Download or read book Collective Risk Assessment in Affordable Care Act Markets written by Juan Ignacio de Oyarbide and published by . This book was released on 2020 with total page 67 pages. Available in PDF, EPUB and Kindle. Book excerpt: The changes that the Affordable Care Act introduced to the US health insurance market have entirely altered the traditional ratemaking process. Precisely, the creation of statewide community rating schemes and a guaranteed issue has facilitated insurance coverage to the high-risk population, leading to massive changes in risk pool compositions. The implementation of Risk Adjustment has neutralized some of the consequences of limiting premium variation in the market. However, setting appropriate rate levels has remained cumbersome due to the uncertainty about the statewide risk pool. Many insurers, who could not quantify the health risk associated with the statewide yearly enrollment, had to face unexpectedly high payments on risk equalization. Natsis (2019) stated that in this environment, the use of traditional univariate techniques to project statewide health care costs could be potentially misleading. This thesis proposes a Bayesian approach to reflect important sources of uncertainty over statewide actuarial estimates. The aggregate loss is modeled with a novel collective risk model based on a Generalized Beta Prime (GBP) distribution, accounting for long tail risks and changes in risk pool compositions. The GBP is presented with a mean-dispersion parametrization, which allows the introduction of a hierarchical prior specification over the state-specific means. This parameter structure, responsible of quantifying uncertainty and sharing information among states, is a cornerstone of the adopted collective risk model. Using the Commercial Health Care data extract published by the Society of Actuaries (2019), the model is applied on the Surgical and Transplant service category. The resulting heavy-tailed posteriors of the nationwide service means illustrate the high variation of inpatient medical costs. Moreover, the posteriors of the statewide aggregate claims remain highly right-skewed, reflecting the risk of facing sicker populations and high-cost treatments at individual claim level.
Download or read book The Affordable Care Act and Health Insurance Markets written by Christine Eibner and published by Rand Corporation. This book was released on 2013-08-29 with total page 117 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this report, the authors estimate the effects of the Affordable Care Act on health insurance enrollment and premiums for ten states (Florida, Kansas, Louisiana, Minnesota, New Mexico, North Dakota, Ohio, Pennsylvania, South Carolina, and Texas) and for the nation overall, with a focus on outcomes in the nongroup and small group markets.
Download or read book The Impacts of the Affordable Care Act on Preparedness Resources and Programs written by Institute of Medicine and published by . This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many of the elements of the Affordable Care Act (ACA) went into effect in 2014, and with the establishment of many new rules and regulations, there will continue to be significant changes to the United States health care system. It is not clear what impact these changes will have on medical and public health preparedness programs around the country. Although there has been tremendous progress since 2005 and Hurricane Katrina, there is still a long way to go to ensure the health security of the Country. There is a commonly held notion that preparedness is separate and distinct from everyday operations, and that it only affects emergency departments. But time and time again, catastrophic events challenge the entire health care system, from acute care and emergency medical services down to the public health and community clinic level, and the lack of preparedness of one part of the system places preventable stress on other components. The implementation of the ACA provides the opportunity to consider how to incorporate preparedness into all aspects of the health care system. The Impacts of the Affordable Care Act on Preparedness Resources and Programs is the summary of a workshop convened by the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events in November 2013 to discuss how changes to the health system as a result of the ACA might impact medical and public health preparedness programs across the nation. This report discusses challenges and benefits of the Affordable Care Act to disaster preparedness and response efforts around the country and considers how changes to payment and reimbursement models will present opportunities and challenges to strengthen disaster preparedness and response capacities.
Download or read book Employment and Health Benefits written by Institute of Medicine and published by National Academies Press. This book was released on 1993-02-01 with total page 381 pages. Available in PDF, EPUB and Kindle. Book excerpt: The United States is unique among economically advanced nations in its reliance on employers to provide health benefits voluntarily for workers and their families. Although it is well known that this system fails to reach millions of these individuals as well as others who have no connection to the work place, the system has other weaknesses. It also has many advantages. Because most proposals for health care reform assume some continued role for employers, this book makes an important contribution by describing the strength and limitations of the current system of employment-based health benefits. It provides the data and analysis needed to understand the historical, social, and economic dynamics that have shaped present-day arrangements and outlines what might be done to overcome some of the access, value, and equity problems associated with current employer, insurer, and government policies and practices. Health insurance terminology is often perplexing, and this volume defines essential concepts clearly and carefully. Using an array of primary sources, it provides a store of information on who is covered for what services at what costs, on how programs vary by employer size and industry, and on what governments doâ€"and do not doâ€"to oversee employment-based health programs. A case study adapted from real organizations' experiences illustrates some of the practical challenges in designing, managing, and revising benefit programs. The sometimes unintended and unwanted consequences of employer practices for workers and health care providers are explored. Understanding the concepts of risk, biased risk selection, and risk segmentation is fundamental to sound health care reform. This volume thoroughly examines these key concepts and how they complicate efforts to achieve efficiency and equity in health coverage and health care. With health care reform at the forefront of public attention, this volume will be important to policymakers and regulators, employee benefit managers and other executives, trade associations, and decisionmakers in the health insurance industry, as well as analysts, researchers, and students of health policy.
Download or read book Communities in Action written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-27 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Download or read book Pooling Health Insurance Risks written by Mark V. Pauly and published by American Enterprise Institute. This book was released on 1999 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt: Uncertainty about risks to health virtually requires that people have health insurance. But how is the cost of premiums determined? Should rates vary according to some indicators of risk? How much do premiums vary with risk? Do the young and the healthy actually subsidize the old and the unhealthy?
Download or read book Assessing Alternative Modifications to the Affordable Care Act written by Christine Eibner and published by Rand Corporation. This book was released on 2014-10-21 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report summarizes analysis in which the COMPARE microsimulation model was used to estimate how several potential changes to the Affordable Care Act, including eliminating the individual mandate and eliminating the law’s tax-credit subsidies, might affect 2015 individual market premiums and overall insurance coverage. The report also presents estimate how changes in young adult enrollment might affect 2015 individual market premiums.
Download or read book Managing Climate Risk in the U S Financial System written by Leonardo Martinez-Diaz and published by U.S. Commodity Futures Trading Commission . This book was released on 2020-09-09 with total page 196 pages. Available in PDF, EPUB and Kindle. Book excerpt: This publication serves as a roadmap for exploring and managing climate risk in the U.S. financial system. It is the first major climate publication by a U.S. financial regulator. The central message is that U.S. financial regulators must recognize that climate change poses serious emerging risks to the U.S. financial system, and they should move urgently and decisively to measure, understand, and address these risks. Achieving this goal calls for strengthening regulators’ capabilities, expertise, and data and tools to better monitor, analyze, and quantify climate risks. It calls for working closely with the private sector to ensure that financial institutions and market participants do the same. And it calls for policy and regulatory choices that are flexible, open-ended, and adaptable to new information about climate change and its risks, based on close and iterative dialogue with the private sector. At the same time, the financial community should not simply be reactive—it should provide solutions. Regulators should recognize that the financial system can itself be a catalyst for investments that accelerate economic resilience and the transition to a net-zero emissions economy. Financial innovations, in the form of new financial products, services, and technologies, can help the U.S. economy better manage climate risk and help channel more capital into technologies essential for the transition. https://doi.org/10.5281/zenodo.5247742
Download or read book Moral Hazard in Health Insurance written by Amy Finkelstein and published by Columbia University Press. This book was released on 2014-12-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: Addressing the challenge of covering heath care expenses—while minimizing economic risks. Moral hazard—the tendency to change behavior when the cost of that behavior will be borne by others—is a particularly tricky question when considering health care. Kenneth J. Arrow’s seminal 1963 paper on this topic (included in this volume) was one of the first to explore the implication of moral hazard for health care, and Amy Finkelstein—recognized as one of the world’s foremost experts on the topic—here examines this issue in the context of contemporary American health care policy. Drawing on research from both the original RAND Health Insurance Experiment and her own research, including a 2008 Health Insurance Experiment in Oregon, Finkelstein presents compelling evidence that health insurance does indeed affect medical spending and encourages policy solutions that acknowledge and account for this. The volume also features commentaries and insights from other renowned economists, including an introduction by Joseph P. Newhouse that provides context for the discussion, a commentary from Jonathan Gruber that considers provider-side moral hazard, and reflections from Joseph E. Stiglitz and Kenneth J. Arrow. “Reads like a fireside chat among a group of distinguished, articulate health economists.” —Choice
Download or read book Market Structure of the Health Insurance Industry written by D. Andrew Austin and published by DIANE Publishing. This book was released on 2010-04 with total page 65 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Benefits Coverage Under Federal Law written by and published by . This book was released on 2010 with total page 108 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Population Health Implications of the Affordable Care Act written by Institute of Medicine and published by National Academies Press. This book was released on 2014-03-20 with total page 99 pages. Available in PDF, EPUB and Kindle. Book excerpt: Population Health Implications of the Affordable Care Act is the summary of a workshop convened in June 2013 by the Institute of Medicine Roundtable on Population Health Improvement to explore the likely impact on population health improvement of various provisions within the Affordable Care Act (ACA). This public workshop featured presentations and discussion of the impact of various provisions in the ACA on population health improvement. Several provisions of the ACA offer an unprecedented opportunity to shift the focus of health experts, policy makers, and the public beyond health care delivery to the broader array of factors that play a role in shaping health outcomes. The shift includes a growing recognition that the health care delivery system is responsible for only a modest proportion of what makes and keeps Americans healthy and that health care providers and organizations could accept and embrace a richer role in communities, working in partnership with public health agencies, community-based organizations, schools, businesses, and many others to identify and solve the thorny problems that contribute to poor health. Population Health Implications of the Affordable Care Act looks beyond narrow interpretations of population as the group of patients covered by a health plan to consider a more expansive understanding of population, one focused on the distribution of health outcomes across all individuals living within a certain set of geopolitical boundaries. In establishing the National Prevention, Health Promotion, and Public Health Council, creating a fund for prevention and public health, and requiring nonprofit hospitals to transform their concept of community benefit, the ACA has expanded the arena for interventions to improve health beyond the "doctor's" office. Improving the health of the population - whether in a community or in the nation as a whole - requires acting to transform the places where people live, work, study, and play. This report examines the population health-oriented efforts of and interactions among public health agencies (state and local), communities, and health care delivery organizations that are beginning to facilitate such action.
Download or read book Assessing the Enabling Environment for Disaster Risk Financing written by Asian Development Bank and published by Asian Development Bank. This book was released on 2020-06-01 with total page 93 pages. Available in PDF, EPUB and Kindle. Book excerpt: Disasters damage and destroy infrastructure and disrupt economic activities and services, potentially delaying long-term development and hampering efforts to reduce poverty in the region. Countries require a strong enabling environment for disaster risk financing to ensure the timely availability of post-disaster funding. This report presents a comprehensive diagnostics tool kit that countries can apply to assess the financial management of disaster risk. The framework examines the state of the enabling environment and provides a basis to enhance financial resilience with insurance and other risk transfer instruments. It incorporates lessons from the country diagnostics assessments for Fiji, Nepal, Pakistan, and Sri Lanka that made use of the tool kit and methodology.
Download or read book Health Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Download or read book Model Rules of Professional Conduct written by American Bar Association. House of Delegates and published by American Bar Association. This book was released on 2007 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.
Download or read book Federal Register written by and published by . This book was released on 2013-10 with total page 292 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Affordable Care Act written by United States. Congress. Senate. Committee on Health, Education, Labor, and Pensions and published by . This book was released on 2013 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt:
