Risk Adjustment  Risk Sharing and Premium Regulation in Health Insurance Markets Book

Risk Adjustment Risk Sharing and Premium Regulation in Health Insurance Markets


  • Author : Thomas G. McGuire
  • Publisher : Academic Press
  • Release Date : 2018-08-06
  • Genre: Business & Economics
  • Pages : 648
  • ISBN 10 : 9780128113264

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Risk Adjustment Risk Sharing and Premium Regulation in Health Insurance Markets Excerpt :

Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment. Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection Brings together international experience from many different countries that apply regulated competition in different ways Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness

Employment and Health Benefits Book

Employment and Health Benefits


  • Author : Institute of Medicine
  • Publisher : National Academies Press
  • Release Date : 1993-02-01
  • Genre: Medical
  • Pages : 381
  • ISBN 10 : 9780309048279

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Employment and Health Benefits Excerpt :

The United States is unique among economically advanced nations in its reliance on employers to provide health benefits voluntarily for workers and their families. Although it is well known that this system fails to reach millions of these individuals as well as others who have no connection to the work place, the system has other weaknesses. It also has many advantages. Because most proposals for health care reform assume some continued role for employers, this book makes an important contribution by describing the strength and limitations of the current system of employment-based health benefits. It provides the data and analysis needed to understand the historical, social, and economic dynamics that have shaped present-day arrangements and outlines what might be done to overcome some of the access, value, and equity problems associated with current employer, insurer, and government policies and practices. Health insurance terminology is often perplexing, and this volume defines essential concepts clearly and carefully. Using an array of primary sources, it provides a store of information on who is covered for what services at what costs, on how programs vary by employer size and industry, and on what governments doâ€"and do not doâ€"to oversee employment-based health programs. A case study adapted from real organizations' experiences illustrates some of the practical challenges in designing, managing, and revising benefit programs. The sometimes unintended and unwanted consequences of employer practices for workers and health care providers are explored. Understanding the concepts of risk, biased risk selection, and risk segmentation is fundamental to sound health care reform. This volume thoroughly examines these key concepts and how they complicate efforts to achieve efficiency and equity in health coverage and health care. With health care reform at the forefront of public attention, this volume will be important to policymakers and regulators, employee

Price Setting and Price Regulation in Health Care Book

Price Setting and Price Regulation in Health Care


  • Author : OECD
  • Publisher : OECD Publishing
  • Release Date : 2019-06-26
  • Genre: Uncategoriezed
  • Pages : 298
  • ISBN 10 : 9789264508866

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Price Setting and Price Regulation in Health Care Excerpt :

The objectives of this study are to describe experiences in price setting and how pricing has been used to attain better coverage, quality, financial protection, and health outcomes. It builds on newly commissioned case studies and lessons learned in calculating prices, negotiating with providers, and monitoring changes. Recognising that no single model is applicable to all settings, the study aimed to generate best practices and identify areas for future research, particularly in low- and middle-income settings. The report and the case studies were jointly developed by the OECD and the WHO Centre for Health Development in Kobe (Japan).

The Future of Disability in America Book

The Future of Disability in America


  • Author : Institute of Medicine
  • Publisher : National Academies Press
  • Release Date : 2007-10-24
  • Genre: Medical
  • Pages : 619
  • ISBN 10 : 9780309104722

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The Future of Disability in America Excerpt :

The future of disability in America will depend on how well the U.S. prepares for and manages the demographic, fiscal, and technological developments that will unfold during the next two to three decades. Building upon two prior studies from the Institute of Medicine (the 1991 Institute of Medicine's report Disability in America and the 1997 report Enabling America), The Future of Disability in America examines both progress and concerns about continuing barriers that limit the independence, productivity, and participation in community life of people with disabilities. This book offers a comprehensive look at a wide range of issues, including the prevalence of disability across the lifespan; disability trends the role of assistive technology; barriers posed by health care and other facilities with inaccessible buildings, equipment, and information formats; the needs of young people moving from pediatric to adult health care and of adults experiencing premature aging and secondary health problems; selected issues in health care financing (e.g., risk adjusting payments to health plans, coverage of assistive technology); and the organizing and financing of disability-related research. The Future of Disability in America is an assessment of both principles and scientific evidence for disability policies and services. This book's recommendations propose steps to eliminate barriers and strengthen the evidence base for future public and private actions to reduce the impact of disability on individuals, families, and society.

Epidemics and the Health of African Nations Book

Epidemics and the Health of African Nations


  • Author : MISTRA MISTRA
  • Publisher : African Books Collective
  • Release Date : 2019-07-25
  • Genre: Social Science
  • Pages : 440
  • ISBN 10 : 9780639995601

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Epidemics and the Health of African Nations Excerpt :

News footage of disease in Africa is a familiar sight. Yet these outbreaks are often presented out of context, with no reference to the conditions that have triggered them. MISTRA’s new book, Epidemics and the Health of African Nations, aims to redress that. Researchers and practitioners from within the continent explore why Africa is so vulnerable to disease, and show how this vulnerability is closely linked to political and economic factors. They demonstrate how these same factors determine the way epidemics are treated. Authors extract lessons from case studies in different parts of Africa; challenge conventional frameworks about disease to argue for a ‘syndemics’ approach that takes into account the interrelationship between disease and political and socio-economic contexts; explore challenges of Africa’s future. They argue that a well-functioning health system is at the core of a country’s capacity to counter an epidemic. This volume brings African experts together to probe possible solutions to the continent’s heavy burden of disease. The insights offered will be helpful in devising policy for the control of disease and the combatting of epidemics in Africa.

Pooling Health Insurance Risks Book
Score: 4
From 1 Ratings

Pooling Health Insurance Risks


  • Author : Mark V. Pauly
  • Publisher : American Enterprise Institute
  • Release Date : 1999
  • Genre: Business & Economics
  • Pages : 120
  • ISBN 10 : 0844741191

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Pooling Health Insurance Risks Excerpt :

This volume describes how insurance markets actually adjust premiums to risk, and they evaluate various proposals for regulating how premiums should vary with risk.

Private Health Insurance and the European Union Book

Private Health Insurance and the European Union


  • Author : Cyril Benoît
  • Publisher : Springer Nature
  • Release Date : 2020-12-03
  • Genre: Political Science
  • Pages : 333
  • ISBN 10 : 9783030543556

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Private Health Insurance and the European Union Excerpt :

Research has paid little attention to date on how European Union law and regulation affect both the public-private mix in healthcare and the organization of private health insurance as an industry. Filling this gap, this collective book provides insights on the political economy of EU insurance regulation, its impact on private health insurers and on its interactions with domestic healthcare policy-making in four countries. Assembling original contributions drafted by a multidisciplinary team, Private Health Insurance and the European Union offers a thorough examination of a largely unrecognized source of EU influence in healthcare – and sheds a new light on the role played by private actors in social policy. Chapter 1 is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com.

Care Without Coverage Book

Care Without Coverage


  • Author : Institute of Medicine
  • Publisher : National Academies Press
  • Release Date : 2002-06-20
  • Genre: Medical
  • Pages : 213
  • ISBN 10 : 9780309083430

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Care Without Coverage Excerpt :

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

Voluntary Health Insurance in Europe  Country Experience Book

Voluntary Health Insurance in Europe Country Experience


  • Author : Sagan A.
  • Publisher : World Health Organization
  • Release Date : 2016-07-20
  • Genre: Business & Economics
  • Pages : 163
  • ISBN 10 : 9789289050371

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Voluntary Health Insurance in Europe Country Experience Excerpt :

No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved. This volume contains short structured profiles of markets for VHI in 34 countries in Europe. These are drawn from European Union member states plus Armenia Iceland Georgia Norway the Russian Federation Switzerland and Ukraine. The book is aimed at policy-makers and researchers interested in knowing more about how VHI works in practice in a wide range of contexts. Each profile written by one or more local experts identifies gaps in publicly-financed health coverage describes the role VHI plays outlines the way in which the market for VHI operates summarises public policy towards VHI including major developments over time and highlights national debates and challenges. The book is part of a study on VHI in Europe prepared jointly by the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe. A companion volume provides an analytical overview of VHI markets across the 34 countries.

The Oxford Handbook of the Welfare State Book

The Oxford Handbook of the Welfare State


  • Author : Daniel Béland
  • Publisher : Oxford University Press
  • Release Date : 2022-01-14
  • Genre: Political Science
  • Pages : 1025
  • ISBN 10 : 9780198828389

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The Oxford Handbook of the Welfare State Excerpt :

This is the comprehensively-revised second edition of a volume that was welcomed at its first appearance as 'the most authoritative survey and critique of the welfare state yet published'. Its fifty-one chapters have been written by acknowledged experts in the field from across Europe, Australia, and North America. Some chapters are brand new; all have been systematically revised, and they are right up to date. The first seven sections of the book cover the themes of Ethics, History, Approaches, Inputs and Actors, Policies, Policy Outcomes, and Worlds of Welfare. A final chapter is devoted to the future of welfare and well-being under the imperatives of climate change. Every chapter is written in a way that is both comprehensive and succinct, introducing the novice reader to the essentials of what is going on while providing new insights for the more experienced researcher. Wherever appropriate, the handbook brings the very latest empirical evidence to bear. It is a book that is thoroughly comparative in every way. The Oxford Handbook of the Welfare State, second edition, is a comprehensible and comprehensive survey of everything that it is important to know about the welfare state in these troubled times. It is an indispensable source for everyone who wants to know what is really going on now, and what is likely to happen next.

Accidental Conflict Book

Accidental Conflict


  • Author : Stephen Roach
  • Publisher : Yale University Press
  • Release Date : 2022-11-08
  • Genre: Political Science
  • Pages : 448
  • ISBN 10 : 9780300259643

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Accidental Conflict Excerpt :

The misguided forces driving conflict escalation between America and China, and the path to a new relationship "A timely, fluid, readable assessment of a testy and rapidly changing global relationship."--Kirkus Reviews (starred review) In the short span of four years, America and China have entered a trade war, a tech war, and a new Cold War. This conflict between the world's two most powerful nations wouldn't have happened were it not for an unnecessary clash of false narratives. America falsely blames its trade and technology threats on China yet overlooks its shaky saving foundation. China falsely blames its growth challenges on America's alleged containment of market-based socialism, ignoring its failed economic rebalancing. In a hard-hitting analysis of both nations' economies, politics, and policies, Stephen Roach argues that much of the rhetoric on both sides is dangerously misguided, amplified by information distortion, and more a reflection of each nation's fears and vulnerabilities than a credible assessment of the risks they face. Outlining the disastrous toll of conflict escalation between China and America, Roach offers a new road map to restoring a mutually advantageous relationship.

Institutions and Incentives in Public Policy Book

Institutions and Incentives in Public Policy


  • Author : Rosolino Candela
  • Publisher : Rowman & Littlefield
  • Release Date : 2022-07-18
  • Genre: Political Science
  • Pages : 317
  • ISBN 10 : 9781538160947

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Institutions and Incentives in Public Policy Excerpt :

Institutions and Incentives in Public Policy: An Analytical Assessment of Non-Market Decision-Making explores, both in theory and in practice, the consequences of using public policy as a tool to achieve specific individual and social goals, as well as its impact on private solutions to address such goals. The chapters examine the institutional incentives that operate in non-market settings, both governmental and non-governmental, using the theoretical frameworks of market process theory and public choice theory, they analyze a diverse set of contemporary public policy issues at both the domestic and international levels. Authored by individuals from a variety of disciplines with diverse interests in public policy, this work includes discussions of topics, such as foreign aid, education policy, environmental policy, health care policy, and the construction of private cities. This volume is relevant to scholars, students, policymakers, and knowledgeable citizens interested in the study of economics, political science, public policy, as well as those interested in particular policies rather than specific disciplines.

Health Care Utilization as a Proxy in Disability Determination Book

Health Care Utilization as a Proxy in Disability Determination


  • Author : National Academies of Sciences, Engineering, and Medicine
  • Publisher : National Academies Press
  • Release Date : 2018-04-02
  • Genre: Medical
  • Pages : 160
  • ISBN 10 : 9780309469210

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Health Care Utilization as a Proxy in Disability Determination Excerpt :

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Federal Register Book

Federal Register


  • Author : Anonim
  • Publisher : Unknown
  • Release Date : 2013-03
  • Genre: Delegated legislation
  • Pages : null
  • ISBN 10 : UCR:31210024841023

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Federal Register Excerpt :

Health Insurance Market Reform Book

Health Insurance Market Reform


  • Author : United States. Congress. Senate. Committee on Finance
  • Publisher : Unknown
  • Release Date : 1994
  • Genre: Government publications
  • Pages : 144
  • ISBN 10 : UCR:31210014050742

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Health Insurance Market Reform Excerpt :