Dissertations / Theses: 'Health insurance claims – United States'

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Zhu, Liye. "Three essays on the United States health insurance market." Ann Arbor, Mich. : ProQuest, 2006. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3220413.

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Thesis (Ph.D. in Economics)--S.M.U.
Title from PDF title page (viewed July 20, 2007). Source: Dissertation Abstracts International, Volume: 67-05, Section: A, page: 1847. Adviser: Daniel L. Millimet. Includes bibliographical references.

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Rein, David Bruce. "Modeling the health care utilization of children in Medicaid." Diss., Available online, Georgia Institute of Technology, 2004:, 2003. http://etd.gatech.edu/theses/available/etd-06072004-131339/unrestricted/rein%5Fdavid%5Fb%5F200405%5Fphd.pdf.

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Fernandez, Juan Gabriel. "Three essays on competition and health insurance markets." Thesis, Boston University, 2012. https://hdl.handle.net/2144/31552.

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Thesis (Ph.D.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Health care systems are complex organizations. Multiple agents interact in different settings to provide health care, each one of them with different objectives and information. How markets are organized and which actions are allowed, has a direct impact on the incentives agents face when making health care choices. In this dissertation, I study the determinants and effects of these choices on market outcomes, focusing on private health insurance markets. The first chapter provides insights about health insurance markets in which workers, rather than firms , choose insurance plans in an imperfect competition setting. Using a unique dataset that includes every person enrolled in private plans in Chile in 2009, I estimate underlying preference parameters over health insurance features. I find large heterogeneity in the valuation of t hese features across age-sex-groups and individual types. Individual characteristics play an important role on health plan choices and therefore, can be used by insurers to design plans targeted to specific groups and for patient selection. The second chapter presents a theoretical model where private insurers compete with a free public alternative to attract clients. Using a two-type model I show that if private insurance companies offer a non-rationing alternative and the public system rationing is done through random selection, an efficiency trap may exist. A marginal increase in the budget allocated to the public system can potentially reduce the expected welfare for all types. This result extends to a model with multiple types, but the negative welfare impact is offset by a crowding-in effect among the rich. Finally, the third chapter provides a general analytical framework that can be used to evaluate risk selection under different health care models. The model is based on the interactions between the four key agents present in every health care system: sponsors, health plans, providers and customers. This framework is used to review risk selection in four countries in the Americas - Canada, Chile, Colombia, and the U.S.-, showing how regulatory policies both create and ameliorate it, and in some cases are as important as risk adjustment, risk sharing and risk selection strategies for reducing risk selection.
2031-01-01

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Lawings, Michael Anthony. "Business continuity operational strategies for national healthcare insurance companies." Thesis, Georgia Institute of Technology, 2002. http://hdl.handle.net/1853/21804.

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Palmedo, P. Christopher. "Equality, Trust and Universalism in Europe, Canada and the United States: Implications for Health Care Policy." PDXScholar, 2014. https://pdxscholar.library.pdx.edu/open_access_etds/1929.

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A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and generalized trust are positively associated with universalism is only partially true. Equality is positively associated (B = .301, p < .001), while generalized trust is negatively associated with universalism (B = -.052, p < .001). Not only do Americans show lower levels of support for income equality and universalism than Europeans, but the effect of being American holds even after controlling for socio-demographic and religious variables (B = .044, p < .01). When the model tests the association of equality and trust on universalism in each region, it explains approximately 17 percent of the variance of universalism for the United States, and approximately 13 percent in Europe and Canada.

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Welle, Derek John. "Health care in the United States: How the determinants of health insurance status differ across regions." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29229.

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Using a nationally representative sample of individuals across all fifty United States from the 2016 American Community Survey (ACS), this research explores differences in the incidence and predictors of health insurance status across region (i.e. West, Midwest, South, and Northeast) for individuals age 18 and older. The data suggests that: 1) Individuals from the Northeast are the most likely to have some form of health insurance, while individuals from the South are the least likely; 2) The factors which influence health insurance status are relatively similar across all regions, though they often differ substantially in magnitude; 3) In some cases region can play a significant role in determining the type of insurance an individual has (i.e. Public versus Private). Policy makers will find these results useful to target specific factors within regions that may prove to increase the number of insured individuals. Furthermore, researchers may choose to use this paper as a current reference and starting point for further in-depth analysis on targeted factors within specific regions.

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Abel, Karin M. "Private or Public Insurance? The Institutional History of Health Care in the United States and the United Kingdom." DigitalCommons@USU, 2010. https://digitalcommons.usu.edu/etd/819.

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The primary question at issue in this paper is the following: given the similarities between the two countries with regard to welfare state institutions, why have the United States and the United Kingdom diverged on the issue of health care? Drawing on sociological institutionalism, a branch of the new institutionalist paradigm, this paper provides an answer to this question: during the formative years of the health care stories in the two countries, variations in institutional and cultural conditions produced contrasting policy outcomes. More specifically, this paper discusses how the combination of institutions (political, labor, and medical) and culture led to private insurance in the United States and public insurance in the United Kingdom. Of course, this paper has implications for several areas of scholarship, as well as for current policy debates on a wide range of issues.

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Potter, Emma C. "Health Insurance Experiences of Gay Father Families: Perceptions, Disclosure, and Roles." Thesis, Virginia Tech, 2013. http://hdl.handle.net/10919/23839.

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Recent developments in public debate, health policy, and research on nontraditional families have brought gay-parent families, especially gay fathers, into the cultural and political spotlight. Existing research and literature on LGBT families and gay fatherhood have emphasized relationship dynamics within the families but there are gaps in the literature regarding the health and well-being of these families, specifically as it relates to health insurance. Using symbolic interactionism, life course theory, and grounded theory methodology, I conducted a qualitative pilot study to investigate gay fathers\' health insurance experiences. I collected responses from 10 White, gay fathers across the United States and asked questions about access to health insurance, the process of providing insurance for their families, access and use of community resources, and unique factors of their health insurance story. This research adds to the same-sex parent knowledge based by (a) gaining an understanding of the family decisions gay fathers make around health insurance, (b) identifying obstacles and subsequent solutions to health insurance problems, (c) discussing issues of disclosure and outness in gay father families, and (d) uncovering continued gender associations with the division of labor. This study has more broad implications for theoretical concepts like intersectionality and agency, but also provides insights into policy inequalities that continue in the United States.
Master of Science

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Hadjimaleki, Sohayla K. "Replacing health insurance with health assurance establishing the right to health care and the need for reform in the United States /." [Denver, Colo.] : Regis University, 2009. http://165.236.235.140/lib/SHadjimaleki2009.pdf.

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Petersen, Mirella. "A retrospective analysis of autism health insurance legislation, small business closures and the percentage of small businesses offering health insurance plans in the United States." Thesis, Central Michigan University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3596751.

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Autism is a rapidly increasing global health concern. In the United States, many families and individuals with autism find it difficult to access treatment for this condition because it is commonly excluded from health insurance plans. Apprehension about passing autism health insurance legislation includes concerns regarding the impact on small businesses. Many businesses advocates and law makers have expressed concern that passing an autism health insurance mandate will cause small businesses to close or to stop offering health insurance plans to their employees. In an effort to substantiate these concerns, this study provides an analysis of publicly available data on small business closures and small business health insurance plans to determine if a relationship exists between passing an autism health insurance mandate and a change in the number of small business closures or the percentage of small businesses that offer health insurance plans to their employees.

The methodology for this study includes testing of Pearson’s r correlation models, semipartial correlation models and analysis of variance (ANOVA) models. Findings indicate there is insufficient evidence to conclude that a relationship exists between enacting an autism health insurance mandate and an increase in the number of small business closures. In addition, findings indicate there is insufficient evidence to conclude that a relationship exists between enacting an autism health insurance mandate and a decrease in the percentage of small businesses offering health insurance to their employees.

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Simuoli, Olivia. "The Impact of the State Children's Health Insurance Program on Educational Outcomes in the United States: A Two-Fold Analysis." Oberlin College Honors Theses / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=oberlin1432154845.

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Opper, Scott. "Redesigning the American healthcare system." Honors in the Major Thesis, University of Central Florida, 2000. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/400.

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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.
Bachelors
Health and Public Affairs
Social Work

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Berger, Loretta Kathleen. "The effect of health insurance plan type on initial colorectal cancer screening in the United States since the inception of health care reform in Massachusetts." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21124.

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Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
The Accountable Care Act (ACA) will expand coverage to millions of Americans. Health insurance plans designed to contain costs and incentivize patients may pose risks that deter members from utilizing recommended services despite provisions such as zero-cost-sharing intended to encourage their use. We evaluated trends (from 2007 to 2011) in health insurance plan type and initial colorectal cancer (CRCA) screening per current guidelines. We hypothesized that consumer-directed and high-deductible health plans (CDHP/HDHP) would be associated with decreased and delayed CRCA screening, and a shift toward lower-cost screening options. Using Thomson MarketScan® data, we analyzed commercial claims for 989,038 American adults (prior colectomy or CRCA excluded) over a full three-year period (starting in January of the fiftieth birthday-year) to assess for CRCA screening (colonoscopy, sigmoidoscopy, or stool test). Using logistic regression, we found that CDHP/HDHP members showed increased likelihood of having had any CRCA screening compared to Preferred Provider Organization (PPO) members, in both Massachusetts (Odds Ratio [OR] 2.321, 95% Confidence Interval [CI] 1.788-3.014) and the Nation (OR 1.640, 95% CI 1.602-1.678). Of those screened, CDHP/HDHP patients were more likely to receive colonoscopy than other recommended alternatives compared to PPO (Massachusetts OR 1.289, 95% CI 1.007-1.651; U.S. OR 1.225, 95% CI 1.192-1.259). Using linear regression, we found that CDHP/HDHP patients were only slightly older at screening compared to PPO, and the difference, while statistically significant, was likely too small to be clinically meaningful. We conclude that contrary to our expectations, CDHP/HDHP members have not been deterred from seeking and obtaining appropriate and timely initial CRCA screening, and they have not chosen lower-cost options. These findings may reflect the newly insured effect, although one limitation of this study was the inability to adjust for selection into CDHP/HDHP. Further study should determine whether CDHP/HDHP members subsequently experience unexpected financial burdens related to CRCA screening that affect future utilization of recommended care. In the pursuit of lower costs through better outcomes, attention should be paid to designing simple and affordable plans with easily understandable features that encourage both patients and providers to follow recommended guidelines while considering the cost-effectiveness of available options.
2031-01-01

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14

Berry, Edmund A. "The Impact of Being Uninsured in the United States on Economic and Humanistic Outcomes: Results from the 2004-2008 Medical Expenditure Panel Surveys." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1353154260.

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15

Hammond, Terry Richard. "Feasible Models of Universal Health Insurance in Oregon According to Stakeholder Views." PDXScholar, 2012. https://pdxscholar.library.pdx.edu/open_access_etds/500.

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This study collects the views of 38 health policy leaders, answering one open-ended question in a 1-hour interview: What state-level reforms do you believe are necessary to implement a feasible model of universal health insurance in Oregon? Interviewees represented seven groups: state officials, insurers, purchasers, hospitals, physicians, public interest, and experts. About 370 coded arguments in the interview transcripts were condensed into 95 categorical topics. A code outline was constructed to present a dialogue among stakeholders in one comprehensive narrative. Topical sections include the cost imperative, politics, model systems, insurance, purchasing, delivery system, practice management, and finance. Summary results show the prevalence of group attention to each topic, group affinities, and proximity correlations of different arguments mentioned by individuals. The most common arguments related to problems of low-value care and delivery system reform. There was a generally felt imperative to control costs. Regarding universal health insurance, stakeholders were split between two main alternatives. One model, favored mostly by insurer and purchaser groups, supported the state-sponsored individual mandate. This plan, embodied in the current Oregon Action Plan to implement universal health insurance, involved managed competition for insurers and clinical governance over professional practice. A separate set of arguments, favored mostly by expert and physician groups, emphasized the need for a unified public system, or utility model, possibly with centralized funds and regional global budgets. The ability of the individual mandate plan to control costs or manage quality appears doubtful, which strengthens opposition. The utility model is more likely to work at cost control and governance, but it disrupts the status quo and its details are vague, which strengthens opposition. Neither model is endorsed by a majority of the stakeholders, and political success for either one alone is not promising. Possibly, a close analysis of the two models could find a way to combine them and generate unified support.

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Quinn, Melane. "Long-term care insurance : a study of participation and need." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/295.

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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.
Bachelors
Health and Public Affairs
Health Services Administration

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Baker, Timothy Alan. "Oregon Primary Care Physicians' Support for Health Care Reform." PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.

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This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI). This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan. Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive. Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI). While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program. This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.

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McEldowney, Rene P. "A century of democratic deliberation over American and British national health care : extending the Kingdon model /." Diss., This resource online, 1994. http://scholar.lib.vt.edu/theses/available/etd-06062008-164612/.

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Madsen, Jesse. "Doe v. Unocal: An Ambiguous Standard for Multinational Corporate Liability." Honors in the Major Thesis, University of Central Florida, 2003. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/690.

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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf
Bachelors
Health and Public Affairs
Legal Studies

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20

Ling, Meng-Chun. "Senior health care system." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2785.

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Senior Health Care System (SHCS) is created for users to enter participants' conditions and store information in a central database. When users are ready for quarterly assessments the system generates a simple summary that can be reviewed, modified, and saved as part of the summary assessments, which are required by Federal and California law.

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21

Velamuri, Malathi Rao. "Health insurance, employment-sector choices and job attachment patterns of men and women." Thesis, 2004. http://hdl.handle.net/2152/1450.

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Strong, James T. "State-sponsored health insurance plans for small business employers : political and economic factors for success." 2010. http://liblink.bsu.edu/uhtbin/catkey/1632472.

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The purpose of this study was to examine three state-sponsored health insurance programs targeted at small businesses and identify the political and economic factors that contributed to their success. I evaluated the success of each states program using three criteria: reducing the number of uninsured, program participation, and providing portability. In my analysis, I examined factors which may have played a role in the varying levels of success that were observed. I found that the success of a program depended largely on two factors: economic conditions within the state and the quality of the program.
Department of Political Science

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23

"Three essays on insurance choice." Thesis, 2007. http://hdl.handle.net/2152/3117.

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Koch, Thomas Gregory 1979. "Three essays on insurance choice." 2007. http://hdl.handle.net/2152/13304.

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YEN, YU-CHIN, and 游進彥. "A Comparison of Health Insurance Regulation in Taiwan and United States- A Case Study of Hospital Indemnity Insurance." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/81590570835953202722.

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碩士
逢甲大學
風險管理與保險研究所
96
Due to the extension of life expectancy and improvement of medical technology, the ration on medical expenses changed dramatically, which increases premium received in health insurance. In the 2nd half of 2008, non-life insurance companies are allowed to health insurance. It is expected that health insurance market will have intense competition, and newer products. However, the regulations and Uniform Provision are not complete in Taiwan, which will affect insured’s right, and waste of resources. From the reasons above, this study will focus on health insurance products such as Hospital Indemnity Insurance’s(HII) regulation in New York State(NYS), and compare with the similar regulations in Taiwan. This study will focus on the application and policy forms as the main study since it affect the consumers the most. The study will discuss Application, Cover Page, Definitions, Form Provisions, Permissible Exclusions & Limitations, Mandatory Policy Provisions and Optional Policy Provisions. After comparing regulations in Taiwan and in NYS, there are four suggestions. 1. Regulations should construct from insured’s angle. 2. Make the regulations of the all Health Insurance’s Uniform Provisions complete in Taiwan. 3. Essentiality and selectivity are critical in new product which also helps to regulate. 4. Synchronize all necessary system to increase the speed of examination and cut the cost of administration and also transparent to the public.

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Nair, Radhika Anantharaman. "Evaluation of factors related to prescription drug expenditures, prescribing trends and physican visits: the role of direct-to-consumer advertising expenditures, demographics, and health insurance coverage." Thesis, 2005. http://hdl.handle.net/2152/1642.

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Gning, Ibrahima. "The effect of immigration status on racial differences in health insurance coverage, access to care, and utilization in the United States." 2008. http://proquest.umi.com.www5.sph.uth.tmc.edu:2048/pqdweb?did=1495950671&sid=1&Fmt=2&clientId=92&RQT=309&VName=PQD.

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Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008.
Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0969. Adviser: Charles E. Begley. Includes bibliographical references.

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Wang, Yun-Ting, and 王韻婷. "A Comparison of Health Insurance Regulation in Taiwan and United States－A Case Study of Group Basic Hospital Insurance of the State of New York." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/01482454689075924270.

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碩士
逢甲大學
風險管理與保險研究所
99
With the increase of average life expectancy and advancement of medical technology, commercial health insurance premium increases year by year. Group health insurance premium tends to be the highest premium income in the group insurance. Due to the enormous market of health insurance, to protect the interests of policyholders and to facilitate the robust development of the health insurance market, the government’s supervision over the insurance industry has become more and more important. Because of the integrity of the Taiwanese supervision on insurance industry still seem inadequate, and given the supervision regulations of the United States is more comprehensive, this study will compare the regulations of group basic hospital insurance products in New York State and the related Taiwanese regulations of group health insurance. With the extensive supervision on the contents of insurance products, it is impossible to discuss each of them. The application and the policy provisions are the main focus in this study. This study compares group basic hospital insurance of the state of New York with health insurance provisions in Taiwan. We found that provisions in New York State are formulated to protect the applicant, and important issues are listed in the application. In the comparison, we found that quantity of relevant policy provisions in New York State is greater than Taiwan and the provisions in New York State are more comprehensive. Besides, there are similar provisions about the cover page and mandates of prescription drugs are covered under this policy in Taiwan, provisions in New York State are worthy of reference for Taiwan. Lastly, in view of group basic hospital insurance of the state of New York and health insurance related provision in Taiwan, our recommendations for future establishment of provision of insurance supervision in Taiwan are as follows. For the purpose of protecting policyholders, the terms related to pre-existing conditions which would affect the validity of insurance, should be stated in the application. To improve efficiency of insurance market in Taiwan, it is necessary to establish the mandatory standard provisions and optional standard provisions and to integrate relevant policy provisions for inquiry.

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Wu, Chih-Wei, and 吳志偉. "A Comparison of Regulations on Health Insurance Rate-Filings in Taiwan and the United States–A Case Study of Group Basic Hospital Insurance of the State of New York." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/27676614107876020153.

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碩士
逢甲大學
統計與精算所
100
With the increase of average life expectancy and the advancement of medical technology, the importance of health insurance increases every day as commercial health insurance premium increases year by year. Because the supervisory regulations of Taiwanese health insurance are still inadequate and those of the United States are more robust, and most of the health insurance of the United States is group insurance, this study will compare the regulations of group basic hospital insurance products in New York State (NYS) with the related regulations of group health insurance in Taiwan. Since the supervisory regulations of health insurance products are far too extensive to examine in full, this study mainly focuses on the rate-filing supervision. After comparing regulations of group health insurance in Taiwan and in NYS, suggestions on insurance supervision in Taiwan are proposed. 1. Enhance the regulations on coverage of mental illness and ratemaking. 2. Enhance the relevant regulations on ratemaking methodology, such as group rate manual. 3. Enhance relevant actuarial standards of practice, such as reserve standard of practice on health insurance. 4. Integrate relevant supervisory review provisions, such as product checklists of health insurance in NYS.

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Eliason, Erica Linn. "The Effects of Health Insurance Eligibility Policies on Maternal Care Access and Childbirth Outcomes." Thesis, 2021. https://doi.org/10.7916/d8-bwaq-kf37.

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This dissertation examines three health insurance eligibility policies and their impact on reproductive health outcomes for low-income women of reproductive age. The first paper examines the effects of expanded eligibility for Medicaid under the Affordable Care Act (ACA), on fertility among low-income women of childbearing age. The second paper explores the effect of presumptive eligibility policies in Medicaid for pregnant women on access to prenatal care and health insurance coverage. Finally, the third paper exploits state-level differences in eligibility for public versus private insurance under the ACA, and the effects on perinatal coverage patterns, childbirth outcomes, and access to care.

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Howard, Steven W. "Medicare managed care : market penetration and the resulting health outcomes." Thesis, 2011. http://hdl.handle.net/1957/26133.

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Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena.
Graduation date: 2012

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Barnes, Stephen Ransom. "Three essays in health economics." 2008. http://hdl.handle.net/2152/17743.

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The first chapter of this dissertation tests for addiction to food. This is the first empirical study using nationally representative data to do so. Data show that many common foods are addictive, suggesting that prices play a larger role in food consumption than previously thought. The finding of significant addiction also suggests that targeted food taxes may provide effective instruments for reducing the prevalence of overweight and obesity. The second chapter of this dissertation investigates the determinants of childhood obesity. This research improves upon previous economic research on the topic by incorporating controls for biological relationships of mothers and fathers and examining the entire child weight distribution using quantile regression. I find evidence of genetic weight transmission though the behavioral influence of mothers appears to be dominant. Furthermore, I find that the commonly cited influences on childhood weight do little to explain the most extreme weights. The third chapter of this dissertation studies the contract choice effect. Though frequently discussed, the impact of changes in insurance contract on utilization in response to a change in the expected cost of care has not been explicitly studied in an empirical setting. The analysis identifies a significantly negative contract choice effect, implying that individuals choose better insurance plans in response to increases in the expected cost of care.
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Dissertations / Theses on the topic 'Health insurance claims – United States'

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