Week 7 Flashcards
What are the reasons for government intervention in health care insurance?
1) Externalities: an individual suffering from illness generates costs to society. e.g., contagious diseases
2) Asymmetric information: one market side knows more than the other e.g, doctor-patient and insurance-patient
3) Moral hazard: Patients adjust risky behavior because losses are bound by insurance.
what are deductibles?
A threshold after which insurance pays (instead of you), can be per year, per treatment,…
Define Co-pay
The percentage of costs you will have to pay . Often depends on care provider having agreement with insurer.
What is a coverage limit?
A maximum insurance company will pay. Can vary by treatment, year,..
Define Out pocket maximum
limit after which insurance company will pay, same as deductible
what are exclusions in the context of insurance?
treatments that are no covered
What is prior authorization?
the insurer allows treatment with specific care providers only
what are the types of coverage in the US?
1)Employer provided heath insurance: wages are taxed, health insurance premiums are not
2)Direct purchase
3) Medicare: For people over 65 and disabled people
4) Medicaid: Health care for the very poor.
5) TRICARE/CHAMPVAL: Military personnel
6) Uninsured: Pay medical providers directly as services are used
What is the affordable care act (ACA)?
- Guarantees access to insurance, removes pre-existing condition exclusions, bans health based pricing.
- Expands free or subsidized insurance for low income people.
- Tax penalty on those who do not get insurance.
What is a Preferred Provider Organization (PPO)?
- PPO sells health insurance at discount but restricts care providers to network.
- To be part of network, care providers have to lower costs by discount.
What is a Health Maintenance Organization (HMO)?
- HMOs may have their own doctors that deliver care.
- Often, registration with HMO’s GP and referral needed for treatment.
Dutch system is similar to HMO.
What do Clemens and Gottlieb (2014) try to find and what are the results they got?
They investigate whether physicians incentive influence health care supply, technology diffusion and resulting patient outcomes.
results: they found that areas with higher payment shocks experience significant increases in health care supply.
What do Finkletstein et al. (2012) test for and what are the results?
In 2008 a group of low income adults were selected to be given the chance to apply for Medicaid. They tested to gauge the effects of expanding access to public heath insurance on heath care use.
Results: The treatment group selected by the lottery was about 25 percentage points more like to have insurance than the control group that was not selected.
What question do Clemens and Gottlieb (2017) try to address and what are the results that they find?
they wanted to find out how physicians and insurers determine prices for medical services.
Question: Do price changes in Medicare affect private sector prices?
the test was carried out through variation in payment changes across geographies and variation in surgical vs non-surgical medical care.
Conclusions: Private insurers follow Medicare price changes closely. Makes it less likely that ‘Medicare for all’ will be more expensive than insurance through private markets.
