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Cost Sharing (cost + sharing)
Selected AbstractsStrategyproof Cost Sharing of Multiple Excludable Public GoodsJOURNAL OF PUBLIC ECONOMIC THEORY, Issue 5 2007SURESH MUTUSWAMI In a model of cost sharing of multiple excludable public goods, we examine the properties of mechanisms satisfying strategyproofness, no subsidy, outcome non-bossiness, budget balance, individual rationality and consumer sovereignty. We show that such mechanisms in general will not satisfy the equity property of equal treatment of equals. This contrasts with the single excludable public good case. [source] Health status and heterogeneity of cost-sharing responsiveness: how do sick people respond to cost-sharing?HEALTH ECONOMICS, Issue 4 2003Dahlia K. Remler Abstract This paper examines whether the responsiveness of health care utilization to cost-sharing varies by health status and the implications of such heterogeneity. First, we show theoretically that if health care utilization of those in poor health is less responsive to cost sharing, this, combined with the skewness of health expenditures in health status, leads to overestimates of the effect of cost sharing. This bias is exacerbated when elasticities are generalized to populations with greater expenditure skewness. Second, we show empirically that cost-sharing responsiveness does differ by health status using data from the Medicare Current Beneficiary Survey. Medicare beneficiaries are stratified into health status groups based on activity of daily living (ADL) impairments and self-reported health status. Separately, for each of the health status groups, we estimate the effect of Medigap insurance on Part B utilization using a two-part expenditure model. We find that the change in expenditures associated with Medigap is smaller for those in poorer health. For example, when stratified using ADLs, Medigap insurance increases expenditures for ,healthy' groups by 36.4%, while the increase for the ,sick' group is 12.7%. Results are qualitatively the same for different forms of supplemental insurance and different methods of health status stratification. We develop a test to demonstrate that adjusting our results for selection bias would result in estimates of greater heterogeneity. Our results imply that a lowerbound estimate of the bias from neglecting heterogeneity is about 2,7%. Copyright © 2002 John Wiley & Sons, Ltd. [source] Strategyproof Cost Sharing of Multiple Excludable Public GoodsJOURNAL OF PUBLIC ECONOMIC THEORY, Issue 5 2007SURESH MUTUSWAMI In a model of cost sharing of multiple excludable public goods, we examine the properties of mechanisms satisfying strategyproofness, no subsidy, outcome non-bossiness, budget balance, individual rationality and consumer sovereignty. We show that such mechanisms in general will not satisfy the equity property of equal treatment of equals. This contrasts with the single excludable public good case. [source] State Responses to New Flexibility in MedicaidTHE MILBANK QUARTERLY, Issue 2 2008TERESA A. COUGHLIN Context: States have long lobbied to be given more flexibility in designing their Medicaid programs, the nation's health insurance program for the low-income, the elderly, and individuals with disabilities. The Bush administration and the Deficit Reduction Act of 2005 have put in place policies to make it easier to grant states this flexibility. Methods: This article explores trends in states' Medicaid flexibility and discusses some of the implications for the program and its beneficiaries. The article uses government databases to identify the policy changes that have been implemented through waivers and state plan amendments. Findings: Since 2001, more than half the states have changed their Medicaid programs, through either Medicaid waivers or provisions in the Deficit Reduction Act of 2005. These changes are in benefit flexibility, cost sharing, enrollment expansions and caps, privatization, and program financing. Conclusions: With a few important exceptions, these changes have been fairly circumscribed, but despite their expressed interest, states have not yet fully used this flexibility for their Medicaid programs. However, states may exercise this newly available flexibility if, for example, the nation's health care system is not reformed or an economic downturn creates fiscal pressures on states that must be addressed. If this happens, the policies implemented during the Bush administration could lead to profound changes in Medicaid and could be carried out relatively easily. [source] Markets and Medical Care: The United States, 1993,2005THE MILBANK QUARTERLY, Issue 3 2007JOSEPH WHITE Many studies arguing for or against markets to finance medical care investigate "market-oriented" measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want. [source] | ||||||||||