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1
Lopez, Quetzalsol F., Karen E. Schetzina, Amanda Haiman et Fernando Mendoza. « Barriers to Obtaining Health Insurance among Patients Served By a Mobile Community Health Van ». Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/5064.
Texte intégral
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Domapielle, Maximillian K. « Extending health services to rural residents in Jirapa District : analyses of national health insurance enrolment and access to health care services ». Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14803.
Texte intégralRésumé :
This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.
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Vangile, Kirsten M. « Childhood Cancer Survivors : Patient Characteristics ». Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/iph_theses/51.
Texte intégralRésumé :
Survivors of childhood cancer are a relatively new phenomenon in the medical world. The introduction of treatment protocols in the 1970s started a trend in curing children of cancer that historically had been a death sentence. Under these treatment protocols children were given different treatment regimens based on past research that helped remove cancerous cells from their bodies, but were later found to be the cause of treatment related morbidities years into the future; for most survivors roughly ten to 20 years post treatment. These morbidities, commonly called late-effects, are the prime reason that survivors of childhood cancer need to participate in survivorship care. Survivors of childhood cancer are particularly vulnerable to late-effects because the majority of them receive their treatment at a time when their bodies are still growing and developing. Survivorship care services vary by site, but all maintain the common goals of providing long-term follow up for the survivor and education about the ways in which treatments may affect a survivors’ health as they age. Similar to many other facets of healthcare and medicine, there are many populations who do not participate in survivorship care. The purpose of this research is to identify possible barriers to care, assess the level of impact these barriers have upon the survivor’s potential for participation and provide suggestions as to how these barriers can be mitigated. Additionally, this research highlights areas that need further research and analysis.
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Christofero, Tracy M. « Information Privacy as Required By The Health Insurance Portability and Accountability Act of 1996 (HIPAA) : Awareness and Barriers to Compliance as Experienced by Small Health Care Practitioners in Rural West Virginia ». NSUWorks, 2005. http://nsuworks.nova.edu/gscis_etd/453.
Texte intégralRésumé :
Physicians have sworn to uphold patient trust and privacy since the time of Hypocrites. Given today's technological innovations and electronic access to medical information, an oath to uphold privacy is not enough. Unlike credit reports, educational records, and video rentals, there have been no U.S. federal privacy laws providing individuals the right to know how their medical records are used and disclosed. The Health Insurance Portability and Accountability Act of 1996 (HIP AA) mandated standards for the transmission of electronic health information and protection of that information by practitioners, health plans, clearinghouses, and pharmaceutical drug card sponsors who electronically process medical transactions. An estimated 400,000 small practitioners were required to comply with HIPAA. Small health care providers in rural West Virginia faced additional challenges. West Virginia is the second most rural state in the nation; has the oldest median age; is the only state to experience a natural decrease in population; ranks first in the percentage of residents on Medicare; placed lowest in median household income; and in 1998, SO of West Virginia's 55 counties were designated as Medically Underserved Areas.
The goals of this study were to promote HIP AA awareness, ascertain levels of HIP AA awareness, and identify barriers or issues that may have hindered those who perceive themselves as HIPAA privacy compliant. The descriptive research methodology was utilized to achieve these goals. Surveys were distributed to 408 licensed physicians in rural West Virginia. This study assessed if participants qualified as small, i.e., annual revenues of $5 million or less; if they were HIP AA covered entities; their HIP AA awareness level; and provided access to no-cost HIPAA training. The 78 HIPAA compliant respondents were asked to identify any barriers or issues they experienced while pursuing compliance. Vagueness of the regulations; confusion by physicians, patients, families, and the public; and the cost of compliance were identified as major concerns. This was consistent with findings in the literature. Results of this research were used to assist West Virginia officials address compliance barriers and identify remediation efforts the state could employ to assist in ongoing HIPAA, and other, legislated compliance efforts.
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BONAN, JACOPO DANIELE. « Essays in development economics ». Doctoral thesis, Università degli Studi di Milano-Bicocca, 2013. http://hdl.handle.net/10281/46828.
Texte intégralRésumé :
Gaps in financial access remain stark in the largest part of developing countries and have relevant consequences on poor households’ economic decisions, such as credit, saving and risk management. Lack of availability of formal financial services provided by either the market or public authorities (e.g in case of health insurance) have been compensated by the activity of informal groups, associations and arrangements. Old and new forms of community-based groups have been largely documented in most of developing countries and are shown to be active in several crucial economic domains. They have different levels of institutionalization as they can simply rely on social norms or can have rules and a certain degree of formalization concerning e.g. selection criteria, enforcement, sanctions. They all have in common the voluntary participation of people from the same community (village, neighbourhood, people of the same profession), the delivery of services to members, the non-profit character, the underpinning values of solidarity and mutual help. Some examples of community-based groups in Sub-Saharan Africa are analysed in this thesis: Rotating Saving and Credit Associations (roscas), funeral groups and mutual health organizations (MHOs).
The importance of studying community-based arrangements lies in the premise that interventions at the level of a local community can deliver more effective and equitable development. Moreover, examining the mechanics of the informal market is very important for two reasons. First, the strength of the informal market is important for measuring and predicting how effective specific formal sector interventions could be, in the perspective of scaling-up. Second, lessons learned in the informal markets can help shape policy in the formal (Karlan and Morduch 2009).
In chapter 1, drawing on data from a household survey in urban Benin1, we examine membership in two types of informal groups that display the characteristics of a commitment device: rotating savings and credit associations (roscas) and funeral groups. We investigate whether agents displaying time-inconsistent preferences are sophisticated enough to commit themselves through taking part in such groups. We provide evidence indicating that women who are hyperbolic are more likely to join these groups and to save more through them, but men displaying similar preferences appear naïve with regards membership. Moreover, we find that hyperbolic agents, irrespective of their gender, tend to restrain consumption of frivolous goods to a larger extent. Furthermore, weak evidence is provided that microcredit can be used as a device to foster self-discipline. We also ensure that our results cannot be explained by intrahousehold conflict issues.
The second chapter largely draws on Bonan J, Dagnelie O., LeMay-Boucher P. and Tenikue M. (2012) “Is it all about Money? A Randomized Evaluation of the Impact of Insurance Literacy and Marketing Treatments on the Demand for Health Microinsurance in Senegal”, Working Papers 216, University of Milano-Bicocca, Department of Economics. It is based on a field work we carried out in Spring-Summer 2010 in Thies, Senegal, which I coordinated and supervised. The chapter presents experimental evidence on mutual health organizations (MHOs) in the area of Thiès, Senegal. Despite their benefits, in some areas there remain low take-up rates. We offer an insurance literacy module, communicating the benefits from health microinsurance and the functioning of MHOs, to a randomly selected sample of households. The effects of this training, and three cross-cutting marketing treatments, are evaluated using a randomized control trial. We find that our various marketing treatments have a positive and significant effect on health insurance adoption, increasing take-up by around 35%. Comparatively the insurance literacy module has a negligible impact on the take up decisions. We attempt at providing different contextual reasons for this result. The third chapter is an extension of the second and draws on the same dataset. We measure the willingness to pay (WTP) for MHOs premiums in a Senegalese urban context. WTP valuations can help both policy makers and existent MHOs in better understanding the characteristics of the demand of microinsurance products. This chapter considers the role of individual and household socio-economic determinants of willingness to pay for a health microinsurance product and add to the previous literature evidence of the role of income, wealth and risk preferences on individual WTP. We find that richer, more wealthy and more risk-averse head of households are more likely to reveal a higher WTP for health microinsurance. Conscious of the potential limits of our elicitation strategy (bidding game), we incorporate the existent literature on the effects of ‘preferences anomalies’ (Watson and Ryan 2007) and estimate WTP accounting for structural shift in preferences (Alberini et al. 1997), anchoring effect (Herriges and Shogren 1996) and the two effects together (Whitehead 2002). We find evidence of slight underestimation of the median WTP if preferences anomalies are not taken into consideration. However, the extent of such difference is far from being relevant. Previous results on the determinants of WTP are robust to the effect of such preference anomalies. We also provide an analysis of the predictive power of WTP on the actual take-up of insurance following our offering of membership to a sample of 360 households. WTP appears to have a positive and significant impact on actual take-up.
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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.
Texte intégralRésumé :
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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Bowles, Paula. « Barriers to Lesbian Health Care ». TopSCHOLAR®, 2003. http://digitalcommons.wku.edu/theses/581.
Texte intégralRésumé :
The primary purpose of this research was to examine a sample of sixteen lesbian women regarding the barriers to lesbian health-care. From this information several interpretive findings regarding lesbian health-care are made. Data were gathered via indepth interviews with each individual lesbian. The data suggest that most lesbian women do not reveal their sexual orientation to their primary-care physician for fear of reprisal. Most of the women interviewed do feel they receive adequate health-care from their physician. The women who participated in this project did so confidentially and were assigned pseudonyms. They were asked questions on a variety of topics, which included demographics, physical health-care, mental health-care, general health, dental care, social and political issues, and homophobia. It was assumed that participants from smaller, more rural areas would face more barriers to health-care than participants from larger cities. The data gathered indicate that only three of the participants had, in fact, informed their primary-care physicians of their sexual orientation. Erving Goffman's stigma and social identity theory, feminist standpoint theory, lesbian feminist theory, and feminist theory provided the theoretical framework utilized in the analysis of barriers to lesbian health care. Combining these three theories allows a discussion of how stigma and homophobia combine to make lesbians invisible in the medical community. Health-care systems, like other major institutions, are structured to support traditional society.
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Noronha, Lisete Fernandes de. « Whole life health insurance ». Master's thesis, FCT - UNL, 2008. http://hdl.handle.net/10362/2362.
Texte intégralRésumé :
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.
Texte intégralRésumé :
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.
Texte intégralRésumé :
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.
Texte intégralRésumé :
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.
Texte intégralRésumé :
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.
Texte intégral
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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/.
Texte intégralRésumé :
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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Ackerman, Eileen. « Microinsurance in the context of social protection : overcoming the barriers of economic growth and development ». Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/78866.
Texte intégralRésumé :
Many South Africans, especially those with low incomes, remain excluded from the formal financial services and products market, ironically so, as these low-income households are more exposed to unforeseen economic shocks and being unable to recover from the unexpected financial impact thereof. Low-income households live in more risky environments and are vulnerable to numerous financial threats. They are also the least able to cope when a crisis present itself as they are the least likely to have any savings to deal with these crises. Vulnerability and poverty causes a downwards spiral of misfortune when reinforcing each other.
Microinsurance has been considered as the next revolution in addressing the vulnerability and risk of low-income households in developing countries such as South Africa. Huge investments have been made by development agencies in an attempt to break the circle of poverty by offering reliable protection to the poor.
A well-designed regulatory framework is important for the efficient and effective provision of microinsurance. Significant steps have been taken in an attempt to formalise the insurance sphere and to make provision for microinsurance. The question now arises, will microinsurance be a useful tool to include the low-income market in to the financial insurance industry and will microinsurance be profitable for insurers, taking in to consideration the cost and expenses of insurers due to over regulation and requirements by various legislation versus the applicable caps prescribed in the policy framework for microinsurance products?Mini Dissertation (LLM (Insurance Law))--University of Pretoria, 2020.
Ubuntu-Batho Community Development Trust, an organisation established by Mr Patrice Motsepe and his partner Dr Johan van Zyl
Mercantile Law
LLM (Insurance Law)
Unrestricted
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Eldridge, Sarah Marie. « The Barriers To Mental Health Services : How Facility Factors Impact Perceived Barriers To Mental Health Services In Nursing Facilities ». Miami University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=miami1409246124.
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Ariyo, Oluwatosin, Amal J. Khoury, M. G. Smith, Edward Leinaar, F. O. Odebunmi et Deborah Slawson. « Barriers to Improving Contraceptive Practices ». Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/8178.
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Myers, Julie Annette. « Discovering Barriers to Quality in Oklahoma Nursing Homes ». Thesis, The University of Oklahoma Health Sciences Center, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10287164.
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Background: While the data indicate that Oklahoma’s nursing home care is lower in quality than the national average, there is a gap in the literature as to what staff perceive as barriers to quality care in Oklahoma. Staff perceptions impact organizational outcomes. Examining staff-perceived barriers presents the opportunity to approach improvement from the perspective of those responsible for implementing interventions.
Hypothesis: Nursing home staff in Oklahoma perceive the following as common barriers to delivering high quality care: (i) culture and structure of the organization; (ii) lack of authority and autonomy related to tasks and care delivery; (iii) high job demands related to disease burden; and (iv) limitations of the physical environment. The central question addressed is what do staff perceive as barriers to providing high quality care in Oklahoma nursing homes?
Methods: A written survey and interview guide were used to collect information from 28 nursing home staff from seven nursing homes in Oklahoma. The survey was crafted to test the perceptions of barriers in alignment with the conceptual model. Quantitative methods were used to determine the sample and analyze written survey responses. Qualitative methods were used to code themes from the interviews to elements of the conceptual model to determine if responses aligned with the hypothesis.
Results: Frequently cited barriers to delivering quality care include: social relationships inclusive of meals, care planning, activities, and dedicated staff time with residents; environmental factors inclusive of room size, privacy, layout, and access to outdoors; job demands inclusive of workload, time pressures, cognitive load, and demands from residents and families; performance evaluation, rewards, and incentives inclusive of recognition, appreciation, wage, bonus pay, performance feedback; and, supervisory and management style inclusive of consistency, equity, perceived fairness, and stress.
Conclusion: Real and perceived barriers to high quality care exist. Perceptions vary by staff role, and perceptions can be aligned with organizational structure and strategies through communication, transparency, and a justice-based approach. Along with changes to regulation and rules, improvement efforts must occur at the facility level with support from leadership and engagement of staff.
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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.
Texte intégralRésumé :
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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Kowalski, Katherine Grace. « Secondary School Professionals' ; Perceptions of Barriers to Mental Health Services : A Mixed Method Exploration of Barriers ». Miami University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=miami1626199879493959.
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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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Beatty, Kate, Jeffrey Mayer, Michael Elliott, Ross C. Brownson, Safina Abdulloeva et Kathleen Wojciehowski. « Barriers and Incentives to Rural Health Department Accreditation ». Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6826.
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Context: Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities.
Objective: To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective.
Design: Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities.
Participants: Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52 000 for accredited RLHDs and from 7200 to 73 000 for unaccredited RLHDs.
Results: Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation.
Conclusions: There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.
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Jackson, Desmarie DeCuir. « Health barriers, health perceptions, and cardiovascular health risk factors of adolescent black American males ». View the abstract Download the full-text PDF version (on campus access only), 2007. http://etd.utmem.edu/ABSTRACTS/2007-003-DeCuir-index.html.
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Thesis (Ph.D )--University of Tennessee Health Science Center, 2007.Title from title page screen (viewed on April 4, 2008). Research advisor: Mona N. Wicks, R. N., Ph. D. Document formatted into pages (x, 126 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 127-146).
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Beatty, Kate, Paul Campbell Erwin, Ross C. Brownson, Michael Meit et James Fey. « Public Health Agency Accreditation among Rural Local Health Departments : Influencers and Barriers ». Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6822.
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Objective: Health department accreditation is a crucial strategy for strengthening public health infrastructure. The purpose of this study was to investigate local health department (LHD) characteristics that are associated with accreditation-seeking behavior. This study sought to ascertain the effects of rurality on the likelihood of seeking accreditation through the Public Health Accreditation Board (PHAB).
Design: Cross-sectional study using secondary data from the 2013 National Association of County & City Health Officials (NACCHO) National Profile of Local Health Departments Study (Profile Study).
Setting: United States.
Participants: LHDs (n = 490) that responded to the 2013 NACCHO Profile Survey.
Main Outcome Measures: LHDs decision to seek PHAB accreditation.
Results: Significantly more accreditation-seeking LHDs were located in urban areas (87.0%) than in micropolition (8.9%) or rural areas (4.1%) (P < .001). LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs (RLHDs). LHDs that had completed an agency-wide strategic plan were 8.5 times (95% CI, 4.0-17.9), LHDs with a local board of health were 3.3 times (95% CI, 1.5-7.0), and LHDs governed by their state health department were 12.9 times (95% CI, 3.3-50.0) more likely to seek accreditation. The most commonly cited barrier was time and effort required for accreditation application exceeded benefits (73.5%).
Conclusion: The strongest predictor for seeking PHAB accreditation was serving an urban jurisdiction. Micropolitan LHDs were more likely to seek accreditation than smaller RLHDs, which are typically understaffed and underfunded. Major barriers identified by the RLHDs included fees being too high and the time and effort needed for accreditation exceeded their perceived benefits. RLHDs will need additional financial and technical support to achieve accreditation. Even with additional funds, clear messaging of the benefits of accreditation tailored to RLHDs will be needed.
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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
info:eu-repo/semantics/nonPublished
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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.
Texte intégralRésumé :
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.
info:eu-repo/semantics/publishedVersion
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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.
Texte intégralRésumé :
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.
Texte intégralRésumé :
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, et Chelsea Clinton. « Choosing Health Insurance : Public, Private or None ? » Thesis, University of Oregon, 2012. http://hdl.handle.net/1794/12390.
Texte intégralRésumé :
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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Ellison, Jacqueline. « Confidentiality, insurance, and provider-based barriers to sexual and reproductive health services ». Thesis, 2020. https://hdl.handle.net/2144/40934.
Texte intégralRésumé :
This dissertation consists of three studies that examine barriers to sexual and reproductive health care among commercially insured young adults and women. Study 1 investigates differences in insurance use behavior for confidential SRH care by young adults with parental versus policyholder coverage. Findings demonstrate that individuals with parental insurance coverage are less likely than their counterparts with policyholder coverage to use their insurance to pay for pap testing, contraception, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Study 2 builds on this work to evaluate the role of the national dependent coverage expansion on insurance use for sexual and reproductive health services. Findings demonstrate an aggregate reduction in insurance use for pap testing, contraception, and STI testing among young adult women newly eligible for parental coverage under the expansion. Study 3 examines prevalence and trends in non-indicated pelvic examinations performed during contraceptive visits, along with variations by provider specialty and patient age. Results show a substantial increase in the number of pelvic examinations performed during contraceptive encounters from 2007 – 2017, and higher rates of non-indicated exams performed by obstetrician-gynecologists. Together, this research provides evidence of barriers to sexual and reproductive health care among commercially insured young adults and women, highlighting ongoing issues of patient privacy and autonomy in health care financing and service delivery.2022-05-14T00:00:00Z
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Thompson, Brandy. « Cost Barriers to Dental Care in Canada ». Thesis, 2012. http://hdl.handle.net/1807/33565.
Texte intégralRésumé :
Objective: To determine who avoids the dentist and declines recommended dental treatment due to cost. Methods: A secondary data analysis was undertaken. Weights were utilized to ensure data were nationally representative. Univariate and bivariate descriptive statistics were calculated and logistic regressions were used to observe the characteristics that were predictive of reporting cost barriers to care. Results: Over 17 per cent of the Canadian population reported avoiding a dental professional due to cost, and 16.5 per cent reported declining recommended dental treatment due to cost. These individuals had a higher prevalence of needing treatment, had more untreated decay, missing teeth, and reported having poor oral health and oral pain often. Having no insurance, lower income, and reporting “poor to fair” oral health were the greatest predictors of reporting cost barriers to care. Conclusions: Individuals who report cost barriers experience more disease and treatment needs than those who do not.
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Dobiášová, Karolína. « Dostupnost zdravotní péče pro migranty ze třetích zemí v České republice ». Doctoral thesis, 2016. http://www.nusl.cz/ntk/nusl-341977.
Texte intégralRésumé :
This Ph.D. thesis discusses the evolution and current situation regarding availability of healthcare for third countries migrants in the Czech Republic. In terms of methodology, the author has chosen a qualitative approach. The research design is a historical case study. The thesis uses a combination of "desk research" and empirical survey based on 56 in-depth interviews with migrants, healthcare providers and experts who come into contact with migrants during the course of their work. Based on the approach of historical institutionalism, the author is explaining policy of migrants' health insurance evolution in Czech Republic since 1993 till today. The author identifies the key events and the roles of particular actors within the observed "sub- system" of public policy. From the viewpoint of migrants and healthcare providers, the thesis also presents how the current institutionalised set-up of migrants' health policy transfers into the real access to healthcare for migrants. It also identifies the main barriers to health care accessibility and the consequences of possible health care unavailability. Key words: migrants, health care availability, health insurance, historical institutionalism, barriers to health care access
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Lin, Shiu-Lun, et 林秀倫. « The Research of Entry Barriers in Taiwan Insurance Market -A Case Study on Metlife Insurance Inc.The Research of Entry Barriers in Taiwan Insurance Market -A Case Study on Metlife Insurance Inc.The Research of Entry Barriers in Taiwan Insurance Market-A Case Study on Metlife Insurance Inc ». Thesis, 2014. http://ndltd.ncl.edu.tw/handle/a2ps6b.
Texte intégralRésumé :
碩士健行科技大學
國際企業經營系碩士班
103
Foreign insurance companies make significant contribution to Taiwan’s insurance industry. Financial tsunami triggered exodus of foreign insurance companies successively, causing many famous international insurance companies sold out their business units in Taiwan one after another. Insurance industry normally influenced on much wider aspects. Transference of a lot of policy holders’ interests and a large amount of funds would result in not only economic turmoil in the society but also general public’s doubts about insurance industry. Any foreign company must face entry barriers when accessing to Taiwan market, which is a key to be noticed. This research selected Metlife Insurance Company that has withdrew from Taiwan market as case study to find out the reason of giving up Taiwan market through deep interview and analysis of the relevant data and explore entry barriers not to be ignored by foreign insurance companies This research considered that there’re four types of entry barriers in Taiwan insurance market: First type, the problem of regulations that are affected by political and legal system and IFRS4 implementation; second type, the problem of negative spread that is caused by low interest rate environment resulted from influence of economic and capital aspects; third type, influence of regional aspect. In the recent years, the existence of entry barriers in Taiwan insurance industry has made frequent change in foreign insurance companies. All of these will strike Taiwan people and foreign insurance companies. Finally, this research proposed and reminded that industrialists should pay attention to the current situation of the development of Taiwan insurance industry, also hoping that the government can develop more favorable business environment to attract foreign investment to Taiwan, and further cooperating with the industrialists to reduce influence of entry barriers for prospect of Taiwan insurance market.
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Jhang, Mao-chang, et 張茂昌. « Comparison of National Health Insurance and Second Generation National Health Insurance ». Thesis, 2006. http://ndltd.ncl.edu.tw/handle/03625817070189304912.
Texte intégralRésumé :
碩士國立中山大學
高階公共政策碩士班
94
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.