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Norbeck, Angela J. "Health Insurance Literacy Impacts on Enrollment and Satisfaction with Health Insurance." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5387.
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Health insurance literacy (HIL) contributes to the lack of understanding basic health insurance (HI) terms, subsidies eligibility, health plan selection, and HI usage. The study is one of few to address the existing gap in the literature regarding the exploration of the relationship between HIL, individuals' HI enrollment, and individuals' satisfaction with their HI. The theoretical framework selected for this study was the prospect theory, which describes the behavior of individuals who make decisions. In this cross-sectional correlational study, secondary data set from the third Quarter 2015 Health Reform Monitoring Survey was used. Binary logistic regression models were used to test hypotheses of four predictive relationships between (a) HI enrollment and HIL with HI terms; (b) marketplace enrollment and HIL with HI terms; (c) satisfaction with HI and HIL with HI access to care; and (d) satisfaction with HI and HIL with HI cost of care. Results indicated that participants with high HIL with HI terms had 4.2 times higher odds that those with low HIL to be enrolled in HI and 81% higher odds than those with low HIL to be enrolled in marketplace HI. The most significant relationship indicated that participants with high HIL with HI activities had 12.8 times higher odds than those with low HIL to have high satisfaction with access to care and 8.8 times higher odds than those with low HIL participants to have high satisfaction with cost of care. The finding that low HIL is associated with lower enrollment and lower satisfaction with HI has implications for social change. Policymakers may have the opportunity to utilize this study to promote policies that promote higher HIL, which may lead to increased HI enrollment and improved satisfaction with HI selection.
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Noronha, Lisete Fernandes de. "Whole life health insurance." Master's thesis, FCT - UNL, 2008. http://hdl.handle.net/10362/2362.
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Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do Grau de mestre em Matemática e AplicaçõesThe health insurance has become complementary to the National Health Care system in Portugal. In the last years, the increase of this insurance has been considerable. Despite the health concerns of Portuguese citizens, related to better life quality, medical technology and others, the ageing of Portuguese population is a reality to be well thought-out. Regarding this fact, the whole life health insurance is an important product to be developed. In this dissertation, it is presented an approach to the calculation of the level premiums for the whole life health insurance in order to fulfil the Portuguese insurer’s market requests. A private health insurance company with a historical data of ten years provided the statistics used for this calculation. The levelled insurance premiums were calculated on the basis of the risk involved and according to the principle of equivalence. This means that regarding the period insured, the total of premiums should match the total of the benefits.
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Barbaccio, Lisa R. "Consumerism in Health Insurance: Understanding Literacy in Health Insurance Purchasing and Benefit Consumption." Diss., Temple University Libraries, 2019. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/540834.
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Business Administration/InterdisciplinaryD.B.A.
The growth rate and percent of GDP spend on health care has brought necessary attention to discussions on cost and quality within the health industry. This research posits that in order to tackle issues within these cost and quality-conscious discussions, consumers require increased literacy in the health insurance shopping and utilization processes. Health insurance literacy is relatively new terminology. In regard to consumer literacy measures in purchasing, the findings in Chapter 1 demonstrate that studies on health insurance literacy are inconsistent, with no consensus on which metrics are most appropriate to measure health insurance literacy. While there is a generally agreed upon definition of health insurance literacy, there is currently no standard scale to determine one’s literacy level. Additionally, literacy, in a broader construct, can assist consumers in making better informed choices about how to engage with and manage their health insurance. One particular example of a poor utilization habit is the use of the Emergency Room (ER) for non-emergent conditions. The findings in Chapter 2 demonstrate that educated consumers can be influenced to choose alternative sites for ER care. This research suggests that taking measures to advance health insurance literacy can improve both shopping and utilization behavior and, in turn, positively impact health care costs and efficiencies. The conclusion of this research theorizes on the best approach to influence literacy in health insurance; ultimately furthering the body of research that moves toward a more efficient, effective, and literate health insurance industry.
Temple University--Theses
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Polyakova, Maria A. (Maria Alexandrovna). "Regulation of public health insurance." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/90128.
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Thesis: Ph. D., Massachusetts Institute of Technology, Department of Economics, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 147-150).
The first chapter takes advantage of the evolution of the regulatory and pricing environment in the first years of a large federal prescription drug insurance program for seniors - Medicare Part D - to explore interactions among adverse selection, switching costs, and regulation. I document evidence of both adverse selection of beneficiaries across contracts and switching costs for beneficiaries in changing contracts within Medicare Part D. Using an empirical model of contract choice and contract pricing, I show that in the present environment, on net, switching costs help sustain an adversely-selected equilibrium with large differences in risks between more and less generous contracts. I then simulate how switching costs may alter the impact of "filling" the Part D donut hole as implemented under the Affordable Care Act. I find that absent any switching costs, this regulation would have eliminated the differences in risks across contracts; however, in the presence of the switching costs that I estimate, the effect of the policy is largely muted. The second chapter (co-authored with Francesco Decarolis and Stephen Ryan) explores federal subsidy policies in Medicare Part D. We estimate an econometric model of supply and demand that incorporates the regulatory pricing distortions in the insurers' objective functions. Using the model, we conduct counterfactual analyses of what the premiums and allocations would be in this market under different ways of providing the subsidies to consumers. We show that some of the supply-side regulatory mechanisms, such as the tying of premiums and subsidies to the realization of average "bids" by insurers in a region, prove to be welfare-decreasing empirically. The third chapter studies two competing systems that comprise the German health insurance landscape. The two systems differ in the ability of insurers to underwrite individual-specific risk. In contrast to the community rating of the statutory insurance system, enrollees of the private plans face full underwriting and may be rejected by the insurers. I empirically assess to what extent the selection of "good risks" dominates the interaction between the two systems, using a regression discontinuity design based on statutory insurance enrollment mandates. I do not find compelling evidence of cream-skimming by private insurers from the statutory system. Motivated by this finding, I quantify the change in consumer welfare that would result if the government relaxed the statutory insurance mandate to lower income levels.
by Maria A. Polyakova.
Ph. D.
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Horvath, Krisztina. "Essays on Health Insurance Markets:." Thesis, Boston College, 2020. http://hdl.handle.net/2345/bc-ir:108717.
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Thesis advisor: Michael D. GrubbThe first chapter studies behavioral mechanisms to expand health insurance coverage. In health insurance markets where regulators limit insurers' ability to price on the health status of individuals, a traditional regulatory intervention to protect the market from adverse selection and expand coverage among young and healthy people is mandating insurance coverage. In this chapter, I analyze an alternative, behavioral mechanism in the context of the Affordable Care Act Marketplaces: the automatic enrollment of the uninsured with possible opt-out. I build a theoretical model which shows that this nudging policy increases coverage rates, and the size of its benefit depends on the strength of consumer inertia. Using an individual-level panel dataset on health insurance plan choice and claims, I estimate a structural model of health insurance demand and supply in the presence of switching costs. Simulating the effects of the policy, I find that auto-enrollment can increase enrollment rates by over 60% and reduce annual premiums by $300. Moreover, I show that taking into account the heterogeneity of preferences is essential when designing default plans for auto-enrolled consumers. Defaulting everyone into the same contract type leads to more quitting due to inefficient matching and it may also indirectly increase adverse selection on the intensive margin through the price adjustment mechanism. The results of this paper suggest that in order to avoid these problems and maximize the benfits of auto-enrollment in selection markets, it is important to design smart default policies. The second chapter explores how changes in cost sharing affect consumers' demand for health care. Cost sharing reduction (CSR) subsidies are a less well-known provision of the Affordable Care Act (ACA) that aimed to make private health insurance coverage more affordable. These subsidies discontinuously increase the share of expenses paid by the insurer as enrollee income crosses the eligibility cutoffs. This specific subsidy design provides a unique setting to identify moral hazard in health care utilization from observational data that is a major empirical challenge in the literature. In this chapter, I combine individual-level post-subsidy premium data from an All Payer Claims Database with information on plan-level base prices to recover the amount of the premium subsidy. Applying the ACA's premium subsidy formula backwards, I am able to estimate family income. Using this imputed income, I exploit a sharp regression discontinuity design to study the impact of changes in actuarial value on consumer behavior. I find significant increases in health care utilization at income levels associated with the CSR subsidy eligibility cutoffs. These results imply that individuals tend to use more health care services only due to the fact that the insurer becomes responsible for a larger share of their expenditures. These results provide insights about the price elasticity of demand for medical care in a new context. The third chapter evaluates the impact of the ACA on HPV vaccination. Rates of completion of the HPV vaccine series remain suboptimal in the US. The effects of the ACA on HPV vaccine completion are largely unknown. The aim of this study was to examine the associations between the ACA's 2010 provisions and 2014 insurance expansions with HPV vaccine completion by sex and health insurance type. Using 2009-2015 public and private health insurance claims, we conducted a logistic regression model to examine the associations between the ACA policy changes with HPV vaccine completion as well as interactions by sex and health insurance type. Among females and males who initiated the HPV vaccine, 27.6% and 28.0%, respectively, completed the series within 12 months. Among females, the 2010 ACA provision was associated with increases in HPV vaccine completion for the privately-insured and Medicaid enrollees. The 2014 health insurance expansions were associated with increases in vaccine completion for females with private insurance and Medicaid. Among males, the 2014 ACA reforms were associated with increases in HPV vaccine completion for the privately-insured and Medicaid enrollees. Despite low HPV vaccine completion overall, both sets of ACA provisions increased completion among females and males. Our results suggest that expanding Medicaid across the remaining states could increase HPV vaccine completion among publicly-insured youth and prevent HPV-related cancers
Thesis (PhD) — Boston College, 2020
Submitted to: Boston College. Graduate School of Arts and Sciences
Discipline: Economics
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Wettstein, Gal. "Essays on Public Health Insurance." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493442.
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Over the last ten years there have been dramatic changes in the health insurance environment in the United States, spurred on by broad reforms in the public health insurance sector. In 2006 the Medicare Prescription Drug, Improvement and Modernization Act went into effect, providing broad access to prescription drug insurance for millions of elderly Americans. In 2014 the main provisions of the Patient Protection and Affordable Care Act began to be felt, dramatically changing health insurance markets, particularly for those seeking non-group coverage. These legislative changes both raise questions regarding how well the policy changes meet their goals, as well as offering new variation with the potential to answer questions of fundamental economic significance.
This dissertation addresses such important questions surrounding the effectiveness of public health insurance in meeting policymakers’ goals, and the implications of public health insurance for private markets. In the three chapters of this dissertation I utilize the policy changes of Medicare Part D and the Affordable Care Act to provide quasi-experimental estimates of retirement lock, of the correlation of risk aversion and crowd-out of private insurance, and of the effectiveness of the individual health insurance mandate in expanding coverage.
The first part studies the implications of public drug insurance for labor markets. This part examines whether the lack of an individual market for prescription drug insurance causes individuals to delay retirement. I exploit the quasi-experiment of the introduction of Medicare Part D, which provided subsidized prescription drug insurance to all Americans over age 65 beginning in 2006. Using a differences-in-differences design, I compare the labor outcomes of individuals turning 65 just after 2006 to those turning 65 just before 2006 in order to estimate the causal effect of eligibility for Part D on labor supply. I find that individuals at age 65 who would have otherwise lost their employer-sponsored drug insurance upon retirement decreased their rate of full-time work by 8.4 percentage points due to Part D, in contrast to individuals with retiree drug insurance even after age 65 for whom no significant change was observed. This reduction was composed of an increase of 5.9 percentage points in part-time work and 2.5 percentage points in complete retirement. I use these estimates to quantify the extent of the distortion due to drug insurance being tied to employment, and the welfare gains from the subsidy correcting that distortion. The results suggest that individuals value $1 of drug insurance subsidy as much as $3 of Social Security wealth.
The second part of this dissertation considers the effect of public drug insurance on private drug coverage, with a focus on the correlation of crowd-out and risk aversion. I utilize Health and Retirement Survey data around the time of introduction of the Medicare Part D prescription drug insurance for the elderly in order to estimate crowd-out of private prescription drug insurance. I use individuals between the ages of 55 and 64, who are not eligible for the program, as a control group relative to individuals aged 65 to 75, who are eligible. I take a differences-in-differences approach to estimation by comparing outcomes before and after 2006, when Medicare Part D went into effect. I construct measures of risk aversion by exploiting unique questions eliciting risk preferences in the Health and Retirement Survey, as well as information on whether individuals have other kinds of insurance, or engage in risky behaviors. I find substantial differential crowd-out by risk aversion: every standard deviation increase in risk aversion was associated with about 5 percentage points less crowd-out, over a base crowd-out rate of 50%-60%. More risk averse individuals also saw greater reductions in out-of-pocket spending on prescription drugs due to Part D, particularly at high levels of spending: at the 85th percentile of spending an individual one standard deviation more risk averse than the average experienced a decline of $110/year due to Part D eligibility, above and beyond the gains for an averagely risk averse individual of $382/year.
The third part of the dissertation estimates the effectiveness of the individual mandate in the Patient Protection and Affordable Care Act in expanding health insurance coverage. This paper studies the impact of the individual health insurance mandate in the Patient Protection and Affordable Care Act (PPACA) on health insurance coverage. This mandate went into effect in 2014, alongside various other elements of the PPACA. I focus on individuals ages 26-64 who are ineligible for the subsidies or Medicaid expansions included in the PPACA to isolate the effect of the mandate from these other components. To account for changes unrelated to the PPACA that occur over time and affect insurance coverage I utilize a control group of residents of Massachusetts who were already subject to mandated insurance following the 2006 health care reform in their state. Employing a differences-in-differences design applied to data from the American Community Survey, I find that the mandate caused an increase of 0.85 percentage points in health insurance coverage, or a 17% decline in the uninsurance rate. This increase was concentrated in coverage purchased directly by individuals, rather than acquired through an employer, and predominantly affected younger individuals. Both these observations are consistent with the mandate ameliorating adverse selection in the individual health insurance market.Economics
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Dyjakon, Malgorzata. "Dental Health Insurance In Australia." Thesis, Faculty of Dentistry, 1996. http://hdl.handle.net/2123/4577.
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Besley, T. J. "The theory of health risk and health insurance." Thesis, University of Oxford, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.384692.
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Chen, Chen. "Health economic analysis of China's health insurance system." Thesis, University of York, 2016. http://etheses.whiterose.ac.uk/17451/.
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This thesis consists of 3 chapters plus an introductory chapter and a concluding chapter. They are on three different topics, but they are all related to China’s health insurance system from 2000 to 2011. Chapter 1 is the introduction to the thesis, providing background to the Chinese insurance system, the theoretical underpinning of the three chapters, a description of the datasets used in the thesis, and an overview of the thesis. Chapter 2 investigates whether there is adverse or advantageous selection in China’s private health insurance market before 2003. We found evidence in favour of adverse selection in a pure private insurance market. For the public insurance group where people already got covered by a public insurance but face the choice of buying a supplementary private insurance, we found advantageous selection. Chapter 3 examines whether implementing nearly universal coverage in 2009 led to a decrease in individual preventive behaviour prior to illness, termed ex-ante moral hazard. We exploit the longitudinal dimension of data from 2006 and 2009 and use Coarsened Exact Matching methods. The results do not provide strong evidence for ex-ante moral hazard. Chapter 4 aims at evaluating whether there is ex-post moral hazard after the introduction of universal coverage. We measured ex-post moral hazard as the impact of co-payment rate on treatment cost, to assess the variation of total medical expenditure to patients due to the decrease of price. We conclude that there is ex-post moral hazard in outpatient services after the reform of universal coverage in China. Chapter 5 is the concluding chapter, including a summary of the findings, policy implications, strength and limitations of the thesis, and challenges for future research.
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Fike, Verinda Jean Esther. "Health insurance and health care access in China." CONNECT TO ELECTRONIC THESIS, 2008. http://dspace.wrlc.org/handle/1961/5527.
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Rütschi, Christian. "Health and health insurance in Switzerland : an empirical investigation /." Berlin : dissertation.de, 2008. http://www.gbv.de/dms/zbw/568522192.pdf.
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Boyle, Melissa Ann. "Health and utilization effects of expanding public health insurance." Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/32410.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2005.Includes bibliographical references.
This thesis exploits a major overhaul in the U.S. Department of Veterans Affairs health care system to answer various questions about publicly-provided health care. The VA restructuring involved the adoption of a capitated payment system and treatment methods based on the managed care model. This reorganization was accompanied by a major expansion in the population eligible to receive VA care. Chapter one analyzes both the efficiency of providing public health care in a managed care setting and the effectiveness of expanding coverage to healthier and wealthier populations. I estimate that between 35 and 70 percent of new take-up of VA care was the result of individuals dropping private health insurance. While utilization of services increased, estimates indicate that the policy change did not result in net health improvements. Regions providing more care to healthier, newly-eligible veterans experienced bigger reductions in hospital care and larger increases in outpatient services for previously-eligible veterans. This shift away from specialty care may help to explain the aggregate health declines. Chapter two examines the impact of the introduction of a VA-sponsored drug benefit on Medicare-eligible veterans. Results suggest that a drug benefit does not result in changes in the quantity of drugs consumed, but does lead to an increase in spending and a shift in who pays for the prescriptions. The benefit appears to have a larger effect on lower-income individuals. Results also show suggestive evidence of positive health effects as a result of the drug benefit, an outcome which could be cost-saving in the long run.
(cont.) Chapter three utilizes the change in government health care coverage for veterans to test whether employer-provided insurance leads to inefficiencies in the labor market, and the degree to which such inefficiencies might be alleviated by expanding public health insurance programs. We examine the impact of health care coverage on labor force participation and retirement by comparing veterans and non-veterans before and after the VA expansion. Results indicate that workers are significantly more likely to cease working as a result of becoming eligible for public insurance, and are also more likely to move to part-time work.
by Melissa Ann Boyle.
Ph.D.
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Rütschi, Christian. "Health and health insurance in Switzerland - an empirical investigation." Berlin dissertation.de, 2007. http://d-nb.info/988891034/04.
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Liu, Fei. "Three essays on health insurance and health care consumption." [Bloomington, Ind.] : Indiana University, 2007. 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:3243799.
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Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2007.Title from PDF t.p. (viewed Nov. 18, 2008). Source: Dissertation Abstracts International, Volume: 67-12, Section: A, page: 4627. Adviser: Pravin K. Trivedi.
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Jamal, Sheri K. Henderson James W. "Hispanic assimilation to American health insurance." Waco, Tex. : Baylor University, 2006. http://hdl.handle.net/2104/4825.
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Rickayzen, Benjamin David. "Some actuarial aspects of health insurance." Thesis, City University London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446443.
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Chavda, Ankur. "Does health insurance matter for entrepreneurship?" Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104260.
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Thesis: S.M. in Management Research, Massachusetts Institute of Technology, Sloan School of Management, 2016.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 57-59).
We study the effect of improved access to health insurance on entrepreneurial rates across industries. We use the 2006 reform of the Massachusetts health care market as our shock. In contrast to previous research, we use our shock to test which kinds of startups were more likely to be created in addition to whether individuals became more likely to become entrepreneurs. We develop a theoretical model uses institutional heterogeneity to make predictions on how the reform should affect the distribution of entrepreneurs across industries. We see evidence that although non-profit entrepreneurship was significantly affected, overall entrepreneurship is constrained by factors other than access to health care.
by Ankur Chavda.
S.M. in Management Research
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Shepard, Mark. "Essays on Health Insurance and Annuities." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17467319.
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Insurance creates an important source of economic well-being by providing for beneficiaries in times of need. But because a variety of forces may inhibit the proper functioning of insurance markets, governments are deeply involved through regulation, subsidies, and direct provision of insurance. This dissertation studies insurance demand, supply, and the role of policy in two types of markets of direct interest to policymakers: health insurance and annuities. I highlight the importance of both traditional market failures (adverse selection and moral hazard) and less standard factors like limited competition (market power) and puzzlingly low insurance demand to influence insurance market outcomes.
In the first chapter, I study how health insurers compete in individual insurance markets like those established in the Affordable Care Act. I focus on the role of an increasingly important benefit: plans’ networks of covered medical providers. Using data from Massachusetts’ pioneer insurance exchange, I show evidence of substantial adverse selection against plans covering the most expensive and prestigious academic hospitals. Individuals loyal to the prestigious hospitals both select plans covering them and are more likely to use these hospitals’ high-price care. Standard risk adjustment does not capture their higher costs driven by preferences for using high-price providers. To study the welfare implications of network-based selection, I estimate a structural model of hospital and insurance markets and use the model to simulate insurer competition on premiums and hospital coverage in an insurance exchange. I find that with fixed hospital prices, adverse selection leads all plans to exclude the prestigious hospitals. Modified risk adjustment or subsidies can preserve coverage, benefitting those who value the hospitals most but raising costs enough to offset these gains. I conclude that adverse selection encourages plans to limit networks and star academic hospitals to lower prices, with the welfare implications depending on whether those high prices fund socially valuable services.
Chapter 2 also studies health insurance exchanges and the competitive effect of a policy design choice: how the level of subsidies is determined. In the Affordable Care Act exchanges and other programs, subsidies depend on prices set by insurers – as prices rise, so do subsidies. I show that these “price-linked” subsidies incentivize higher prices, with a magnitude that depends on how much insurance demand rises when the price of uninsurance (the mandate penalty) increases. To estimate this effect, I use two natural experiments in the Massachusetts subsidized insurance exchange. In both cases, I find that a $1 increase in the relative monthly mandate penalty increases plan demand by about 1%. Using this estimate, my model implies a sizable distortion of $48 per month (about 12%). This distortion has implications for the tradeoffs between price-linked and exogenous subsidies in many public insurance programs. I discuss an alternate policy that would eliminate the distortion while maintaining many of the benefits of price-linked subsidies.
Chapter 3 studies demand for annuities – insurance products that protect retirees against outliving their assets. Standard life cycle theory predicts that individuals facing uncertain mortality will annuitize all or most of their retirement wealth. Researchers seeking to explain why retirees rarely purchase annuities have focused on imperfections in commercial annuities – including actuarially unfair pricing, lack of bequest protection, and illiquidity in the case of risky events like medical shocks. I study the annuity choice implicit in the timing of Social Security claiming and show that none of these can explain why most retirees claim benefits as early as possible, effectively choosing the minimum annuity. Most early claimers in the Health and Retirement Study had sufficient liquidity to delay Social Security longer than they actually did and could have increased lifetime consumption by delaying. Because the marginal annuity obtained through delay is better than actuarially fair, standard bequest motives cannot explain the puzzle. Nor can the risk of out-of-pocket nursing home costs, since these are concentrated at older ages past the break-even point for delayed claiming. Social Security claiming patterns, therefore, add to the evidence that behavioral explanations may be needed to explain the annuity puzzle.Economics
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Péron, Mathilde. "Three essays on Supplementary Health Insurance." Thesis, Paris Sciences et Lettres (ComUE), 2017. http://www.theses.fr/2017PSLED015/document.
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Cette thèse est consacrée aux systèmes d'assurance maladie mixtes où la couverture publique obligatoire peut être améliorée par une complémentaire santé. Les questions abordées portent sur l'effet inflationniste de la complémentaire sur le prix des soins et sur l'impact de la tarification à l'âge sur les solidarités entre malades et bien portants et entre catégories de revenu. Les analyses empiriques sont réalisées sur données françaises. Cette base de données originale regroupe les consommations de soins de 99,878 affiliés à la MGEN sur la période 2010-2012. Le chapitre 1 estime l'effet causal d'une meilleure couverture sur la consommation de dépassements d'honoraires et démontre l'effet inflationniste de la complémentaire sur le prix des soins. Le chapitre 2 considère l’hétérogénéité de l'impact d'une meilleure couverture sur les dépassements et sa corrélation avec la demande d'assurance. De fait, l’effet inflationniste de la complémentaire est accentué par des effets de sélection. Le chapitre 3 montre que la tarification à l'âge permet de maximiser les transferts entre malades et bien portants au détriment de la solidarité entre hauts et bas revenusThis thesis deals with two questions relative to efficiency and fairness in mixed health insurance systems with partial mandatory coverage and voluntary supplementary health insurance (SHI): (i) the inflationary effect of SHI on medical prices; (ii) the fairness of SHI premiums. We set the analysis in the French context and perform empirical analyses on original individual-level data, collected from the administrative claims of a French insurer (MGEN). The sample is made of 99,878 individuals observed from 2010 to 2012. In Chapter 1, we estimate the causal impact of a generous SHI on patients' decisions to consult physicians who balance bill their patients. We find evidence that better coverage contributes to the rise in medical prices. In Chapter 2, we specify individual heterogeneity in moral hazard and consider its possible correlation with coverage choices. We find evidence of selection on moral hazard: individuals who are more likely to ask for coverage exhibit stronger moral hazard. In Chapter 3, results show that when SHI is voluntary, age-based premiums maximize transfers between low and high healthcare users but do not guarantee vertical equity
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Blanton, Sandra. "Justice in Health Care Access Measuring Attitudes of Health Care Professionals." TopSCHOLAR®, 2000. http://digitalcommons.wku.edu/theses/714.
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To measure attitudes toward justice in access to health care services in managed care plans in a convenience sample of medical professionals at Clark Memorial Hospital in Jeffersonville, Indiana. Methods. A sixteen item, self-administered instrument based on Morreim's four concepts of justice in health care access was administered to 147 health care professionals, representing physicians, allied health, and hospital administration. SPSS was used to analyze the results. Results. The attitudes of the respondents were negative toward managed care. They did not feel that managed care had been a positive development in the United States or that managed care had improved access to preventive care or improved primary care. On the survey instrument, respondents scored highest on the scale measuring fairness to individual patients. Conclusion. In a convenience sample of health care professionals at Clark Memorial Hospital in Jeffersonville, Indiana, equity in distributing access to health care among individual patient needs was found to more closely meet their expectations of justice in health care access. There were no differences found across occupational groups in their responses to the two scales. There were differences in attitudes toward managed care among occupational groups.
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Ng, Jessica. "Determinants of High Deductible Health Plan Choice." Scholarship @ Claremont, 2017. http://scholarship.claremont.edu/cmc_theses/1629.
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This paper analyzes the role that demographics, health services utilization, and knowledge play in determining the choice of insurance plan. Using data from a 2014 National Opinion Research Center (NORC) report and by estimating a probit model, I examine the effect of the three variable categories on the probability of selecting a High Deductible Health Plan (HDHP). While many of the results align with the existing literature, I contribute to prior insurance studies by finding that confusion over health services and plan benefits is the largest driver in HDHP choice, as it increases the probability that an individual enrolls in an HDHP by over 15 percentage points. This result provides evidence to policymakers that insurance education should be more widely available to ensure that individuals are choosing a plan that best fits their needs.
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Jiang, Yuansheng. "Health insurance demand and health risk management in rural China /." Frankfurt am Main [u.a.] : Lang, 2004. http://www.gbv.de/dms/zbw/387845968.pdf.
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Höfter, Ricardo Andres Henriquez. "Preferred providers, health insurance and primary health care in Chile." Thesis, Queen Mary, University of London, 2006. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1772.
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Reforms in the early 1980s created Chile's mixed system of health care provision and finance. Since then Chileans have had to choose between a statesubsidised public health insurance system or the private health plans offered by several insurance companies. In the public system, users may be restricted to the public facility network, with no choice of doctor or medical centre, or they may opt for a free choice mode (preferred providers), which lets them choose both doctor and place of attention. Private insurance providers offer a wide variety of health plans, giving the customer a reasonable range of care options. Although this public-private mix has now been operating for more than 20 years, there has been no empirical study of the factors determining the choice of the preferred providers' mode by public beneficiaries. Likewise, few studies have looked at the determinants in the choice between public and private insurance, and the relationship between the latter choice and the use of health services. The first two empirical chapters of this thesis look at the determinants of these sources of choice, using different econometric tools: the choice of preferred providers is examined using a logit model; the analysis into the choice between public and private insurance uses a probit model; and the impact of holding private insurance as a factor in determining use of health services is estimated through a two-stage tobit model. A further significant aspect of the reforms of the '80s was the process of decentralisation for primary health care provision. Since then a substantial part of preventive health care and promotion occurs locally, and among these services children's health checks are an important policy objective. To encourage attendance parents are given free food supplements if they keep to the timetable for their child's check-ups. However these free food handouts partially account for attendance at the check-ups. Thus the final empirical chapter of the thesis uses a probabilistic model to look at the monetary and non-monetary factors that lead parents to request health checks for their children.
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Thutloa, Alfred Mautsane. "Promoting health citizenship and multilingualism in the health insurance industry." University of the Western Cape, 2018. http://hdl.handle.net/11394/6506.
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Philosophiae Doctor - PhDThe thesis explores the role of semiotic structuring of health information in relation to language, multimodality and health literacy and the affordances for agentive participation among consumers of two leading South African medical schemes - Discovery Health Medical Scheme (Discovery Health) and the Government Employees Medical Scheme (GEMS). The focus is on who has access to health information, how this information is constructed and what the semiotic health habitat looks like for citizen-consumers. Through a virtual ethnographic approach the thesis explores the design of genres of health information artefacts: application forms, application guides, a comic book, and a variety of website images. The choice to study the commercial package of a private health industry is aimed at finding and defining codes of practice in health communication that could be replicable in the public health sector. A new perspective emerging out of the thesis is how semiotic structuring of style, stance-taking, and choice of registers affects reading positions, and how these determine with what voice citizenconsumers can engage with this information.
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Nanna, Anoo. "Health insurance in developing countries : willingness to pay for health insurance in Thailand using discrete choice experiment methods." Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/945.
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In Thailand, a universal health insurance coverage policy was implemented in 2001 alongside the reform of public health insurance. Since the reform, Thailand has had three major public health insurance schemes of the Social Security Scheme (SSS), Civil Servant Medical Benefit Scheme (CSMBS) and the Gold Card scheme. These three schemes covered more than 90 percent of the Thai population in 2003, moving the country closer to universal coverage.The Gold Card scheme was a new public health insurance scheme, introduced in 2001 and covering the majority of Thai population. The scheme is designed to provide coverage for those on low and middle incomes and, thus, plays a vital role in the drive towards universal coverage. There are problems that need to be rectified in this scheme, including financing feasibility, the need for additional sources of finance and the problems of contracted hospitals in the Gold Card scheme.This thesis seeks to elicit the willingness to pay (WTP) for public health insurance (the Gold Card scheme) in Thailand by using a Discrete Choice Experiment (DCE) approach. DCE provides an interesting application to decision- making in health care financing and this study is the first to use the DCE approach to elicit the WTP for public health insurance in Thailand.WTP may help policy makers understand the communities’ preferences because it is elicited through community consultation. Although insured people in the Gold Card scheme currently pay nothing for accessing health care, the DCE approach finds that insured people may be willing to contribute to the cost of running the scheme through the payment of a premium.The DCE was conducted in the northern part of Thailand from 1st August to 31 October 2009. The sample size comprising 1,200 heads of households from five districts who are covered by the Gold Card scheme were surveyed and interviewed. Both qualitative and quantitative methods were used. Qualitative methods were used to collect socio- economic status, health expenditures, hospitalisation and financing experience. Quantitative methods were used to analyse DCE data.The study finds that the Gold Card scheme is very important for respondents and if the Gold Card scheme is able to extend the choices of health care providers and the waiting time in Out-Patient-Department (OPD) can be reduced, insured people would be willing to pay a premium for the Gold Card scheme.Thus, it is possible that premium payment can be used to raise additional funds for the Gold Card scheme. This study recommends that as long as other additional public funds such as tax reform cannot be sourced, the Gold Card scheme may require the insured to pay the premium in order to ensure its long-term viability.
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Govorun, Maria. "Pension and health insurance, phase-type modeling." Doctoral thesis, Universite Libre de Bruxelles, 2013. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209447.
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Depuis longtemps les modèles de type phase sont utilisés dans plusieurs domaines scientifiques pour décrire des systèmes qui peuvent être caractérisés par différents états. Les modèles sont bien connus en théorie des files d’attentes, en économie et en assurance.La thèse est focalisée sur différentes applications des modèles de type phase en assurance et montre leurs avantages. En particulier, le modèle de Lin et Liu en 2007 est intéressant, parce qu’il décrit le processus de vieillissement de l’organisme humain. La durée de vie d’un individu suit une loi de type phase et les états de ce modèle représentent des états de santé. Le fait que le modèle prévoit la connexion entre les états de santé et l’âge de l’individu le rend très utile en assurance.
Les résultats principaux de la thèse sont des nouveaux modèles et méthodes en assurance pension et en assurance santé qui utilisent l’hypothèse de la loi de type phase pour décrire la durée de vie d’un individu.
En assurance pension le but d’estimer la profitabilité d’un fonds de pension. Pour cette raison, on construit un modèle « profit-test » qui demande la modélisation de plusieurs caractéristiques. On décrit l’évolution des participants du fonds en adaptant le modèle du vieillissement aux causes multiples de sortie. L’estimation des profits futurs exige qu’on détermine les valeurs des cotisations pour chaque état de santé, ainsi que l’ancienneté et l’état de santé initial pour chaque participant. Cela nous permet d’obtenir la distribution de profits futurs et de développer des méthodes pour estimer les risques de longevité et de changements de marché. De plus, on suppose que la diminution des taux de mortalité pour les pensionnés influence les profits futurs plus que pour les participants actifs. C’est pourquoi, pour évaluer l’impact de changement de santé sur la profitabilité, on modélise séparément les profits venant des pensionnés.
En assurance santé, on utilise le modèle de type phase pour calculer la distribution de la valeur actualisée des coûts futurs de santé. On développe des algorithmes récursifs qui permettent d’évaluer la distribution au cours d’une période courte, en utilisant des modèles fluides en temps continu, et pendant toute la durée de vie de l’individu, en construisant des modèles en temps discret. Les trois modèles en temps discret correspondent à des hypothèses différentes qu’on fait pour les coûts: dans le premier modèle on suppose que les coûts de santé sont indépendants et identiquement distribués et ne dépendent pas du vieillissement de l’individu; dans les deux autres modèles on suppose que les coûts dépendent de son état de santé.
Doctorat en Sciences
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Singkaew, Songphan. "Policy options for health insurance in Thailand." Thesis, London School of Economics and Political Science (University of London), 1991. http://etheses.lse.ac.uk/1112/.
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This study explores the policy options for health insurance in Thailand, considering the present structure of the country and taking account of international experiences. The development of health insurance in Thailand is analysed from the supply side i.e. health services. The problem of inefficiency and inequity in the health care system has led to the search for better alternatives for organizing and financing. This coincides with the overall growth in the country's socio-economic situation and the policy of health insurance laid down in the Sixth Five Year Health Development Plan (1987-1991). These factors provide positive conditions for establishing health insurance in Thailand. The demand for health insurance from employers who are likely to join the scheme is investigated. A survey of 200 private establishments in Thailand was conducted. This investigation provides essential national baseline data for the organization of health insurance, particularly on the health care fringe benefits provided by employers, and the methods of paying health care providers. Methods of organizing health insurance are formulated from international experience. The historical development of voluntary health insurance and its modified forms, as well as that of compulsory health insurance, are examined. The arguments for and against each form of health insurance are analysed. The study also highlights salient issues of health care reforms which attract the world's attention. International experience has shown that methods of paying providers is a major issue in providing viable health insurance. The study comprehensively analyses the advantages and disadvantages of each method of paying the doctor and the hospital under health insurance systems. Finally, it explores the policy options for the future development of national health insurance in Thailand.
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Eichner, Matthew Jason. "Medical expenditures and major risk health insurance." Thesis, Massachusetts Institute of Technology, 1997. http://hdl.handle.net/1721.1/10316.
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McKnight, Robin. "Essays on the economics of health insurance." Thesis, Massachusetts Institute of Technology, 2002. http://hdl.handle.net/1721.1/32713.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2002.Includes bibliographical references.
This thesis brings together three essays on issues in the economics of health insurance. The first study considers the effects of average per-patient caps on Medicare reimbursement for home health care, which took effect in October 1997. I use regional variation in the restrictiveness of per-patient caps to identify the short-run effects of this reimbursement change on home health agency behavior, beneficiary health care utilization, and health status. The empirical evidence suggests that agencies responded to the caps by shifting the composition of their caseload towards healthier beneficiaries. In addition, I find that decreases in home care utilization were associated with an increase in outpatient care, and had little adverse impact on the health status of beneficiaries. In the second paper, I examine the impact of Medicare balance billing restrictions on physician behavior and on beneficiary spending. My findings include a significant decline in out-of-pocket expenditures for medical care by elderly households, but no impact on the quantity of care received or in the duration of office visits. The third paper (written with Jonathan Gruber) explores the causes of the dramatic rise in employee contributions to employer-provided health insurance over the past 20 years. We find that there was a large impact of falling tax rates, rising eligibility for insurance through the Medicaid system and through spouses, and deteriorating economic conditions (in the late 1980s and early 1990s). We also find more modest impacts of increased managed care penetration and rising health care costs. Overall, this set of factors can explain about one-quarter of the rise in employee contributions over the 1982-1996 period.
by Robin Lynn McKnight.
Ph.D.
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Valente, Ana Beatriz Marques Cabral. "Health insurance pricing with generalised linear models." Master's thesis, Instituto Superior de Economia e Gestão, 2020. http://hdl.handle.net/10400.5/20988.
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Mestrado em Actuarial ScienceOs Modelos Lineares Generalizados (GLMs) são amplamente utilizados na precificação de seguros do ramo Não Vida. O prémio cobrado pela seguradora é calculado com base em uma tarifa. A abordagem clássica para estimar o prémio é feita assumindo a independência entre o número de sinistros e o seu custo. A partir desta independência, a frequência e a severidade dos sinistros são estimados através de GLMs separados e a tarifa é obtida combinando os dois modelos. O presente relatório fornece uma breve introdução sobre a metodologia e descreve como preparámos os dados antes da aplicação do GLM. Os modelos obtidos para os Tratamentos e Consultas de Estomatologia, uma das muitas coberturas que podem ser incluídas numa apólice de Seguro Saúde, são analisados neste relatório. O software SAS foi utilizado para construir as bases de dados e para organizar adequadamente a informação e o software R foi utilizado para o processo de modelagem. Uma vez estimados os modelos, o prémio puro foi calculado e a tarifa, para a cobertura mencionada, foi construída. Por fim, comparámos os resultados obtidos em R com as conclusões obtidas pelos meus colegas, utilizando o software implementado pela empresa. Concluímos que ambos os modelos não são significativamente diferentes, apesar de apresentarem algumas distinções estruturais.
Generalized Linear Models (GLMs) are being broadly used in the Non-Life Insurance Pricing. The premium charged by the insurance company is calculated based on a tariff. The most standard procedure to estimate the pure premium is by assuming that the claim counts and claim amounts are independent. From this independence, the claim frequency and severity can be forecasted by distinct GLMs and the Tariff is obtained by combining both models. The present report gives a brief introduction on the methodology and describes how we prepared the data prior to the GLM application. The models obtained for the Stomatology Treatments and Appointments, one of the many coverages that can be included in a Health Insurance policy, are analyzed in this report. The SAS software was used to construct the datasets and to properly organize the data and R was the software used for the modelling process. Once the models were estimated, the pure premium was calculated and a tariff for the mentioned coverage was constructed. Finally, we compared the results obtained by modelling the coverage in R with the output obtained by my colleagues, using the software implemented by the company. We conclude that both models are not significantly different, despite having some structural distinctions.
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Sadikaj, Ylli. "Personalized Health Insurance Services Using Big Data." Thesis, North Dakota State University, 2016. https://hdl.handle.net/10365/27978.
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Cloud computing paradigm has significantly affected the healthcare sector like various other business domains. Persistently growing healthcare data over the Internet has called for the development of methodologies to efficiently handle the health big data. This study presents a framework that utilizes the cloud computing services to offer personalized recommendations about the most apposite health insurance plans. The users are offered implicit and explicit recommendations.
A standard ontology is presented to offer a unified representation to the health insurance plans. The plans are ranked based on: (a) similarities between the users? coverage requirements and the plans (b) priority of the cost based criteria in the users? query. The framework overcomes the issues pertaining to the long-tail in recommender systems and propose to cluster plans to reduce the number of comparisons.
Experimental results exhibit that the framework accurately identifies the appropriate health insurance plans that satisfy user?s requirements and is scalable.United States Agency for International Development (USAID)
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Pelech, Daria. "Competition and Selection in Health Insurance Markets." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17464292.
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Competition in US health insurance markets is low and has declined in recent years. Insufficient competition is often assumed to increase plan premiums or decrease benefit quality, but the latter has been difficult to establish empirically. Moreover, why health insurance competition is so low is poorly understood. As recent health insurance expansions rely on private insurers to provide coverage, understanding why health insurance competition is low and how this affects consumers is important for policy.
Paper 1 tests for a relationship between insurer competition and health plan benefit generosity. I examine the impact of a regulatory change that led to the cancellation of 40% of the private plans participating in the Medicare program. I isolate the causal effect of cancellation using variation induced by insurers who removed all plans nationally. Insurers in markets affected by cancellation responded by reducing benefit generosity. In the average market, out-of-pocket costs for a representative beneficiary increased by about $130 per year. Tests of possible mechanisms suggest that insurers primarily responded to changes in competition, rather than the policy's direct costs or anticipated changes in enrollees' health risks. In the least competitive markets, out-of-pocket costs increased by more than $200 a year, while in markets with the most substitutes for cancelled plans, benefit generosity barely changed. These findings have crucial implications for markets such as health insurance exchanges, as they suggest health plan quality is degraded when competition is insufficient.
Paper 2 explores why health insurance markets are so concentrated. This paper tests how insurer and provider market power affects insurer exit using a policy change in Medicare Advantage. Under the policy, a group of indemnity insurers were forced to form provider networks de novo. Insurers cancelled two-thirds of the affected plans following passage of this mandate. Comparison across markets where insurers selectively withdrew plans suggests that greater provider market power led to increased exit while greater insurer market power protected against it. Insurers in markets at the top decile of physician and hospital concentration were respectively 17 and 15% more likely to exit than those in the bottom decile, while insurers in the top decile of insurer market share were 68% less likely to exit than those in the bottom decile. Additionally, insurer bargaining power is found to be most protective in the most concentrated hospital markets. Findings suggest that policies to foster insurer market participation must consider both insurer and provider market structure.
Paper 3 examines trends in Medicare Advantage enrollment. Medicare Advantage enrollment grew to its highest point in program history in 2014, despite five years of payment cuts and declining plan availability. This paper investigates whether recent enrollment growth can be expected to continue by examining trends in 65-year-olds' Medicare Advantage enrollment. As 65-year-olds are choosing among supplemental Medicare options for the first time, they may be more responsive to market conditions than other beneficiaries. Findings show that 65-year-olds' enrollment patterns differ from older cohorts, in that they increased between 2006-2009 and then leveled off between 2009-2011. Among a range of market and plan characteristics, changes in Medicare Advantage plan premiums and benefit generosity most plausibly explain slowing enrollment growth. The data also suggest that, absent the recession, enrollment might have further declined.Health Policy
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Clinton, Chelsea, and Chelsea Clinton. "Choosing Health Insurance: Public, Private or None?" Thesis, University of Oregon, 2012. http://hdl.handle.net/1794/12390.
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I estimate two models of consumer health insurance choices where individual attributes and e.g., income, age, gender, cost, etc. affect qualification for specific programs e.g., Medicaid and Medicare, but also affect the choices individuals make. From these results, I assess how these attributes affect health insurance choices using the 2008 Medical Expenditure Panel Survey. I then use these results to predict how individual health insurance choices change with the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. My predictions estimate that more 50 percent of those who become eligible for Medicaid under ACA will switch to Medicaid or choose to have both Private and Medicaid insurance.
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Laughridge, James Lee. "An analysis of mechanisms designed to reduce crowd-out among state children's health insurance programs and their implications for public service." Birmingham, Ala. : University of Alabama at Birmingham, 2009. https://www.mhsl.uab.edu/dt/2009m/laughridge.pdf.
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Chomi, Eunice Nahyuha. "Service provider's perceptions of the quality and accessiblity of health services under social health insurance in Dar-Es-Salaam." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/489.
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Social health insurance is a form of health care financing that has gained increased attention in African countries in the past decade. Tanzania introduced social health insurance by the establishment of the National Health Insurance Fund (NHIF) in 1999 with, inter alia, the objective of improvement of the quality and availability of health services. The goal of this study was to determine the perceptions of services providers on the quality and accessibility of health services following the introduction of social health insurance. A qualitative approach was used to gain an insider's perspective from the service providers of how the services have changed following the introduction of the scheme. Individual interviews, observation and field notes were used to gather information on the quality and accessibility of health services under the policy of social health insurance. Data were analysed using Tesch's method of data analysis. The health workers generally perceived the fund as being beneficial to its members as it reduced the financial barriers to receiving health care. However, the objectives of the NHIF as a health financing mechanism were not adequately understood by the health workers. Although they perceived the quality of health services as having improved compared to previous years, they did not associate this improvement with the NHIF. The health workers also perceived accessibility of health services as having improved for insured patients but not for non-insured patients.
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Abdelrahim, Mahgoub. "Sudan social health insurance : challenges towards universal access to health care." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/sudan-social-health-insurance-challenges-towards-universalaccess-to-health-care(cd798918-f63f-4d3d-8019-2229c89ca3dc).html.
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To achieve effective access to health care, countries have adopted various policies to improve the populations' legitimate right to obtain health care when needed. Social health insurance has been proposed by the WHO as a means to securing sustainable access to health care particularly for developing countries. As one of the developing countries, Sudan launched SHI in 1994; however, population coverage still does not exceed 28.7% of the total population. Given the complexities of access to health care, the issue of achieving universal access by the adoption of SHI is faced with various challenges. Recognising the factors that influence an individual's decision to access health care ultimately adds to the success of the policy intervention to meet the stated goals. In addition, understanding and recognising the households' perspectives and motives to affiliate with SHI is critical to the success of the devised policy initiative. Therefore, this thesis examines the determinants of both access to health care and enrolment in social health insurance in Sudan. It also examines the implication of the adoption of social health insurance as a means to improving the population's access to health care. To achieve the stated objectives, the thesis adopted a quantitative cross-sectional study design involving a household survey in Kassala State in Sudan. The household survey (n=560) collected information from 280 voluntary insured households as well as 280 uninsured households living in rural and urban areas of Kassala State. The study confirms that both access to health care and voluntary enrolment in SHI in Sudan are influenced by factors embedded in the Andersen and Penchansky models of access to health care. These factors include the head of the household's; age, place of residence, gender, health status, the number of family members, perception about the waiting time to see the doctor, perception about the staff treatment, the level of knowledge about SHI and the monthly income. The study confirms that SHI does not act directly to improve utilization of health care; instead, its effect is mediated by other factors especially income level. Thus, access to health care is not merely the function of the health insurance status of the population; however, together with empowering the household's income level, improving the supply side of the health delivery system and reducing the gender inequality SHI is more likely to improve the population's access to health care. In addition, the study proves that those who are able to pay the health insurance premium and joined the scheme, are either looking for additional value for money (e.g. getting health services at a cheap price) or escaping an escalating cost of health care resulting from personal costly health status (e.g. chronic illness). Thus, the success of improving voluntary uptake of SHI depends on adding convincing value for money, raising the people's awareness about the scheme especially female households, targeting rural residence, especially those with large family size, and otherwise adopting a compulsory enrolment policy. The thesis contributed to knowledge through the development of a single theoretical framework encompassing both the health seeking behaviour and the adequacy of the health delivery system. The theoretical framework not only studied access to healthcare but also the factors that influence enrolment in health insurance. The new conceptual framework and the thesis's policy implications are applicable to developing countries that adopt SHI and express socioeconomic characteristic and problems resembling that of Sudan. It is also worth mentioning it is the first study to evaluate the impact of Sudan SHI in terms of population access to health care.
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Thomson, Sarah. "Voluntary health insurance and health system performance in the European Union." Thesis, London School of Economics and Political Science (University of London), 2011. http://etheses.lse.ac.uk/226/.
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This thesis examines the usefulness of voluntary health insurance (VHI) as a lever for improving health system performance. It posits that VHI may further health policy goals if it addresses gaps in statutory coverage, if it does not make those who rely on statutory coverage worse off, and if those who need VHI have access to it. The thesis presents four studies that analyse markets for VHI in the European Union; developments in public policy towards VHI, including the implications of the EUlevel regulatory framework for VHI; the impact of VHI on health system performance; the effects of allowing people to choose between statutory and voluntary health insurance; and VHI’s influence on consumer mobility where insurers compete to offer statutory benefits. The thesis finds that while VHI is critical to financial protection in some countries, it does not always address key gaps in statutory coverage or reach those who need it, and the depth of its coverage has declined over time, even in heavily regulated markets. VHI has a regressive effect on equity in health financing, lowers equity in the use of health services and does not seem to have a positive effect on efficiency, partly because insurers in many countries lack appropriate incentives. What is more, a failure to align incentives across VHI and statutory health insurance can undermine the efficiency of public spending on health. Many of VHI’s negative effects can be attributed to poor policy design. Policy makers can try and ensure VHI contributes to rather than undermines health system performance through the following mechanisms: better understanding of VHI’s interaction with the health system; stronger policy design, focusing on aligning incentives in pursuit of health policy goals and ensuring efficiency in the use of public resources; willingness and capacity to regulate the market to secure financial and consumer protection; and regular monitoring and evaluation.
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Smith, Anna Jo Bodurtha. "Adult-Oriented Health Insurance Reform and Children's Health Insurance: the Massachusetts Experience and Implications for the Affordable Care Act." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27007737.
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BACKGROUND: The Massachusetts health reform and the Affordable Care Act (ACA) were focused on adults, but have the potential to reduce uninsurance and increase access to affordable health care for children. Little is known about the impact of Massachusetts health reform on children, including the vulnerable sub-population of children with special health care needs (CSHCN).
OBJECTIVES: The first two aim of this thesis were to examine whether Massachusetts health reform was associated with lower levels of child uninsurance, increased access to care, and improved financial protection for: (1) children generally and (2) CSHCN specifically. The third aim of this thesis is to explore ESI eligibility among uninsured children and uninsured CSHCN prior to the implementation of ACA’s individual and employer mandates in 2015.
METHODS: For aims 1 and 2, we used a difference-in-differences approach to compare changes in uninsurance, access to care, and financial protection (CSHCN only) in the intervention group, Massachusetts, and the comparison group, other states, before and after Massachusetts health reform. For children overall, we used parent-reported data from the 2003, 2007, and 2011-2012 National Survey of Children’s Health. For CSHCN, we used parent-reported data from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs. For aim 3, we conducted a cross-sectional analysis using the 2011-2012 National Survey of Children’s Health to estimate the proportions of uninsured children and uninsured CHSCN, who were eligible for ESI, but not enrolled, and to assess the barriers that parents reported to obtaining ESI for their uninsured, ESI-eligible children.
RESULTS: Massachusetts health reform was not associated with significant changes in uninsurance for children overall or CSHCN. Access to a personal doctor increased for children previously-eligible for public insurance and did not change for children overall or CSHCN. Access to specialty care increased for children newly-eligible for public insurance under Massachusetts health reform and for privately-insured CSHCN. For CSHCN, there were no significant changes in financial protection under Massachusetts health reform. Nationwide, one-fifth of uninsured children—around 1.2 million children, including 174,000 uninsured CSHCN—were eligible for ESI, but not enrolled prior to ACA implementation. Cost and application difficulties were the main barriers to ESI enrollment.
CONCLUSION: Massachusetts health reform had some positive impact on children’s access to care, but did not decrease uninsurance or improve financial protection. Comparable provisions within the ACA may produce similarly modest outcomes for children and CSHCN. Child-oriented reforms, including making ESI more affordable and enrollment easier, may be necessary to reduce uninsurance and significantly increase access to affordable health care for children.
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Caeiro, João Paulo Marques. "Supplementary private health insurance: The characteristics of subscribers." Master's thesis, NSBE - UNL, 2012. http://hdl.handle.net/10362/9536.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and EconomicsDespite the fact that public medical care has being heavily subsidized through a statutory national health system there has been a growing number of people who opt to enroll in extra private coverage. Using a two part model to infer the insurance decision and subsequent amount of insurance chosen we found out that people’s decision over private health coverage is not related with their health. The pattern of consumption of medical care that is not available in the public sector and a good socio economic background were found significant modeling the demand for private health insurance.
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Cheung, Po-yi Polly, and 張寶儀. "How can Hong Kong learn from Australia's lessons from promoting private health insurance as a supplementary source of health carefunding?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46935113.
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Richardson, Hugh Stanley. "Industrial organization of markets for health insurance and medical services /." Thesis, Connect to this title online; UW restricted, 1997. http://hdl.handle.net/1773/7517.
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Jhang, Mao-chang, and 張茂昌. "Comparison of National Health Insurance and Second Generation National Health Insurance." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/03625817070189304912.
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碩士國立中山大學
高階公共政策碩士班
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The National Health Insurance (NHI) in Taiwan has implemented over ten years. It’s always attention-getting when the govermnet changes some policy or insurance premium of NHI. This time, our government wants to make a bigger reform of NHI called “second generation NHI” and it will make a bigger storm of our social. So this research compares the NHI with “second generation NHI” not only to let us know what NHI in Taiwan is but also to give the government the references of NHI. This research will discuss insurance organization, insured object, insurance agent, insurance recompense, insurance Healing institute and insurance finance between NHI and “second generation NHI” and it will point out what are good and bad of two NHIs to help the government to correct NHI. Finally, I find five problems of our NHI’s development in the result of my research; they are problems of insurance finance, NHI Payment, waste of NHI expense, quality of cure and executive extent of NHI. Also, I suggest several parts of NHI: first, advance the health protection; second, manage the medicine strictly; third, improve the use of NHI IC card; fourth, public NHI’s financial affairs; fifth, make a new NHI payment; sixth, assist the Healing institutes; seventh, establish the bureau of national social insurance and eighth, adhere to the original plan of NHI.
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Huang, Chuang-Hao, and 黃俊豪. "Claim of Health Insurance." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/65897458553639773061.
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碩士淡江大學
保險學系保險經營碩士班
93
The purpose of health insurance claim is to indemnify loss from hospitalizing because of accident or illness and get compensation when the hospitalization expense may beyond social insurance claim. However, health insurance has become a tool of fraud crime due to the economic depression recently, so that this study is aimed to expound a prevention system on health insurance fraud. In this study, we mainly focus on an actual insurance fraud case to present its seriousness and problems for giving contributions to develop a wholesome health insurance prevention system. The contents are: 1.Medical System Problems Anamnesis versus health insurance fraud National health insurance declaration The controversy of fraudulent and excessive hospitalization Inferior quality hospital and clinic 2.Problems of insured and criminal group 3.Insurance company management analysis 4.Supervise system analysis 5.Judiciary verdict analysis The various components of health insurance fraud prevention system need highly professional proficiency. Only when those components modify their own problems by themselves, the whole system should be facilitated to decrease health insurance fraud and then to promote the insured’s medical quality.
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"Essays in Health Insurance." Doctoral diss., 2011. http://hdl.handle.net/2286/R.I.8910.
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abstract: This work is driven by two facts. First, the majority of households in the U.S. obtain health insurance through their employer. Second, around 20% of working age households choose not to purchase health insurance. The link between employment and health insurance has potentially large implications for household selection into employment and participation in public health insurance programs. In these two essays, I address the role of public and private provisions of health insurance on household employment and insurance decisions, the distribution of welfare, and the aggregate economy. In the first essay, I quantify the effects of key parts of the 2010 health care reform legislation. I construct a lifecycle incomplete markets model with an endogenous choice of health insurance coverage and calibrate it to U.S. data. I find that the reform decreases the fraction of uninsured households by 94% and increases ex-ante household welfare by 2.3% in consumption equivalence. The main driving force behind the reduction in the uninsured population is the health insurance mandate, although I find no significant welfare loss associated with the elimination of the mandatory health insurance provision. In the second essay, I provide a quantitative analysis of the role of medical expenditure risk in the employment and insurance decisions of households approaching retirement. I construct a dynamic general equilibrium model of the household that allows for self-selection into employment and health insurance coverage. I find that the welfare cost of medical expenditure risk is large at 5% of lifetime consumption equivalence for the non-institutionalized population. In addition, the provision of health insurance through the employer accounts for 20% of hours worked for households ages 60-64. Finally, I provide an quantitative analysis of changes in Medicare minimum eligibility age in a series of policy experiments.Dissertation/Thesis
Ph.D. Economics 2011
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Chang, Chih Cheng, and 張志誠. "Research on health insurance medical payment review of health services of Taiwan's national health insurance system." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/62145622722530849338.
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Makokotlela, Lionel. "The perceptions of South African health insurance companies regarding the national health insurance plan." 2015. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1001892.
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M. Tech. Organisational LeadershipThe objective of this research is to assess the perceptions held by the medical aid schemes and the general public on the National Health Insurance (NHI). It also identifies areas that need attention to improve service delivery through the National Health Insurance model.
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Mark, Elyse, and 麥麗施. "Can Health Insurance Boost Fertility? The Fertility Effect of National Health Insurance in Taiwan." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/rkbu77.
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碩士國立政治大學
國際研究英語碩士學位學程(IMPIS)
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The implementation of Taiwanese National Health Insurance in 1995 affected almost every Taiwanese citizen’s healthcare options and coverage. Inclusion of low-cost prenatal and postnatal care, delivery services, and child healthcare coverage indicates the implicit pronatalism of NHI policy. Given the endogeneity of healthcare availability to childbearing decisions, this study uses the 1995 implementation of NHI to estimate the impact of national healthcare on Taiwanese fertility. We first approach this question using OLS regression to test for correlation between completed childbearing and an NHI dummy, among other demographic factors. In the second approach, difference-in-differences methodologies estimate the effect of 1995 NHI implementation on the treatment group of Taiwanese women and state-insured control group. Our data sources are the 1979-2016 waves of the Women’s Marriage, Fertility, and Employment Survey conducted by the Statistical Department of the Taiwanese Ministry of the Interior. We hypothesize that the 1995 NHI policy change increased the fertility of Taiwanese women around the cutoff date despite sub-replacement national fertility beginning in the 1980s. OLS analysis fails to show a positive correlation between NHI and women’s fertility in Taiwan, however. Further, DID estimations using a maternal age and a conception time both reject the hypothesis that lowered cost of childbearing through NHI stimulated Taiwanese fertility.
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Carvalho, Armindo Barbosa de. "Peer to Peer Health Insurance." Master's thesis, 2016. https://hdl.handle.net/10216/96448.
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Nos últimos anos, a tecnologia tem vindo a mudar a forma como vivemos. O acesso cada vez mais generalizado à internet faz com que a informação seja partilhada de forma exponencial e permite que as pessoas estejam conectadas como nunca, o que potencia a criação de economias de partilha e a formação de redes sociais. Isto leva a que os comportamentos dos clientes mudem, fazendo com que os intervenientes mais tradicionais, enfrentem cada vez mais a competição de novos concorrentes que exploram novas formas de negócio.No caso do setor segurador uma dessas novas formas de negócio que tem sido apontada como uma grande tendência nesta indústria é o "Peer to Peer Insurance", que visam a aproveitar as potencialidades de construção de comunidades na internet de modo a fornecer um serviço segurador mais personalizado, transparente e mais facilmente acessível. Desta forma, o "Peer to Peer Insurance" promove a criação de apólices em grupo, sendo o risco das mesmas partilhado pelos membros desse grupo, permitindo, caso a taxa de sinistralidade seja baixa, a devolução de parte do prémio pago.Ao longo desta dissertação, este tema será analisado para o caso dos seguros do ramo saúde, utilizando metodologias ágeis de desenvolvimento focadas no cliente, nomeadamente "Design Thinking" e a framework de projetos de inovação da Deloitte, "Digital Agility". Sendo assim, no final deste projeto, o estudo realizado sobre a temática culminará na ideação e desenvolvimento de um protótipo que simule uma plataforma que aplique este conceito.The technology has been changing the way we live and the global access to the internet has facilitated the information sharing and allowed people to be more connected than ever, enhancing the creation of sharing economies and social networks. Thus, the behavior of the customers are changing, threatening traditional market players with the competition of new entrants exploring disruptive technologies.In the Insurance industry, one disruptive idea that has been indicated as a trend is the Peer to Peer Insurance. This new way to sell insurance tries to leverage the advantages of internet communities to provide a better service, more customized, transparent and accessible. With this goal, "Peer to Peer insurance", allows the creation of groups of people to share the risk of insurance products and in case of low number of claims, part of the premium is returned to the customer or used to pay the insurance in the next year .During this dissertation, this topic will be analyzed to the field of health insurance, and the research will be based on agile methodologies like "Design Thinking"and Deloitte's framework for innovation projects, "Digital Agility". The main goal of this research is the ideation and development of proof of concept for a Peer to Peer Health Insurance platform.
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Carvalho, Armindo Barbosa de. "Peer to Peer Health Insurance." Dissertação, 2016. https://hdl.handle.net/10216/96448.
Full textAbstract:
Nos últimos anos, a tecnologia tem vindo a mudar a forma como vivemos. O acesso cada vez mais generalizado à internet faz com que a informação seja partilhada de forma exponencial e permite que as pessoas estejam conectadas como nunca, o que potencia a criação de economias de partilha e a formação de redes sociais. Isto leva a que os comportamentos dos clientes mudem, fazendo com que os intervenientes mais tradicionais, enfrentem cada vez mais a competição de novos concorrentes que exploram novas formas de negócio.No caso do setor segurador uma dessas novas formas de negócio que tem sido apontada como uma grande tendência nesta indústria é o "Peer to Peer Insurance", que visam a aproveitar as potencialidades de construção de comunidades na internet de modo a fornecer um serviço segurador mais personalizado, transparente e mais facilmente acessível. Desta forma, o "Peer to Peer Insurance" promove a criação de apólices em grupo, sendo o risco das mesmas partilhado pelos membros desse grupo, permitindo, caso a taxa de sinistralidade seja baixa, a devolução de parte do prémio pago.Ao longo desta dissertação, este tema será analisado para o caso dos seguros do ramo saúde, utilizando metodologias ágeis de desenvolvimento focadas no cliente, nomeadamente "Design Thinking" e a framework de projetos de inovação da Deloitte, "Digital Agility". Sendo assim, no final deste projeto, o estudo realizado sobre a temática culminará na ideação e desenvolvimento de um protótipo que simule uma plataforma que aplique este conceito.The technology has been changing the way we live and the global access to the internet has facilitated the information sharing and allowed people to be more connected than ever, enhancing the creation of sharing economies and social networks. Thus, the behavior of the customers are changing, threatening traditional market players with the competition of new entrants exploring disruptive technologies.In the Insurance industry, one disruptive idea that has been indicated as a trend is the Peer to Peer Insurance. This new way to sell insurance tries to leverage the advantages of internet communities to provide a better service, more customized, transparent and accessible. With this goal, "Peer to Peer insurance", allows the creation of groups of people to share the risk of insurance products and in case of low number of claims, part of the premium is returned to the customer or used to pay the insurance in the next year .During this dissertation, this topic will be analyzed to the field of health insurance, and the research will be based on agile methodologies like "Design Thinking"and Deloitte's framework for innovation projects, "Digital Agility". The main goal of this research is the ideation and development of proof of concept for a Peer to Peer Health Insurance platform.
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Gamble, Hamish William. "Health or wealth: decision making in health insurance." Thesis, 2016. http://hdl.handle.net/2440/103756.
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In this thesis we investigate whether health insurance decisions can be explained by loss aversion. We use a model of reference dependent preferences as developed by Koszegi and Rabin (2006) to show that under loss aversion there are different maximum willingness to pay for private health insurance. We do not endogenise the reference point. Instead we attempt to alter the reference point through framing in a laboratory setting, in a manner which is consistent with the original Tversky and Kahneman (1981) formulation of prospect theory. We find that the framing effect did not result in a difference between the proportion of subjects who purchased private health insurance. We do find that subjects make decisions closer to that of an expected utility maximiser in the treatment which is framed such that the reference point is consistent with having private health insurance, where there is a loss in health and a gain in wealth from giving up the insurance. Our result highlights the importance of framing for governments or policy makers who are attempting to influence individuals behaviour.Thesis (M.Phil.) -- University of Adelaide, School of Economics, 2016.