ABSTRACT One of the key terms in contracts between hospitals and insurers is how the parties apportion the financial risk of treating unexpectedly costly patients. "Prospective" payment contracts give hospitals a lump-sum amount, depending on the medical condition of the patient, with limited adjustment for the level of services provided. We use data from the Medicare Prospective Payment System an...
By: Carolyn Johnson While politicians have been embroiled in a fiery debate over President Obama's signature health-care law, a quiet but profound shift is fundamentally reshaping how health insurance works for the roughly 155 million Americans who receive coverage through their employers. A national survey of employer health benefits released Wednesday shows how much deductibles — the healt...
By: Dan Mangan Your less expensive health insurance plan could cost you — even if you use less health care. People in so-called consumer-driven health plans tend to use fewer medical services than people with other types of coverage, a new study finds. But they also tend to spend substantially more out of their own pocket at the same time, both in dollar terms and as a share of their overall healt...
ABSTRACT Importance: Most states have passed insurance mandates requiring commercial health plans to cover services for children with autism spectrum disorder (ASD). Insurers have expressed concerns that these mandates will increase the number of children diagnosed with ASD (treated prevalence) and therefore increase costs associated with their care. To our knowledge, no published studies have add...
This data brief examines the health care use and spending from 2010-2014 for people who are enrolled in consumer-driven health plans (CDHPs), and compares these trends to non-CDHP enrollees. Findings indicate that although fewer total dollars were spent on health care for CDHP enrollees, they had higher per capita out-of-pocket spending on deductibles, copays, and coinsurance. Downloa...
