Health insurers often tie payments to providers' quality of care. Although payers do this to elicit more effort from providers, some providers may game the system by avoiding patients who would cause their quality scores to fall. We use annual variation in the criteria for Medicare's Quality...

Long waiting lines are a common feature and a major concern in many public health care delivery systems. The waiting lines are often characterized as inefficient, because they are a burden to patients without generating any gains for providers. There is an ongoing debate in Germany regarding the...

This paper examines the determinants of hospital stay intensity, the decision to seek hospital care as a public or private patient and the decision to purchase private hospital insurance. We describe a theoretical model to motivate the simultaneous nature of these decisions. For the empirical...

This paper analyzes the potential unintended consequences and incentive effects of the Affordable Care Act's minimum medical loss ratio (MLR) regulations, which are designed to guarantee that a specific percentage of health insurance premiums are spent on medical care and activities that improve...

Medicare pricing is known to indirectly influence provider prices and care provision for non-Medicare patients; however, Medicare's regulatory externalities are less well-understood. We study such implications by examining how physicians' outpatient surgery setting preferences respond to the...

The Affordable Care Act included a provision to eliminate the Medicare prescription drug coverage gap. The policy was phased in by gradually diminishing the gap each year between 2011-2020. This provides a natural experiment to conduct an in-depth study of how the policy affected medication use,...

Despite promises that Medicare would not interfere with patients' ability to choose their physician and to purchase additional health coverage on the open market, over the decades Medicare rules and regulations have gradually eroded senior citizens' ability to control their healthcare choices....

In this paper, we explore the effects of primary care physician (PCP) practice competition on five distinct quality metrics directly tied to screening, follow-up care, and prescribing behavior under Medicare Part B. Controlling for physician, practice, and area characteristics as well as zip...

The recent final rule on Medicaid managed care establishes the minimum medical loss ratio (MLR) requirement for Medicaid managed care and contains several provisions to strengthen delivery and payment reforms and improve efficiency and quality of care. Accordingly, this research examines the...

The paper explores the role that Social Health Insurance (SHI), as an organisational mechanism for raising and pooling additional funds, can play in financing health services in India. It formulates an SHI concept and its aims for India and examines case studies of different countries that have...