scholarly journals A Prescription for Drug Formulary Evaluation: An Application of Price Indexes

2012 ◽  
Vol 15 (2) ◽  
Author(s):  
Jacob Glazer ◽  
Haiden A. Huskamp ◽  
Thomas G. McGuire
Keyword(s):  
Economic Theory ◽  
Health Insurance ◽  
Health Plan ◽  
Private Health Insurance ◽  
Drug Acquisition ◽  
Drug Coverage ◽  
Demand Side ◽  
Drug Formulary ◽  
Price Indexes ◽  
Acquisition Costs

Existing economic approaches to the design and evaluation of health insurance do not readily apply to coverage decisions in the multi-tiered drug formularies characterizing drug coverage in private health insurance and Medicare. This paper proposes a method for evaluating a change in the value of a formulary to covered members based on the economic theory of price indexes. A formulary is cast as a set of demand-side prices, and our measure approximates the compensation (positive or negative) that would need to be paid to consumers to accept the new set of prices. The measure also incorporates any effect of the formulary change on plan drug acquisition costs and “offset effects” on non-drug services covered by the plan. Data needed to calculate formulary value are known or can be forecast by a health plan. We illustrate the method with data from a move from a two- to a three-tier formulary.

scholarly journals Impact of the Guaranteed Health Plan with a single community premium on the demand for private health insurance in Chile

CEPAL Review ◽  
2018 ◽  
Vol 2017 (123) ◽  
pp. 210-227
Author(s):  
Eduardo Bitran ◽  
Fabián Duarte ◽  
Dalila Fernandes ◽  
Marcelo Villena
Keyword(s):  
Health Insurance ◽  
Health Plan ◽  
Private Health Insurance

Labor Market Concentration and Worker Contributions to Health Insurance Premiums

2021 ◽  
pp. 107755872110129
Author(s):  
Mark K. Meiselbach ◽  
Matthew D. Eisenberg ◽  
Ge Bai ◽  
Aditi Sen ◽  
Gerard F. Anderson
Keyword(s):  
Labor Market ◽  
Health Insurance ◽  
Labor Markets ◽  
Health Plan ◽  
Fixed Effects ◽  
Health Benefits ◽  
Market Concentration ◽  
Medical Expenditure ◽  
Insurance Premiums ◽  
Health Insurance Premiums

In concentrated labor markets, where workers have fewer employers to choose from, employers may exploit their monopsony power by contributing less to workers’ health benefits. This study examined if labor market concentration was associated with higher worker contributions to health plan premiums. We combined publicly available data from the Census to calculate labor market concentration and the Medical Expenditure Panel Survey Insurance/Employer Component to determine premium contributions from 2010 to 2016 for metropolitan areas. After controlling for year fixed-effects and market characteristics, we found that higher labor market concentration was associated with higher worker contributions to health plan premiums, lower take-home income, and no change in employer contributions to premiums, consistent with the hypothesis that greater labor market concentration is associated with less generous health benefits. When evaluating the effects of mergers and acquisitions on labor markets, regulatory agencies should critically assess worker contributions to health insurance premiums.

Constructing health consumers: Private health insurance discourses in Australia and the United Kingdom

2011 ◽  
Vol 20 (3) ◽  
pp. 306-320 ◽  
Author(s):  
Kirsten Harley ◽  
Karen Willis ◽  
Jonathan Gabe ◽  
Stephanie Doris Short ◽  
Fran Collyer ◽  
...  
Keyword(s):  
United Kingdom ◽  
Health Insurance ◽  
Private Health Insurance ◽  
The United Kingdom ◽  
Health Consumers

scholarly journals Private Health Insurance in Malaysia: Who Is Left Behind?

2021 ◽  
pp. 101053952110009
Author(s):  
Nur Zahirah Balqis-Ali ◽  
Jailani Anis-Syakira ◽  
Weng Hong Fun ◽  
Sondi Sararaks
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Home Ownership ◽  
Insurance Coverage ◽  
Binary Logistic Regression ◽  
Health Insurance Coverage ◽  
Rural Government ◽  
Lower Education Level ◽  
Current Drinker ◽  
Study Population

Despite various efforts introduced, private health insurance coverage is still low in Malaysia. The objective of this article is to find the factors associated with not having a private health insurance in Malaysia. We analyze data involving 19 959 respondents from the 2015 National Health Morbidity Survey. In this article, we describe the prevalence of not having health insurance and conducted binary logistic regression to identify determinants of uninsured status. A total of 56.6% of the study population was uninsured. After adjusting for other variables, the likelihood of being uninsured was higher among those aged 50 years and above, females, Malay/other Bumiputra ethnicities, rural, government/semigovernment, self-employed, unpaid workers and retirees, unemployed, lower education level, without home ownership and single/widowed/divorced, daily smoker, underweight body mass index, and current drinker. The likelihood of being uninsured also increased with increasing household size while the inversed trend was seen for household income. A substantial proportion of population in Malaysia did not have private health insurance, and these subgroups have limited preferential choices for provider, facility, and care.

scholarly journals Self-Rated Health Status Based on the Type of Health Insurance: A Socioeconomic Perspective

2021 ◽  
Vol 58 ◽  
pp. 004695802110281
Author(s):  
Minsung Sohn ◽  
Minsoo Jung ◽  
Mankyu Choi
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Health Status ◽  
Regression Models ◽  
Private Health Insurance ◽  
Public And Private ◽  
Logistic Regression Models ◽  
Self Rated Health ◽  
Interaction Terms ◽  
Healthcare Coverage

To investigate the effects of public and private health insurance on self-rated health (SRH) status within the National Health Insurance (NHI) system based on socioeconomic status in South Korea. The data were obtained from 10 867 respondents of the Korea Health Panel (2008-2011). We used hierarchical panel logistic regression models to assess the SRH status. We also added the interaction terms of socioeconomic status and type of health insurance as moderators. Medical aid (MA) recipients were 2.10 times more likely to have a low SRH status than those who were covered only by the NHI, even though the healthcare utilization was higher. When the interaction terms were included, those not covered by the NHI and had completed elementary school or less were 16.59 times more likely to have a low SRH status than those covered by the NHI and had earned a college degree or higher. Expanding healthcare coverage to reduce the burden of non-payment and unmet use to improve the health status of MA beneficiaries should be considered. Particularly, the vulnerability of less-educated groups should be focused on.

A clinical update on managed care implications for Australian psychiatric practice

2021 ◽  
pp. 103985622110300
Author(s):  
Jeffrey CL Looi ◽  
Stephen R Kisely ◽  
Tarun Bastiampillai ◽  
William Pring ◽  
Stephen Allison
Keyword(s):  
Health Insurance ◽  
Managed Care ◽  
Private Health Insurance ◽  
Psychiatric Treatment ◽  
Patient Choice ◽  
Insurance Sector ◽  
Cost Cutting ◽  
Appropriate Treatment ◽  
The Us ◽  
Limit Access

Objective: To provide a clinical update on private health insurance in Australia and outline developments in US-style managed care that are likely to affect psychiatric and other specialist healthcare. We explain aspects of the US health system, which has resulted in a powerful and profitable private health insurance sector, and one of the most expensive and inefficient health systems in the world, with limited patient choice in psychiatric treatment. Conclusions: Australian psychiatrists should be aware of changes to private health insurance that emphasise aspects of managed care such as selective contracting, cost-cutting or capitation of services. These approaches may limit access to private hospital care and diminish the autonomy of patients and practitioners in choosing the most appropriate treatment. Australian patients, carers and practitioners need to be informed about the potential impact of private managed care on patient-centred evidence-based treatment.

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