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The Impact of Supplemental Private Health Insurance on Health-Related Behaviours
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Author: Ekaterina Aleksandrova, National Research U. Higher School of Economics
Author: Christopher Gerry, U. of Oxford
Author: Andrey Aistov, National Research U. Higher School of Economics
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This paper contributes to the discussion around ex-post (increased utilisation of health care) and ex-ante (changes in health behaviours) moral hazard in voluntary, supplemental private health insurance. Applying a novel fixed effects ordered choice methodology on data from the Russian Longitudinal Monitoring Survey – Higher School of Economics we compare the impact of workplace provided and individually purchased supplemental health insurance on the utilisation of health care, on a range of health behaviours and on self-assessed health. We find compelling evidence of ex-post moral hazard that confirms a theoretical predication and empirical regularity found in other settings. In contrast to other empirical findings though, our data reveals evidence of ex-ante moral hazard demonstrated by clear behavioural differences between those with self-funded supplemental health insurance and those for whom the workplace finances the additional insurance. We find no evidence that either form of insurance is related to improved self-assessed health.
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Paper is No Longer Available Online: Please contact the author(s).
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Decisive impulses: The effects of incentives on the adoption of personal health records
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Author: Marie Gabel, WWU Münster
Author: Stephan Nüesch, Westfälische Wilhelms-U. Münster
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Advances in digital health are crucial to meet the increasing demands for medical care of an aging population. Personal electronic health records (PHRs) have the potential to push the digitization of health care and increase its overall efficiency. Despite unequivocal benefits for individuals, healthcare professionals, governments, insurers, and employers, the adoption rate of PHRs is still low. Therefore, our study seeks to identify measures that motivate individuals to adopt PHRs. Drawing on justice theory, we argue that incentives in terms of financial compensation and personalization, as well as the signal of fair information practices, increase the adoption rate of PHRs. To test our theorizing, we conducted a field experiment in cooperation with a PHR platform provider. Our findings suggest that personalization incentives and fair information practices increase the adoption rate of PHRs, while the effect of financial incentives is not significant.
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Paper is No Longer Available Online: Please contact the author(s).
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Hospital Performance in the First Six Years of Medicare's Value Based Purchasing Program
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Author: Nathan Carroll, U. of Alabama, Birmingham
Author: Jan Clement, Virginia Commonwealth U.
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The Medicare Value Based Purchasing (VBP) program, ongoing since 2013, uses the promise of financial bonuses and penalties to incentivize hospital quality improvements. Although previous research, primarily from the early years of the program, has identified characteristics of hospitals likely to receive penalties, prior research has not examined characteristics associated with improvements in VBP program performance over time. We examine this question by defining four different trajectories of program performance (improvement, decline, consistent good or poor performance). We find that 11% of hospitals were penalized every year of the program while 24% of hospitals were able to improve their performance during the course of the VBP program. Logistic regression showed not-for-profit hospitals have higher odds of being in the improving group (relative to the poor performing group), as do hospitals in counties with more primary care physicians. Factors including safety-net status, bed size and case mix index are associated with lower odds of being in the improving group. Participation in an ACO was associated with higher odds of being an improving hospital. Finally, we find some evidence that changes in VBP program metrics may have contributed to improvement in some hospitals’ VBP program scores.
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Paper is No Longer Available Online: Please contact the author(s).
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Personal Budget Schemes and Deinstitutionalization:Systematic Review on Changes in Care Organization
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Author: Eva Lilie Josephine Pattyn, U. of Ghent
Author: Amber Werbrouck, U. of Ghent
Author: Paul Gemmel, Ghent U.
Author: Jeroen Trybou, Ghent U.
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Deinstitutionalization and the provision of community care are rising policy goals, because user organizations advocate to have more control of their care arrangements and to have the possibility to choose support services as they prefer. Several high income countries therefore have introduced personal budget schemes, which enable care users to choose and organize their support arrangements as preferred. This review examines if personal budget schemes lead to a higher uptake of informal, respite, and home care and the deinstitutionalization of support services. Ten databases comprising medical, nursing and social science journals, were searched in October 2018 resulting in 4301 articles. 17 articles were retained after screening title, abstract and full-text. No clear answer can be given if personal budget schemes cause a higher uptake of informal, respite or home care. Influenced by other factors, the choosing process leads to a mix of possibilities regarding the uptake of community care. However, we can, with caution, state that it does lead to a reduction in the use of residential facilities. To conclude, more research on the service use by personal budget holders and the influencing factors on these choices is needed.
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Paper is No Longer Available Online: Please contact the author(s).
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