Cost Sharing

Publication Title: 
Health Economics

This paper uses data from the 1987 National Medical Expenditure Survey to examine the nature of equilibrium in the market for employment-related health insurance. We examine coverage generosity, premiums, and insurance benefits net of expenditures on premiums, showing that despite a degree of market segmentation, there was a substantial amount of pooling of heterogeneous risks in 1987 among households with employment-related coverage. Our results are largely invariant to (i) firm size and (ii) whether or not employers offer a choice among plans.

Author(s): 
Monheit, A. C.
Selden, T. M.
Publication Title: 
Health Affairs (Project Hope)

Research has demonstrated that Medicare beneficiaries with drug coverage consume more clinically essential drugs. However, generosity of coverage varies considerably across beneficiaries. This study examines the association between types of drug coverage and the consumption and cost per tablet of essential antihypertensive medications among beneficiaries with hypertension.

Author(s): 
Adams, A. S.
Soumerai, S. B.
Ross-Degnan, D.
Publication Title: 
Journal of Health Economics

Although most private health insurance in US is employment-based, little is known about how employers choose health plans for their employees. In this paper, I examine the relationship between employee preferences for health insurance and the health plans offered by employers. I find evidence that employee characteristics affect the generosity of the health plans offered by employers and the likelihood that employers offer a choice of plans.

Author(s): 
Bundorf, M. Kate
Publication Title: 
American Journal of Public Health

OBJECTIVES: This study examined the impact of drug coverage generosity on older persons' prescription events (fills) and expenditures. METHODS: A cross-sectional study was conducted of 6237 older persons from the 1995 Medicare Current Beneficiary Survey. Dependent variables were per capita prescription events and expenditures. Independent variables were insurance type and drug coverage generosity. Control variables included sociodemographic and health status factors.

Author(s): 
Artz, Margaret B.
Hadsall, Ronald S.
Schondelmeyer, Stephen W.
Publication Title: 
The Canadian Journal of Clinical Pharmacology = Journal Canadien De Pharmacologie Clinique

INTRODUCTION: Federal legislation outlined in the Medical Care Act of 1966 and the Canada Health Act of 1984 stipulates that Canadian provincial governments are to administer insurance programs for "medically necessary" services provided by hospitals and physicians. The legislation did not mandate provincial government coverage for prescription drugs taken outside of the hospital. Each province has, however, provided coverage to senior citizens and social assistance recipients; some provinces have introduced drug coverage for the general public.

Author(s): 
Grootendorst, Paul
Publication Title: 
Medical care research and review: MCRR

The authors examine the generosity of private employer health insurance coverage using data from two large national surveys of employers. Generosity is measured as the expected out-of-pocket share of medical expenditures for a standard population, given the provisions of the coverage. On average, those covered by employer-sponsored insurance can expect to pay 25 percent of expenditures out of pocket. There is little variability across plans in this share, though plans offered by smaller employers are somewhat less generous than those offered by larger employers.

Author(s): 
Gabel, Jon R.
Long, Stephen H.
Marquis, M. Susan
Publication Title: 
The Journal of Mental Health Policy and Economics

BACKGROUND: Insurance benefits can have a large effect on whether one is able to access health care services. Mental health and substance abuse (MHSA) insurance coverage has typically been less generous than that of general health services. AIMS OF THE STUDY: This paper examines trends in the generosity of private insurance benefits for mental health (MH) services in the United States from 1987 to 1996.

Author(s): 
McKusick, David R.
Mark, Tami L.
King, Edward C.
Coffey, Rosanna M.
Genuardi, James
Publication Title: 
Inquiry: A Journal of Medical Care Organization, Provision and Financing

Concerns about attracting disproportionate numbers of employees with alcohol problems limit employers' willingness to offer health plans with generous alcohol treatment benefits. This paper analyzes two potential avenues of adverse selection, namely biased enrollment into plans and biased exit from plans offered by 57 employers between 1991 and 1997.

Author(s): 
Harris, Katherine M.
Sturm, Roland
Publication Title: 
International Journal of Health Care Finance and Economics

This paper addresses two seeming paradoxes in the realm of employer-provided health insurance: First, businesses consistently claim that they bear the burden of the insurance they provide for employees, despite theory and empirical evidence indicating that workers bear the full incidence. Second, benefit generosity and the percentage of premiums paid by employers have decreased in recent decades, despite the preferential tax treatment of employer-paid benefits relative to wages-trends unexplained by the standard incidence model.

Author(s): 
Sommers, Benjamin D.
Publication Title: 
Health Affairs (Project Hope)

This paper reports national and state findings on the generosity or actuarial value of U.S. employer-based plans and adjusted premiums in 2002. The basis for our calculations is simulated bill paying for a large standardized population. After adjusting for the quality of benefits, we find from regression analysis that adjusted premiums are 18 percent higher in the nation's smallest firms than in firms with 1,000 or more workers. They are 25 percent higher in indemnity plans and 18 percent higher in preferred provider organizations than in health maintenance organizations.

Author(s): 
Gabel, Jon
McDevitt, Roland
Gandolfo, Laura
Pickreign, Jeremy
Hawkins, Samantha
Fahlman, Cheryl

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