Premium Plans Research Articles

Reducing social security contribution rate on the financial performance of state-owned and non-state-owned manufacturing industries in the post-epidemic era.

Social insurance is an essential component of a contemporary social security system since it protects people's fundamental well-being, but it also incurs a heavy cost for businesses. If social security costs are excessively high, business profitability will suffer, and innovation will be discouraged. The most affected companies would be those in labor-intensive industries and medium-sized enterprises. Chinese businesses have suffered severe losses as a result of the COVID-19 outbreak. Given the circumstance, China enacted additional tax cuts and preferential social insurance premium plans. This article suggests a lower ratio of contribution as a strategy to cut the cost of social insurance premiums for businesses, given the growth of the social security fund in recent years and the proportion of participants to recipients in pension funds. It would be possible to increase firm profitability and lessen the impact of COVID-19 on industries by minimizing this operation burden. In order to compare the financial performance of state-owned manufacturers (SOMs) to that of their non-state-owned peers, who have a lower ratio of contribution, this study uses a multiple regression model. The ratio of contributions was inversely correlated with an enterprise's financial performance. In other words, financial performance will improve as the ratio of contribution lowers; nevertheless, this effect is more pronounced in SOMs. The final section of this study proposed optimized approaches for social insurance premiums reform.

GIBLIB (4.0).

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Association of Medicare Advantage Premiums With Measures of Quality and Patient Experience

Quality of care varies substantially across Medicare Advantage plans. The price information that Medicare Advantage enrollees are most likely to consider when selecting a Medicare Advantage plan is the monthly premium. Enrollees may select plans to minimize premium or, alternatively, use premium as a proxy for quality and select plans with higher premiums; however, quality implications of these choices are unknown. To determine the extent to which the quality of care offered by Medicare Advantage plans varies within vs across premium levels. This was a retrospective cross-sectional study of the population enrolled in Medicare Advantage plans in 2016 to 2017 using clinical quality measures from the Healthcare Effectiveness Data and Information Set (HEDIS), patient experience measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, and administrative data. Data were analyzed from March 2021 to March 2022. Medicare Advantage monthly premium. Ten publicly reported 2017 HEDIS measures and 5 publicly reported 2017 CAHPS measures linearly transformed to a 0 to 100 scale. The 168 968 Medicare Advantage CAHPS respondents were representative of the enrollee population (14% were <65 years old and eligible through disability; 24% ≥80 years old; sex and race/ethnicity data were not considered); 40% were in 591 plans with no monthly premiums and less than 6% were in 144 plans with monthly premiums of $120 or more. There were from 77 054 to 2 139 422 enrollees by HEDIS measure. Among all Medicare Advantage enrollees, 79% were in plans with either a $0 premium or a low monthly premium (≤$60); patient experience and clinical quality were generally similar in these 2 categories of plans. To a small extent, enrollees in moderately high ($60-$120) and high (≥$120) premium plans reported better patient experience (+1.4 [95% CI, 0.7-2.1] and 2.2 [95% CI, 1.5-2.9] points) and received better clinical care (1.4 [95% CI, 0.3-2.5] to 3.3 [5% CI, 2.1-4.5] percentage points on most measures than those with $0 and low-premium plans. Quality differences within each premium level category were substantial; the within-premium category plan-level SDs were 6.5 points and 7.2 percentage points for patient experience and clinical quality, respectively. A plan at the 50th percentile of clinical quality and patient experience in the high premium category would fall in the 65th and 62nd percentile within the $0-premium category, respectively. This population-based cross-sectional study found that although quality of care and patient experience were slightly higher with higher-premium plans, quality varied widely within each premium category. High-quality care and patient experience were found in each price category. Thus, paying higher premiums is not necessary for higher quality care in Medicare Advantage plans. Greater engagement of enrollees and advocates with quality of care and patient experience information for Medicare Advantage plan selection is recommended.

Screening with Under-Utilization: Tiers, Add-ons, and Multi-Part Tariffs

We study a screening model in which agents can under-utilize goods. We characterize implementable and optimal contracts and show that, whenever the principal values usage instrumentally, the optimal menu involves multi-part tariffs with tiers of zero marginal prices. We apply our results to study the pricing of digital goods which naturally feature usage-based revenue and unpunishable under-utilization, such as social media, news, and content streaming. We derive comparative statics that map the structure of usage-based revenues to familiar multi-part pricing schemes (premium plans, free trials, and free products) and study the welfare implications of technological progress in targeted advertising. We show how partial contractibility of usage generates an endogenous separation between users and employees of digital platforms.

Terminating Cost-Sharing Reduction Subsidy Payments: The Impact Of Marketplace Zero-Dollar Premium Plans On Enrollment.

The termination of cost-sharing reduction subsidy payments to insurers in 2017 by the administration of President Donald Trump resulted in a proliferation of Marketplace plans having zero-dollar premiums in 2018 and 2019. While it is known that lower premiums increase Marketplace enrollment, it is not clear whether a zero-price effect exists in which enrollment spikes when health insurance is free. We examined whether such an effect exists and found that increased availability of zero-dollar premium plans would have caused a 14.1percent enrollment increase among lower-income Marketplace enrollees in 2019. If zero-dollar premium plans had not been available in 2019, our simulation results suggest that enrollment in the federally facilitated Marketplace would have decreased by roughly 200,000 enrollees. When we accounted for this zero-price effect, we found that variation in premiums above zero dollars was not associated with enrollment changes. These results suggest that efforts to insure lower-income populations should focus on making health insurance free to potential enrollees, instead of simply reducing premiums. However, increased enrollment in zero-dollar premium plans could result in increased cost sharing among Marketplace enrollees and increased federal outlays for Advance Premium Tax Credits.

Predictors of Customer’s Subscriptions to Movie and Sport Packages

Subscription-based television services providers, which operate in a highly competitive industry with high saturation, are finding it exceedingly difficult to grow their customer base. The ability to identify customers with a higher possibility of subscribing to the premium plans, is undoubtedly critical to increasing future sales. In that vein, we seek to identify predictors to premium packages selection behavior by jointly modeling customer subscriptions of premium movie, premium sport and basic sport packages. We show that, the customer subscriptions of different TV packages can be highly correlated. Moreover, our model profiles likely subscribers to premium movie, premium sport and basic sport packages using both subscriber demographic and lifestyle information.

Pharmacy Benefit Manager Profitability and Valuation: Business Models Matter

The purpose of this paper is to present the case that the difference in profitability between Wellpoint’s PBM business and other PBM operations stems more from differences in business models than from differences in the efficiency of operations. And Express Scripts is paying a premium for Wellpoint’s business on the expectation that it will be able to convert (“decapitate”) some of Wellpoint’s fixed premium and ASO plans to more profitable benefits reseller plans.

152 Applying Network Adequacy Standards to Emergency Medicine

The Affordable Care Act authorized the U.S. Department of Health and Human Services (HHS) to regulate qualified health plans’ (QHPs) network adequacy. QHPs must include a sufficient number and type of physicians within their provider network to deliver contracted benefits and services. HHS determines adequacy by applying a “reasonable access” standard using provider network data reported by QHPs. While the regulations apply to all specialties, emergency medicine (EM) is clinically and operationally unique due to emergency physicians’ distinct billing and employment practices. Although many emergency physicians employed by large urban hospitals are paid rates negotiated between the hospital and insurers, approximately 65% of hospitals staff their emergency departments with independently contracted emergency physicians, many of whom do not negotiate with insurers. We investigated whether applying the reasonable access standard to in-network emergency physicians provides sufficient information for determining network adequacy. We hypothesized that roughly 10% of plans would lack in-network emergency physicians. We examined Silver QHPs offered in the 34 states in the Marketplace in 2015. An estimated 65% of participants select Silver Plans. In each state, we sampled four plans available in the insurance rating area containing the most populous county: the lowest, second-lowest, median, and highest premium plans. Premium pricing information was obtained using publicly available QHP Marketplace data from the Center for Medicare and Medicaid Services. Using each QHP’s publicly available provider directory, we identified the number of in-network emergency physicians within 100 miles of the primary ZIP code for the rating area’s most populous city. If a directory’s maximum search radius was less than 100 miles, we selected the broadest search radius available. We applied this same methodology to identify in-network hospitals within the same search radius. Data were summarized using descriptive statistics. Among the 136 QHPs analyzed, the total number of identifiable in-network emergency physicians ranged from 0 to 840 (median: 28). We identified 30 plans (22%) with networks completely lacking emergency physician coverage. The number of in-network hospitals ranged from 0 to 500 (median: 28). Five plans (3.7%) lacked hospital coverage. Three plans (2.2%) covered emergency physicians but did not cover a hospital. Two plans (1.5%) lacked both in-network emergency physician and hospital coverage. Information regarding whether emergency physicians were hospital employees or independent contractors was not available. Our findings raise serious questions about the application of the network adequacy framework to EM. One-in-five plans lacked identifiable in-network emergency physicians, a situation that does not meet the reasonable access standard. The same is true of hospital coverage. There is a broad range of in-network coverage of both emergency physicians and hospitals. While some health plans cover a large number of in-network emergency physicians and hospitals, others lack coverage of both. The opaque nature of physician-hospital contracts and billing obscures the ability to identify whether an in-network hospital employs out-of-network emergency physicians, or vice-versa. In light of these obstacles, regulators seeking to determine emergency physician network adequacy will require additional information beyond that presently requested of QHPs.

Quality Ratings and Premiums in the Medicare Advantage Market

We examine the response of Medicare Advantage contracts to published quality ratings. We identify the effect of star ratings on premiums using a regression discontinuity design that exploits plausibly random variation around rating thresholds. We find that 3, 3.5, and 4-star contracts in 2009 significantly increased their 2010 monthly premiums by $20 or more relative to contracts just below the respective threshold values. High quality contracts also disproportionately dropped $0 premium plans or expanded their offering of positive premium plans. Welfare results suggest that the estimated premium increases reduced consumer welfare by over $250 million among the affected beneficiaries.

Pupil premium plans

Following the announcement that children will be assessed against a baseline upon entry to reception, we are now digesting plans to introduce the pupil premium in the early years, to address disadvantage.

U.S. Broadcaster Plans for Provision of ATSC Mobile DTV

As the U.S. broadcast industry gears up to provide the Advanced Television Systems Committee (ATSC) Mobile DTV service to consumers throughout 2010, this paper describes the technical parameters of that service. It includes basic consumer use cases and system requirements necessary to implement Mobile DTV. Services envisioned range from basic linear simulcast to interactive and location-based services, with a variety of premium and advertising-supported subscription plans. The primary value proposition for Mobile DTV is live transmission of content identical to local television stations transmitted in full-motion digital format to a variety of consumer devices. This summarizes expected broadcaster launch plans, future use cases envisioned by broadcasters, and station requirements to realize those plans.

The Express Scripts - Wellpoint Deal: A 'Double Trouble' Front

The purpose of this paper is present a more detailed view of the likely structure of Express Scripts' 10 year purchase of Wellpoint's pharmacy benefit manager book of business. It is based on quantitative estimates of (1) the proportion of Wellpoint’s business represented by fixed premium plans; (2) the premium Express Scripts is paying for this business; and (3) the relative efficiencies of both parties in managing the SG&A costs of the business.We will present the case that the two parties have chosen to structure the deal as a “double fronting arrangement” because it solves the dilemma of how to capture Express Scripts’ strength as a PBM specialist and plan converter while holding on to Wellpoint’s status as an insurance underwriter and the more efficient SG&A manager.But, the complexity of this arrangement will cause problems for Express Scripts. In the short term, Express Scripts will face regulatory scrutiny concerning its status as a “risk-bearing entity” despite Wellpoint being the nominal underwriter of fixed premium plans. Also, it is likely that Express Scripts will retain Wellpoint as routine manager of SG&A and this arrangement will cause ongoing and long term tension between the two parties over who is managing what and how.

Employee Choice of Flexible Spending Account Participation and Health Plan

Despite the fact that flexible spending accounts (FSAs) are becoming an increasingly popular employer-provided health benefit, there has been very little empirical study of FSA use among employees at the individual level. This study contributes to the literature on FSAs through the use of a unique dataset that provides three years of employee-level matched benefits data. Motivated by the theoretical model of FSA choice presented in Cardon and Showalter (2001), we examine the determinants of FSA participation and contribution levels using cross sectional and random effect two part models. FSA participation and health plan choice are also modeled jointly in each year using conditional logit models. We find that, even after controlling for a number of other demographic characteristics, non-whites are less likely to participate in the FSA program, have lower contributions conditional on participation, and have a lower probability of switching to new lower cost share, higher premium plans when they were introduced. We also find evidence that choosing health plans with more expected out-of-pocket expenses is correlated with use of the FSA program.

Employee choice of flexible spending account participation and health plan

Despite the fact that flexible spending accounts (FSAs) are becoming an increasingly popular employer-provided health benefit, there has been very little empirical study of FSA use among employees at the individual level. This study contributes to the literature on FSAs using a unique data set that provides three years of employee-level-matched benefits data. Motivated by the theoretical model of FSA choice presented in Cardon and Showalter (J. Health Econ. 2001; 20(6):935-954), we examine the determinants of FSA participation and contribution levels using cross-sectional and random-effect two-part models. FSA participation and health plan choice are also modeled jointly in each year using conditional logit models. We find that, even after controlling for a number of other demographic characteristics, non-whites are less likely to participate in the FSA program, have lower contributions conditional on participation, and have a lower probability of switching to new lower cost share, higher premium plans when they were introduced. We also find evidence that choosing health plans with more expected out-of-pocket expenses is correlated with participation in the FSA program.

Optimal Premium Plans for Reinsurance with Reinstatements

The present paper is concerned with optimal premium plans for a reinsurance contract with reinstatements. In the reinsurance contract considered here, constant reinstatement premiums are due when the reinsurer’s loss exceeds certain bounds. For this reinsurance contract we examine the existence of a premium plan which minimizes the expected squared difference between the loss and the total premium income of the reinsurer. We show that an optimal premium plan exists, that it is unique, and that it satisfies the net premium principle.

Optimal Premium Plans for Reinsurance with Reinstatements

The present paper is concerned with optimal premium plans for a reinsurance contract with reinstatements. In the reinsurance contract considered here, constant reinstatement premiums are due when the reinsurer’s loss exceeds certain bounds. For this reinsurance contract we examine the existence of a premium plan which minimizes the expected squared difference between the loss and the total premium income of the reinsurer. We show that an optimal premium plan exists, that it is unique, and that it satisfies the net premium principle.

Payment policy and inefficient benefits in the Medicare+Choice program.

We investigated whether constraints on premium rebates by health plans in the Medicare+Choice program result in inefficient benefits. Since relationships between revenue and benefits could be confounded by unobserved variation in the cost of coverage, we took advantage of natural experiment that occurred following passage of the Benefits Improvement and Protection Act of 2000. Our findings indicate that benefits in zero premium plans were more sensitive to changes in payment rates than were benefits in plans that charged nonzero premiums. These results strongly suggest that current Medicare policy induces plans to offer benefits that are not valued by enrollees at or above their cost.

Credibility premium plans which make allowance for bonus hunger

Abstract By “bonus-hunger” is meant the tendency of an experience rated policy holder to self-insure small damages in order to avoid an increase in future premium costs. The aim of this paper is to demonstrate, within the framework of a simple model, how fair experience rating plans can be constructed when the policy-holders hunger for bonus. In the first three sections some basic concepts of credibility theory are introduced, and specific assumptions are made concerning the risk process and the bonus-hunger strategy of the policy holders. In section 4 a credibility formula is derived which is optimal (in the sense of least squares) when the bonus-hunger strategy is independent of the premium system. In section 5 credibility formulas are derived in cases when the bonushunger strategy depends on the premium system, and a numerical example is given. The practical applicability of the results is discussed in section 6.