak for the interests and health of children, as well as the interests of its pediatric members. This year also marks the beginning of a new decade, a decade which holds great promise for the future of pediatrics but a decade which also presents significant challenges which we must meet if we are to deliver quality health care to all children. The American Academy of Pediatrics is indeed fortunate to be able to draw from the accomplishments of a progressive history of achievement, distinguished by the vision of its early founders. In the 1920's the medical community widely predicted that pediatrics was disappearing as a specialty, that in a few years it would merge into the field of general medicine. Concern was also expressed that pediatrics was not sufficiently represented in the echelons of organized medicine and, consequently, the cause of child health was not being served adequately. To pediatricians like Isaac A. Abt, the first president of the Academy, to John L. Morse, its first vice-president, and to Clifford G. Grulee, the Academy's pioneering executive director, these were very real challenges, but they were not causes for pessimism or defeatism.

Contending with Risk Selection in Health Insurance Markets in Germany

2006 ◽  
Vol 7 (Supplement) ◽  
pp. 75-91 ◽  
Author(s):  
Jacob Glazer ◽  
Thomas G. McGuire
Keyword(s):  
Health Insurance ◽  
Risk Adjustment ◽  
Simple Approach ◽  
Insurance Markets ◽  
Risk Selection ◽  
Health Plans ◽  
Health Insurance Markets ◽  
The U.S

Abstract In many countries, competition among health plans or sickness funds raises issues of risk selection. Funds may discourage or encourage potential enrollees from joining, and these actions may have efficiency or fairness implications. This article reviews the experience in the U.S., and comments on the evidence for risk selection in Germany. There is little evidence that risk selection causes efficiency problems in Germany, but risk selection does lead to an inequality in contribution rates. A simple approach to equalizing contribution rates that does not involve risk adjustment is presented and discussed.

Cloud-Based Healthcare Systems

2015 ◽  
pp. 315-338
Author(s):  
Ahmed Shawish ◽  
Maria Salama
Keyword(s):  
Gross Domestic Product ◽  
Mobile Computing ◽  
Population Health ◽  
Developed Countries ◽  
Healthcare Systems ◽  
It Infrastructure ◽  
Research Issues ◽  
Comprehensive Review ◽  
Smart Healthcare ◽  
And Storage

Healthcare is one of the most important sectors in all countries and significantly affects the economy. As such, the sector consumes an average of 9.5% of the gross domestic product across the most developed countries; they should invoke smart healthcare systems to efficiently utilize available resources, vastly handle spontaneous emergencies, and professionally manage the population health records. With the rise of the Cloud and Mobile Computing, a vast variety of added values have been introduced to software and IT infrastructure. This chapter provides a comprehensive review on the new Cloud-based and mobile-based applications that have been developed in the healthcare field. Cloud's availability, scalability, and storage capabilities, in addition to the Mobile's portability, wide coverage, and accessibility features, contributed to the fulfillment of healthcare requirements. The chapter shows how Cloud and Mobile opened a new environment for innovative services in the healthcare field and discusses the open research issues.

scholarly journals Physician-Patient Relationship: The Present Situation and Our Responsibilities

2014 ◽  
Vol 41 (1) ◽  
pp. 55-58
Author(s):  
MS Islam ◽  
ST Jhora
Keyword(s):  
Health Care ◽  
Developed Countries ◽  
Present Moment ◽  
Patient Relationship ◽  
Professional Relationship ◽  
Physician Patient Relationship ◽  
Doctor Patient Relationship ◽  
Quality Health Care ◽  
Quality Health ◽  
Physician Patient

The "doctor-patient" relationship (DPR) or the "physician-patient" relationship (PPR) has long been recognized as a complex, multifaceted, and complicated balance of engagement between the care-seeker and the care-giver. The physician-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics. In the present moment doctor-patient relationship (DPR) or physician-patient relationship (PPR) is one of the major issues in health-care throughout the world. The most common complains about the physicians of Bangladesh is their attitude towards the patients. The patients must have confidence in the competence of doctors and should feel that they can confide in him or her. For physicians, the establishment of a good relationship with the patients is also important. In developed countries students are taught from the beginning, even before they set foot in hospitals, to maintain a professional relationship with the patients, to uphold patients' dignity, and respect their privacy. These are deficient in Bangladesh. In addition to service factors, perceived treatment cost is another factor that patients may perceive as excessive. This special article reflects the importance as well as the necessary elements to establish this sacred relationship. DOI: http://dx.doi.org/10.3329/bmj.v41i1.18786 Bangladesh Medical Journal 2012 Vol. 41 No. 1; 55-58

E-Commerce Contribution to Economic Growth

2011 ◽  
pp. 140-154
Author(s):  
Ing-wei Huang ◽  
Songsak Vanichviroon
Keyword(s):  
Economic Growth ◽  
21St Century ◽  
Growth And Development ◽  
Developing Economies ◽  
Past Research ◽  
Developed Countries ◽  
Economic Growth And Development ◽  
Research Findings ◽  
Ict Development

As the trend of ICT development is gaining larger influence over countries’ development and growth, e-commerce plays an important role in enhancing the growth of several developed and developing economies over the 21st century. This paper aims to build the analytical base to support the importance of the development of e-commerce. This is by investigating the role and contribution of e-commerce to economic growth and development. The paper first investigates past contribution of e-commerce to economic growth in developed countries. Second, past research findings and framework are utilized to investigate the contribution of e-commerce towards economic growth focusing on the case of e-commerce in Thailand. The study found that e-commerce plays an important role in enhancing economic growth of Thailand. Two important findings had supported the growth of e-commerce. First is the increase in sales generated by the use of e-commerce. Second, e-commerce induces productivity development of firms through higher competition and innovation.

scholarly journals Cost-effectiveness of interventions to reduce the risk of healthcare-acquired infections in middle-income countries: A systematic review

2019 ◽  
Vol 20 (6) ◽  
pp. 266-273
Author(s):  
Pushpa Udayangani Gamalathge ◽  
Sanjeewa Kularatna ◽  
Hannah E Carter ◽  
Sameera Senanayake ◽  
Nicholous Graves
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Developed Countries ◽  
Healthcare Systems ◽  
Quality Of Reporting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Use Of Resources ◽  
The Cost

Background: Hospital-acquired infections (HAI) contribute to prolonged hospital stays and account for a substantial economic burden to healthcare systems. Middle-income countries (MICs) experience a greater burden of HAI than developed countries. Evidence on the cost-effectiveness of interventions to reduce HAI is required to inform decision-making in these settings. Aim: To synthesise the evidence on cost-effectiveness as related to HAI interventions in MICs and to assess the quality of this evidence. Methods: A systematic review of published literature on the cost-effectiveness of interventions to reduce the incidence of HAI in MICs between 2000 and 2018 was conducted. Results: Six studies met the pre-determined inclusion criteria. The studies were from three countries: Thailand; India; and Vietnam. The evidence suggests that interventions to reduce HAI are cost-effective and, in most cases, cost-saving to healthcare systems. The quality of the reporting varied across studies. Conclusions: The implementation of HAI prevention interventions appears to be a high value use of resources in MICs. There is a need for further cost-effectiveness analyses in a wider range of MICs in order to confirm these findings. Improved standardisation and quality of reporting is required.

scholarly journals Risk selection into supplemental private health insurance in China

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yawen Jiang ◽  
Weiyi Ni
Keyword(s):  
Health Insurance ◽  
Instrumental Variable ◽  
Private Health Insurance ◽  
Developed Countries ◽  
Risk Selection ◽  
Alternative Analysis ◽  
Cross Sectional ◽  
Advantageous Selection ◽  
Using Data ◽  
Sectional Analysis

Abstract Background Information on risk selection is important for the regulation and development of supplemental private health insurance (PHI). The research on risk selection into supplemental PHI has been documented in several developed countries where the regulation of the PHI markets was relatively mature. However, evidence on this important aspect of the supplemental PHI market in China is still absent in the literature. The private insurers in China were not prohibited from discrimination against pre-existing conditions and did not guarantee ongoing enrolment. Therefore, the direction and degree of risk selection could not be inferred using the evidence from the other countries. To provide evidence on risk selection into supplemental PHI in China, we conducted a cross-sectional analysis using data from the 2015 wave of China Health and Retirement Longitudinal Study (CHARLS). Results Using probit models, we found that individuals having better self-reported general health were more likely to enrol in PHI in China, suggesting advantageous selection. This result was confirmed by an alternative analysis using an instrumental variable. We also adjusted the realized occurrence of hospitalization by excluding potential moral hazard effect and showed that the adjusted hospitalization risk was negatively associated with PHI enrolment, which also indicated advantageous selection. Conclusions The findings suggested potential over-insurance of healthier individuals or under-insurance of less healthy individuals. The regulation of the PHI market in China should aim to address the inefficiency. The current study could also contribute to the information base for policymakers in countries where the PHI markets similarly lack strong regulation.

Healthy and wellbeing activities’ promotion using a Big Data approach

2016 ◽  
Vol 24 (2) ◽  
pp. 125-135 ◽  
Author(s):  
Diego Gachet Páez ◽  
Manuel de Buenaga Rodríguez ◽  
Enrique Puertas Sánz ◽  
María Teresa Villalba ◽  
Rafael Muñoz Gil
Keyword(s):  
Machine Learning ◽  
Health Care ◽  
Big Data ◽  
Economic Crisis ◽  
Healthy Lifestyle ◽  
Developed Countries ◽  
Healthcare Systems ◽  
Machine Learning Algorithms ◽  
Public And Private ◽  
Private Healthcare

The aging population and economic crisis specially in developed countries have as a consequence the reduction in funds dedicated to health care; it is then desirable to optimize the costs of public and private healthcare systems, reducing the affluence of chronic and dependent people to care centers; promoting healthy lifestyle and activities can allow people to avoid chronic diseases as for example hypertension. In this article, we describe a system for promoting an active and healthy lifestyle for people and to recommend with guidelines and valuable information about their habits. The proposed system is being developed around the Big Data paradigm using bio-signal sensors and machine-learning algorithms for recommendations.

scholarly journals Innovating in Health Care – Modern Challenges

2013 ◽  
Vol 3 (3) ◽  
pp. 261-266
Author(s):  
Sebija Izetbegović ◽  
Goran Stojkanović ◽  
Suvada Švrakić ◽  
Eldar Mehmedbašić
Keyword(s):  
Health Care ◽  
Prescription Drugs ◽  
Empirical Studies ◽  
Medical Science ◽  
Malignant Neoplasm ◽  
Developed Countries ◽  
Quality Health Care ◽  
National Priority ◽  
Quality Health ◽  
The Cost

Introduction: The goal of this article is to present that innovating in health care begins to become an imperative in present time. Innovating will enable the achievement of the highest quality health care results and the patients' satisfaction with the least amount of financial resources.Methods: The thorough literature review of multifaceted sources was conducted including: studies, books, monographies and peer – reviewed journals with the goal of achieving the clearer picture of today's modern challenges in the complex fi eld of health care innovation.Discussion: Theoretical and empirical studies clearly indicate that the innovation is one of the key factors in the competitiveness of the organization and its survival in the market. Developed countries of the world today are making significant efforts in order for innovation to become a national priority, with special emphasis placed on measuring innovation performance. Results of theoretical and practical studies show that in the future, treatment of the most diffi cult and complex diseases of our time, through the entirely new discoveries and results, derived from the process of innovation, will project entirely new positive forms and outcomes in the health care.Conclusion: There is no doubt that the humanity and medical science will through innovation succeed to win the battles against the majority of the most complex contemporary diseases. Malignant neoplasm of tomorrow, through the application of a new, innovative approaches to research, processes and treatments will become a chronic diseases. Among many, the particular problem in the process of innovation will represent the cost of research and development (R&D), production and the safety of prescription drugs.

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