Findings From the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey

Presents findings on the growth of account-based and high-deductible health plans, the health status and demographic profiles of enrollees, and the health plans' impact on consumer behavior, based on an online survey of privately insured adults

Private Health Plans Under the ACA: In Brief

[Excerpt] The Patient Protection and Affordable Care Act (ACA, P.L. 111-148), as amended, expands federal private health insurance market requirements, and requires the creation of health insurance exchanges (marketplaces) to provide certain individuals and small employers access to private insurance, among other provisions. While some of ACA’s private insurance provisions have already become effective, full implementation begins in 2014 and beyond. Given the breadth of ACA’s reforms to the existing private insurance market and creation of new health insurance marketplaces, there is interest in understanding what types of health plans may be offered once these ACA provisions are fully implemented. This report provides short descriptions of health plans that may be offered inside and outside of exchanges, and includes information about interaction with other selected ACA provisions. The descriptions are displayed in a side-by-side format to facilitate comparison of exchange and non- exchange plans. This report does not attempt to identify all forms of health insurance coverage, but does address all plan types specified under ACA’s exchange provisions, as well as major medical plans and certain limited benefit plans offered outside of exchanges. In addition, this report indicates the applicability of ACA’s market reforms to plans offered in the private market

Integrated health and care systems in England : can they help prevent disease?

Objectives: Over the past 12 months, there has been increasing policy rhetoric regarding the role of the NHS in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change. Methods: We reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health. Results: The evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health. Conclusions: For ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants

Are We Heading Toward Socialized Medicine?

Defines socialized medicine, examines claims that the State Children's Health Insurance Plan and Democratic presidential candidates' reform plans would lead to government-run health care, and compares the plans with Republicans' market-oriented proposals

Health plan pricing behaviour and managed competition

In the Dutch social health insurance scheme, health plans operate in a managed competition framework. Essential features of this framework are risk adjustment, open enrolment and community rating. The objective is to study how health plans determine their community rated premiums. Using a panel data set for all health plans operating in the Dutch social health insurance market over the period 1996-2004, we estimate a premium model to determine which factors explain the price setting behaviour of health plans. Our empirical results indicate that competition did not play a major role in premium setting by health plans. We find that financial stability rather than profit maximisation offers the best explanation for health plan pricing behaviour. The forecast of next year's health-care expenditure by the government and the adjusted forecast by the insurers' association play a major role in health plans' pricing decisions. The introduction of a national health insurance scheme in 2006 urged all citizens to reconsider their health plan choice. The threat of losing customers had a profound impact on health plans' pricing behaviour. In sharp contrast to the period 1996-2005, in 2006 competition seems to play a dominant role in insurers' pricing decisions. Whether this will be a temporary or a lasting phenomenon is hard to predict.

Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act (ACA)

[Excerpt] The private health insurance provisions in the Patient Protection and Affordable Care Act (P.L. 111-148, ACA, as amended) include market reforms that impose requirements on private health insurance plans. Such reforms relate to the offer, issuance, generosity, and pricing of health plans, among other requirements. This report provides background information about the private health insurance market, including market segments and regulation. It describes each ACA market reform and notes any major implementation activity that has occurred (e.g., issuance of final rule from a department such as Health and Human Services). The appendices of the report provide additional information about the status of regulations relating to each reform and how the reforms apply to the different market segments and health plans

Maternity Care and Consumer-Driven Health Plans

Compares out-of-pocket costs of maternity care under consumer-driven health plans (CDHP) to a traditional health insurance plan. Explores related factors including prenatal care coverage and unpredictability of costs for delivery and hospital stays

Federal Standardized Health Insurance Plans Could Improve Access to Care without Raising Premiums

Health insurance companies should offer plans on the Affordable Care Act marketplaces that cover the cost of basic outpatient care—like primary care, specialty care, and prescription drugs—before people pay off their deductible. The new federal standardized silver plans, released by the Department of Health and Human Services (HHS) earlier this year, will do just that. New, original research shows that federal standardized plans are a good deal for consumers who need a plan that covers basic health care services before they meet their deductible. Our report found that:The federal standardized silver plans would have premiums that are comparable to current silver marketplace plans that cover little to no services before the deductible.Offering these standardized plans could improve access to outpatient care without driving up premiums.Families USA produced the report with Milliman, an independent actuarial firm. Families USA believes that insurers in all 34 states with federally facilitated marketplaces should offer these plans in 2017 so that consumers in these states have access to these plan options. In 2018 and future years, we urge the federal government to require insurers in these states to offer the federal standardized plans

Animal Health Plans for Organic Livestock Farms

The new UKROFS Standards require organic farmers to prepare an animal or livestock health plan. This should aim to be prevent disease by means of suitable breeds, good husbandry, quality feed, regular exercise and access to pasture and appropriate stocking densities. This article gives an introduction to the process and explains the help that is available

Aggregating Physician Performance Data Across Health Plans

Describes the Data Aggregation Pilot, a portal designed to aggregate provider performance data from various health plans to ensure valid and reliable measurement; physician feedback on the aggregated reports; and next steps