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Estimating The Impact Of The Medical Loss Ratio Rule
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Book Synopsis Estimating the Impact of the Medical Loss Ratio Rule by : Mark A. Hall
Download or read book Estimating the Impact of the Medical Loss Ratio Rule written by Mark A. Hall and published by . This book was released on 2012 with total page 13 pages. Available in PDF, EPUB and Kindle. Book excerpt: One of the most visible consumer protections in the Patient Protection and Affordable Care Act is the requirement that health insurers pay out at least 80 percent to 85 percent of premium dollars for medical care expenses. Insurers that pay out less than this minimum "medical loss ratio" (MLR) must rebate the difference to their policyholders, starting in 2011. Using insurers' MLR data from 2010, this issue brief estimates the rebates expected in each state if the new rules had been in effect a year earlier. Nationally, consumers would have received almost $2 billion of rebates if the new MLR rules had been in effect in 2010. Almost $1 billion would be in the individual market, where rebates would go to 5.3 million people nationally. Another $1 billion would go to policies covering about 10 million people in the small- and large-group markets.
Book Synopsis Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (ACA): Issues for Congress by : Suzanne M. Kirchhoff
Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act (ACA): Issues for Congress written by Suzanne M. Kirchhoff and published by Createspace Independent Pub. This book was released on 2012-10-20 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires certain health insurers to provide rebates to their customers for each year that the insurers do not meet a set financial target called a medical loss ratio (MLR). At its most basic, a MLR measures the share of a health care premium dollar spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if total premiums collected are $100,000, and $85,000 is spent on medical care, the MLR would be 85%. The ACA sets the minimum required MLR at 80% for the individual and small group markets and at 85% for the large group market. In general, the higher the MLR, the more value a policyholder receives for his or her premium payment. Congress imposed the MLR in an effort to provide “greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care.” Insurers that fail to meet these minimum standards must provide rebates to policyholders. The Department of Health and Human Services (HHS), with input from state insurance commissioners who are the main regulators of health insurance, issued rules for implementing the provisions. These rules provided greater details for calculating the MLR and issuing rebate payments. ACA allows companies to include quality improvements along with medical benefits when calculating the MLR. In addition, state and local taxes and some licensing fees are subtracted (i.e., disregarded) from expenses in the MLR formula. ACA's requirements are different from those imposed by state laws, which generally compare only medical claims to premiums. Though a number of states have their own MLRs, the ACA is now the minimum standard that must be met nationwide by certain health insurers. About 12.8 million U.S. consumers were due more than $1.1 billion in ACA MLR rebate payments in August 2012, for an average award of $151 per qualifying household. Employers or insurers can provide the rebates, which are based on activity in 2011, via a check, an electronic deposit in a bank account, a reduction in future insurance premiums in the amount of the rebate, or by spending the funds for the benefit of employees. About 66.7 million people were insured by covered companies that met or exceeded MLR standards for 2011, and will not receive rebates. The MLR is based on the aggregate performance of a health plan, not individual policy history. Even if a beneficiary had no medical claims during a given year, he or she would not receive a rebate if the broader plan met the MLR requirements. In addition, many Americans were enrolled in health plans that were not covered by the ACA MLR provisions in 2011. The ACA MLR provisions cover only fully funded health plans, which are plans where insurance companies assume the full risk for medical expenses incurred. The requirements do not extend to self-funded plans, which are health care plans offered by businesses in which the employer assumes the risk for, and pays for, medical care. Non-profit insurers and some Medicare Advantage plans were not covered by the ACA MLR standards in 2012, though the MLR provisions will be phased in during 2013 and 2014, respectively. In addition, some states won special exceptions for individual insurance policies, based on a HHS determination that meeting the MLR requirement would harm a state's insurance market. Several issues have been raised about the MLR provisions since the ACA was enacted. These include considerations regarding the treatment of insurance agent and broker bonuses and commissions, the impact of the MLR on insurers that provide high deductible plans, and special rules for non-profit health insurers.
Book Synopsis Care Without Coverage by : Institute of Medicine
Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Book Synopsis Measuring and Modeling Health Care Costs by : Ana Aizcorbe
Download or read book Measuring and Modeling Health Care Costs written by Ana Aizcorbe and published by University of Chicago Press. This book was released on 2018-03-05 with total page 535 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health care costs represent a nearly 18% of U.S. gross domestic product and 20% of government spending. While there is detailed information on where these health care dollars are spent, there is much less evidence on how this spending affects health. The research in Measuring and Modeling Health Care Costs seeks to connect our knowledge of expenditures with what we are able to measure of results, probing questions of methodology, changes in the pharmaceutical industry, and the shifting landscape of physician practice. The research in this volume investigates, for example, obesity’s effect on health care spending, the effect of generic pharmaceutical releases on the market, and the disparity between disease-based and population-based spending measures. This vast and varied volume applies a range of economic tools to the analysis of health care and health outcomes. Practical and descriptive, this new volume in the Studies in Income and Wealth series is full of insights relevant to health policy students and specialists alike.
Book Synopsis Moral Hazard in Health Insurance by : Amy Finkelstein
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
Book Synopsis Estimation of the Time Since Death by : Burkhard Madea
Download or read book Estimation of the Time Since Death written by Burkhard Madea and published by CRC Press. This book was released on 2015-09-08 with total page 292 pages. Available in PDF, EPUB and Kindle. Book excerpt: Estimation of the Time Since Death remains the foremost authoritative book on scientifically calculating the estimated time of death postmortem. Building on the success of previous editions which covered the early postmortem period, this new edition also covers the later postmortem period including putrefactive changes, entomology, and postmortem r
Book Synopsis Learning from SARS by : Institute of Medicine
Download or read book Learning from SARS written by Institute of Medicine and published by National Academies Press. This book was released on 2004-04-26 with total page 376 pages. Available in PDF, EPUB and Kindle. Book excerpt: The emergence of severe acute respiratory syndrome (SARS) in late 2002 and 2003 challenged the global public health community to confront a novel epidemic that spread rapidly from its origins in southern China until it had reached more than 25 other countries within a matter of months. In addition to the number of patients infected with the SARS virus, the disease had profound economic and political repercussions in many of the affected regions. Recent reports of isolated new SARS cases and a fear that the disease could reemerge and spread have put public health officials on high alert for any indications of possible new outbreaks. This report examines the response to SARS by public health systems in individual countries, the biology of the SARS coronavirus and related coronaviruses in animals, the economic and political fallout of the SARS epidemic, quarantine law and other public health measures that apply to combating infectious diseases, and the role of international organizations and scientific cooperation in halting the spread of SARS. The report provides an illuminating survey of findings from the epidemic, along with an assessment of what might be needed in order to contain any future outbreaks of SARS or other emerging infections.
Book Synopsis Technical Explanation, Estimated Revenue Effects, Distributional Analysis, and Macroeconomic Analysis of the Tax Reform Act of 2014, a Discussion Draft of the Chairman of the House Committee on Ways and Means to Reform the Internal Revenue Code by : United States. Congress. Joint Committee on Taxation
Download or read book Technical Explanation, Estimated Revenue Effects, Distributional Analysis, and Macroeconomic Analysis of the Tax Reform Act of 2014, a Discussion Draft of the Chairman of the House Committee on Ways and Means to Reform the Internal Revenue Code written by United States. Congress. Joint Committee on Taxation and published by . This book was released on 2014 with total page 708 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Health System Efficiency by : Jonathan Cylus
Download or read book Health System Efficiency written by Jonathan Cylus and published by Health Policy. This book was released on 2016-12-15 with total page 264 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this book the authors explore the state of the art on efficiency measurement in health systems and international experts offer insights into the pitfalls and potential associated with various measurement techniques. The authors show that: - The core idea of efficiency is easy to understand in principle - maximizing valued outputs relative to inputs, but is often difficult to make operational in real-life situations - There have been numerous advances in data collection and availability, as well as innovative methodological approaches that give valuable insights into how efficiently health care is delivered - Our simple analytical framework can facilitate the development and interpretation of efficiency indicators.
Book Synopsis Health Insurance and the Demand for Medical Care by : Willard G. Manning
Download or read book Health Insurance and the Demand for Medical Care written by Willard G. Manning and published by Rand Corporation. This book was released on 1988 with total page 99 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Supported by the U.S. Department of Health and Human Services."
Book Synopsis Coverage Matters by : Institute of Medicine
Download or read book Coverage Matters written by Institute of Medicine and published by National Academies Press. This book was released on 2001-10-27 with total page 204 pages. Available in PDF, EPUB and Kindle. Book excerpt: Roughly 40 million Americans have no health insurance, private or public, and the number has grown steadily over the past 25 years. Who are these children, women, and men, and why do they lack coverage for essential health care services? How does the system of insurance coverage in the U.S. operate, and where does it fail? The first of six Institute of Medicine reports that will examine in detail the consequences of having a large uninsured population, Coverage Matters: Insurance and Health Care, explores the myths and realities of who is uninsured, identifies social, economic, and policy factors that contribute to the situation, and describes the likelihood faced by members of various population groups of being uninsured. It serves as a guide to a broad range of issues related to the lack of insurance coverage in America and provides background data of use to policy makers and health services researchers.
Download or read book Studies in Income and Wealth written by and published by . This book was released on 1937 with total page 544 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Federal Register written by and published by . This book was released on 2013-02 with total page 388 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309439981 Total Pages :587 pages Book Rating :4.3/5 (94 download)
Book Synopsis Making Eye Health a Population Health Imperative by : National Academies of Sciences, Engineering, and Medicine
Download or read book Making Eye Health a Population Health Imperative written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-01-15 with total page 587 pages. Available in PDF, EPUB and Kindle. Book excerpt: The ability to see deeply affects how human beings perceive and interpret the world around them. For most people, eyesight is part of everyday communication, social activities, educational and professional pursuits, the care of others, and the maintenance of personal health, independence, and mobility. Functioning eyes and vision system can reduce an adult's risk of chronic health conditions, death, falls and injuries, social isolation, depression, and other psychological problems. In children, properly maintained eye and vision health contributes to a child's social development, academic achievement, and better health across the lifespan. The public generally recognizes its reliance on sight and fears its loss, but emphasis on eye and vision health, in general, has not been integrated into daily life to the same extent as other health promotion activities, such as teeth brushing; hand washing; physical and mental exercise; and various injury prevention behaviors. A larger population health approach is needed to engage a wide range of stakeholders in coordinated efforts that can sustain the scope of behavior change. The shaping of socioeconomic environments can eventually lead to new social norms that promote eye and vision health. Making Eye Health a Population Health Imperative: Vision for Tomorrow proposes a new population-centered framework to guide action and coordination among various, and sometimes competing, stakeholders in pursuit of improved eye and vision health and health equity in the United States. Building on the momentum of previous public health efforts, this report also introduces a model for action that highlights different levels of prevention activities across a range of stakeholders and provides specific examples of how population health strategies can be translated into cohesive areas for action at federal, state, and local levels.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309477891 Total Pages :399 pages Book Rating :4.3/5 (94 download)
Book Synopsis Crossing the Global Quality Chasm by : National Academies of Sciences, Engineering, and Medicine
Download or read book Crossing the Global Quality Chasm written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2019-01-27 with total page 399 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.
Book Synopsis Cost-Effectiveness in Health and Medicine by : Marthe R. Gold
Download or read book Cost-Effectiveness in Health and Medicine written by Marthe R. Gold and published by Oxford University Press. This book was released on 1996-07-18 with total page 462 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cost-effectiveness in health and medicine presents a consensus of experts on appropriate methods for standardizing the conduct of CEAs for use in policy arenas. Standardization is of particular importance for CEA, because it allows comparisons of the costs and health outcomes of alternative methods of improving health, such as public health programs and medical technologies. The book provides a detailed discussion of the theoretical background underlying areas of controversy, and uses theory to guide explicit recommendations for study conduct.
Author :United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health Publisher : ISBN 13 : Total Pages :144 pages Book Rating :4.:/5 (319 download)
Book Synopsis Cutting the Red Tape by : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health
Download or read book Cutting the Red Tape written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2012 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt:
