Premium Support Research Articles

Illinois Transplant Fund Experience: Is It a Pathway to Increased Transplant Access for Hispanic Patients With Kidney Failure?

The Illinois Transplant Fund, established in 2015, provides private health insurance premium support for noncitizen patients with kidney failure in Illinois and thus allows them to qualify for kidney transplants. Our objective was to describe trends in kidney transplant volumes over time to inform the development of a hypothesis regarding the impact of the Illinois Transplant Fund on kidney transplant volumes for adult Hispanic patients with kidney failure in Illinois, especially noncitizen patients. Retrospective study. We used data on the annual number of kidney transplants and kidney failure prevalence aggregated to the national and state levels from the Organ Procurement and Transplantation Network and United States Renal Data System, respectively. The annual number of transplants as a percentage of prevalent kidney failure cases among adults over time from 2010 to 2020 by race/ethnicity for all payer and private insurance-paid transplants and the annual number of transplants by citizenship status (for Hispanic patients only) were examined for the United States (US), Illinois, and 6 selected US states. Descriptive study. From pre- to post-Illinois Transplant Fund, the average annual number of transplants as a percentage of the average annual prevalent kidney failure cases for Hispanic adults increased by 4% in Illinois while the same figure increased by 33% for privately insured transplants. The observations reported in this paper cannot be interpreted as evidence for the program's impact. Observed trends suggest plausibility of developing a hypothesis that Illinois Transplant Fund's introduction may have contributed to improvement in kidney transplantation access for Hispanic patients in Illinois, especially noncitizens, but cannot constitute evidence in support of or against this hypothesis. Future research should test whether the Illinois Transplant Fund improved access to kidney transplants for noncitizens with kidney failure. Health policies regarding kidney transplant access for undocumented residents vary widely by state. The Illinois Transplant Fund (ITF) provides financial support for health insurance premiums, so undocumented patients with kidney failure in Illinois can qualify for a kidney transplant. In this study, we reported kidney transplant trends in Illinois before and after the creation of the ITF along with kidney transplant trends in the US overall and selected states that share similarities to Illinois.

The Effect of the Regional “Income Tax Withholding Allowance” and “Social Security Premium Support” Programmes on Labour Outcomes in Turkey

Abstract This paper examines the employment effects of the “Income tax withholding allowance” and “Social security premium support” programmes implemented in Turkey in 2012. The programmes aim to provide incentives to firms and generate employment opportunities for groups in targeted regions in the Eastern part of Turkey. The analysis relies on detailed micro-level data derived by the Household Labour Force Survey in 2008–2016. We apply the difference-in-differences (DID) method, and we use as treated subjects the respondents located in the regions affected by the policy. Moreover, we propose the propensity score matching approach within the DID framework to reduce the possible selection bias. The findings show a positive impact of the programme on employment, wages, the number of working hours and labour force participation, but we find a negative effect on the probability of being employed in a permanent job for the treated group.

An analysis on medical expenses of multidisciplinary cancer care under health insurance

Background: Cancer has been the leading cause of death in Korea for more than 40 years. As the aging population in the country increases, this trend is expected to continue. Cancer care is also being subdivided into specialties according to the development of medical technology. This division of care has made it difficult for a single physician to set up a complete cancer treatment plan. As a result, the call for multidisciplinary care has risen. Multidisciplinary cancer care allows physicians to share opinions and choose optimal patient treatment plans across multiple specialties. In August 2014, the Ministry of Health and Welfare designated a set number of approved multidisciplinary treatments and has included them under its health insurance coverage. As a result, multidisciplinary care is rapidly increasing.Current Concepts: An analysis on cancer care was conducted from 2014 to 2018, which examined the average medical expenses, hospitalization costs, and surgery costs per person according to therapeutic modality. Findings showed that multidisciplinary care decreased the overall cost of medical care in cancer patients compared to segmented care provided by single specialty physicians.Discussion and Conclusion: This study predicted that multidisciplinary care would be effective in reducing medical expenses. Cancer patients do not need to be treated by individual subspecialty physicians when personalized care treatment plans through a multidisciplinary approach is possible. The results of this study show that the Korean government should expand health insurance premium support and coverage for multidisciplinary cancer care.

Potential effects of market power in Hungarian solar boom

The Hungarian Government intends to increase the photovoltaic capacities installed in the country sixfold between 2020 and 2030. New investment is encouraged by a floating premium support system in which producers sell electricity on the market and can thus have a direct impact on prices. This article simulates hourly volumes and price data in a Cournot equilibrium model, taking into account the technical and economic characteristics of electricity producers. The model was calibrated with Hungarian data from 2019 and then a theoretical year of 2030 was simulated at different market concentrations. The results show that if prices are above premium levels, operators may reduce their production and thus increase prices as market concentration increases. This phenomenon could dampen the expected price reduction despite the increasing penetration of zero marginal cost solar capacities and threaten the country’s renewable production commitments for 2030. Below the premium level, the effect of market power does not prevail, and prices can nose-dive. In this case, renewable production targets are achieved, but the state’s premium subsidy payments are significantly increased. Sensitivity analysis shows that the amount of new photovoltaic capacities and increased electricity demand both increase the effects of market power.

Some Thoughts on Controlling Federal Spending

This paper is an overview of thoughts about controlling federal spending. At the outset, I note my concern that federal spending is too high and comes at the detriment of good incentives, productivity, and growth. I review the market-oriented economist’s view of the proper role of government and note that many government activities go well beyond them. “Doing something” about it is problematic due to the difficult politics of special interests and of reliance on government programs. In this light, I discuss four specifics. Regarding Social Security, I suggest moving it further toward a program for low-income seniors and allowing younger people outside options. For Medicare, I suggest moving to premium support and capping the real dollar value of government-paid premiums. This should be combined with encouraging competitive pricing of insurance plans for seniors well as for care. This avoids the harsh effects of “cost controls” through price controls and government care restrictions. Mean-tested programs should diminish with strong economic growth, though better targeting and effectiveness can reduce their burden. Finally, I offer hope that fiscal rules (e.g., debt brakes, base closing commissions) may arise to help reduce spending.

Analysis of canola (rapeseed) production cost and income in context of oilseeds production support policies: A case study from Trakya region of Turkey

The study aimed to analysis the cost and income of canola production in the context of support policies to oilseeds production in the Trakya region of Turkey. In this study, the average production costs of canola were calculated as 600.13 US$ ha-1. Gross profit and net profit excluding support payments were found as 515.98 and 310.32 US$ ha-1, respectively. It was determined that the gross profit and net profit including support payments were found to be 921.37 and 715.72 US$ ha-1. It was calculated that the share of supports is 44% in gross and 56.64% in net profits. The results indicated that the supports of diesel oil, fertilizer, certified seed usage and premium support have important increasing effects on farmer income and decreasing costs in canola production. As a result, it can be said that with the support policies applied in canola production, important increases have occurred in canola cultivation areas and production in Turkey. In order to have an efficient oilseed support policy, farmer’s extension service should develop various programs regarding sustainable canola production practices to educate farmers.

How Different Payment Models Support (or Undermine) a Sustainable Health Care System: Rating the Underlying Incentives and Building a Better Model

Summary There are many layers of payment in the health care system as a whole. The most salient nexus for creating the right incentives for utilization of care — and therefore the part of the system most in need of reform — is how funds flow from insurers to the organizations that deliver care. From the perspective of health care economics, the authors review the evidence around three leading payment models and rate each on criteria desirable to providers, payers, and patients. They recommend a better population-based payment model that applies to the Medicare accountable care organization program: provider premium support.

Economic Principles for Medicare Reform

In this article, we develop an economic framework for Medicare reform that highlights trade-offs that reform proposals should grapple with, but often ignore. Central to our argument is a tension in administratively set prices, which may improve short-term efficiency but do so at the expense of dynamic efficiency (slowing innovations in new treatments). The smaller the Medicare program is relative to the commercial market, the less important this is; but in a world where there are no market prices or the private sector is very small, the task of setting prices that are dynamically correct becomes more complex. Reforming Medicare should focus on greater incentives to increase competition between Medicare Advantage plans, which necessitates a role for government in ensuring competition; premium support; less use of regulated prices; and less appetite for countless “pay for performance” schemes. We apply this framework to evaluate Medicare for All proposals.

Financing Medicare Into The Future: Premium Support Fails The Risk-Bearing Test.

One often-discussed option for controlling Medicare spending is to switch to a premium-support design. This would shift part of the risk of future health care cost increases from the federal treasury to Medicare beneficiaries. The economics of risk bearing suggests that this would be a mistake for three reasons. First, political decisions, not beneficiary choices, are the critical determinants of future health care costs. Second, only Congress can take into account the consequences of cost-containment decisions for both current and future generations. Third, the federal government is best able to diversify against the risk of future cost growth. Tying Medicare spending to the government's budget so that Congress sees the benefits of tough cost containment choices is the only way to force the program to make those politically difficult decisions. Economic efficiency is served by retaining the program's current structure instead of shifting risk to beneficiaries.

Farm Sizes Impacted by a $40,000 Crop Insurance Premium Support Limit

Farm Sizes Impacted by a $40,000 Crop Insurance Premium Support Limit

Family support and gains in school readiness: A longitudinal study.

Traditional measures of school readiness are labour-intensive and do not assess family support. The current study used the newly developed Brief Early Skills and Support Index (BESSI: Hughes, Daly, Foley, White and Devine 2015) to examine 6-month longitudinal stability and change in teachers' ratings of young children's school readiness and investigate the role of family support as a predictor of school readiness. Five hundred and seventy-eight children (270 boys; 74.2% White British) were included at Time 1 aged 2.58-5.84years (Mage =3.98years, SD=0.66). Teachers and nursery workers completed BESSI questionnaires for each participant on two occasions separated by 6months. The four latent factors of the BESSI (i.e., Behavioural Adjustment, Language and Cognition, Daily Living Skills and Family Support) exhibited longitudinal measurement invariance and individual differences in ratings on each factor showed strong stability over time. BESSI ratings were also sensitive to improvements over time. Auto-regressive models showed that family support and family income (as measured by eligibility for pupil premium support) at Time 1 each uniquely predicted child outcomes at Time 2. These findings highlight the importance of family contexts for children's school readiness.

Physician Reimbursement in Medicare Advantage Compared With Traditional Medicare and Commercial Health Insurance

Nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, yet little is known about the prices that MA plans pay for physician services. Medicare Advantage insurers typically also sell commercial plans, and the extent to which MA physician reimbursement reflects traditional Medicare (TM) rates vs negotiated commercial prices is unclear. To compare prices paid for physician and other health care services in MA, traditional Medicare, and commercial plans. Retrospective analysis of claims data evaluating MA prices paid to physicians and for laboratory services and durable medical equipment between 2007 and 2012 in 348 US core-based statistical areas. The study population included all MA and commercial enrollees with a large national health insurer operating in both markets, as well as a 20% sample of TM beneficiaries. Enrollment in an MA plan. Mean reimbursement paid to physicians, laboratories, and durable medical equipment suppliers for MA and commercial enrollees relative to TM rates for 11 Healthcare Common Procedure Coding Systems (HCPCS) codes spanning 7 sites of care. The sample consisted of 144 million claims. Physician reimbursement in MA was more strongly tied to TM rates than commercial prices, although MA plans tended to pay physicians less than TM. For a mid-level office visit with an established patient (Current Procedural Terminology [CPT] code 99213), the mean MA price was 96.9% (95% CI, 96.7%-97.2%) of TM. Across the common physician services we evaluated, mean MA reimbursement ranged from 91.3% of TM for cataract removal in an ambulatory surgery center (CPT 66984; 95% CI, 90.7%-91.9%) to 102.3% of TM for complex evaluation and management of a patient in the emergency department (CPT 99285; 95% CI, 102.1%-102.6%). However, for laboratory services and durable medical equipment, where commercial prices are lower than TM rates, MA plans take advantage of these lower commercial prices, ranging from 67.4% for a walker (HCPCS code E0143; 95% CI, 66.3%-68.5%) to 75.8% for a complete blood cell count (CPT 85025; 95% CI, 75.0%-76.6%). Traditional Medicare's administratively set rates act as a strong anchor for physician reimbursement in the MA market, although MA plans succeed in negotiating lower prices for other health care services for which TM overpays. Reforms that transition the Medicare program toward some premium support models could substantially affect how physicians and other clinicians are paid.

Could Improving Choice and Competition in Medicare Advantage be the Future of Medicare?

About 30 percent of Medicare beneficiaries enroll in private Medicare Advantage (MA) plans but do so at a relatively high-cost. This paper explores the advantages and challenges of introducing competitive bidding among MA plans (Plan One) or among MA plans and Fee-for-Service (Plan Two or Premium Support). We conclude that competitive bidding could reduce the cost of Medicare, especially in densely populated urban areas. However, there would be serious challenges in rural areas and risk adjustment methodology would have to be substantially improved. In Plan Two, sicker beneficiaries might move to Fee-for-Service and beneficiaries might have to pay more to stay with a preferred provider or broader network. If these problems are addressed, we believe that premium support can be a meaningful improvement to the MA program.

Variations In County-Level Costs Between Traditional Medicare And Medicare Advantage Have Implications For Premium Support

Concern about the future growth of Medicare spending has led some in Congress and elsewhere to promote converting Medicare to a "premium support" system. Under premium support, Medicare would provide a "defined contribution" to each Medicare beneficiary to purchase either a Medicare Advantage (MA)-type private health plan or the traditional Medicare public plan. To better understand the implications of such a shift, we compared the average costs per beneficiary of providing Medicare benefits at the county level for traditional Medicare and four types of MA plans. We found that the relative costs of Medicare Advantage and traditional Medicare varied greatly by MA plan type and by geographic location. The costs of health maintenance organization-type plans averaged 7percent less than those of traditional Medicare, but the costs of the more loosely structured preferred provider organization and private fee-for-service plans averaged 12-18percent more than those of traditional Medicare. In some counties MA plan costs averaged 28percent less than costs in traditional Medicare, while in other counties MA plan costs averaged 26percent more than traditional Medicare costs. Enactment of a Medicare premium-support proposal could trigger cost increases for beneficiaries participating in Medicare Advantage as well as those in traditional Medicare.

Mistaken for Dead: The Affordable Care Act and the Continued Resilience of Medicare Advantage

AbstractIn 2009, Medicare Advantage became a prime target in the Obama Administration’s efforts to pay for the Affordable Care Act (ACA). After securing substantial cuts to a program the President described as a failure, the Obama administration was compelled to take unprecedented administrative steps to put billions of dollars back into Medicare Advantage. These developments demonstrate how Medicare Advantage’s support constituency, which has come to include Democrats, Republicans, beneficiaries, and the managed care industry, has maintained more political influence in the aftermath of the ACA than some initially believed. The continued and growing influence of the Medicare Advantage constituency does not, however, mean that Medicare is primed for a more conservative turn toward vouchers or premium support. With the provision of generous benefits and increasing evidence that Medicare Advantage produces higher quality health outcomes than traditional Medicare, Medicare Advantage appears to be secure in its current form.

Supporting Insurance in European Agriculture: Experience of Mutuals in the Netherlands

SummaryThe Common Agricultural Policy currently allows the support of agricultural insurance, with a particular focus on mutuals. This article analyses the experience of mutuals in the Netherlands over the past 20 years. A total of nine mutuals are reviewed, some operating on a purely private basis, others receiving some form of public support. Results illustrate that mutuals are well equipped to insure risks that are uninsurable in the commercial market. This is especially true for animal and crop disease risks. Mutuals are furthermore able to fulfil the EU conditions for receiving premium support hence opening up the opportunity for farmers to insure against multi‐peril weather risks. Experience has however demonstrated that mutuals are not always successful, even with substantial public support. Lack of members caused several mutuals to be discontinued only a few years after their foundation. In order to secure the benefits of mutuals, it is shown that there is a need to carefully balance size of risk, affordability of premiums, financial robustness and solidarity. These issues are even more important in the case of mutuals providing income stabilisation tools as these have the added responsibility of data and (classified) market information management.

Three Large-Scale Changes To The Medicare Program Could Curb Its Costs But Also Reduce Enrollment

With Medicare spending projected to increase to 24 percent of all federal spending and to equal 6 percent of the gross domestic product by 2037, policy makers are again considering ways to curb the program's spending growth. We used a microsimulation approach to estimate three scenarios: imposing a means-tested premium for Part A hospital insurance, introducing a premium support credit to purchase health insurance, and increasing the eligibility age to sixty-seven. We found that the scenarios would lead to reductions in cumulative Medicare spending in 2012-36 of 2.4-24.0 percent. However, the scenarios also would increase out-of-pocket spending for enrollees and, in some cases, cause millions of seniors not to enroll in the program and to be left without coverage. To achieve substantial cost savings without causing substantial lack of coverage among seniors, policy makers should consider benefit changes in combination with other options, such as some of those now being contemplated by the Obama administration and Congress.

English

Sunflower takes an important place in terms of raw materials provided for the oil industry and of added value, as well as bring-in income for producers in Turkey’s economy. Sunflower is an important source of income by standing the main product in alternation of the wheat in the sense of manufacturers in Thrace Region which constitutes the European part of Turkey. In this study, the effect of premium support application on sunflower cultivation area and production amount in Thrace where approximately 65% of sunflower production in Turkey is met and also the effect of support payments on producer income are investigated. In this study, it is concluded that premium supports are inefficient in increasing sunflower cultivation area and production whereas it is concluded that it has an important role on producer income and on the determination of the market price. In fact, from a survey that was carried out, it emerges that the area-based support (diesel oil, fertilizer etc. support) together with premium support increase the revenue of sunflower up to 27.74% per area unit and the gross profit in proportion to 98.87%. This study indicates that in order to increase the sunflower production in Turkey the amounts of sunflower premium support, diesel oil and fertilizer should be rearranged in compliance with current market conditions. Moreover, as well as for other agricultural products, the use of certified seed should also be included into agricultural support programmes, production on well irrigated areas should be widened and the use of oil crops varieties with high oil ratio should be extended.   Key words: Oil crops, sunflower, agricultural subsidy, agricultural income, gross profit.

Organizing Your Clinical Service Line: Colon Cancer Prevention

P Purchasers of health care are slowly shifting from a defined benefit to a defined contribution infrastructure. Examples include accountable care organizations, premium support, and state block grants to name a few. Concomitantly, reimbursement for specific medical services is moving from a volume-based to a value-based model. Both trends will force gastroenterologists to restructure their practices so they deliver care through clinical service lines (CSLs). In the second of two articles about CSLs, we describe the fundamentals of a colon cancer prevention program. Last month, Dr Sunanda Kane described a CSL for inflammatory bowel disease. These are significant steps along the roadmap to the future of gastroenterology practice.

Farm-level crop yield distribution estimated from country-level crop damage

Abstract Commercial yield insurances are not available for Finnish farmers. However, local legislation and the Common Agricultural Policy (CAP) in the EU are moving towards commercial yield insurances. The crop damage compensation (CDC) programme implemented in Finland will expire within a few years and CAP rules suggest premium support of up to 65% for commercial yield insurances. Regardless of these major changes, Finnish insurance companies have not yet shown great interest in supplying insurance schemes. We strongly believe that this is due to uncertainty over the yields to be insured. Asymmetric information is a well-established phenomenon in the insurance industry. In yield insurances, it results from farmers having better knowledge of their yields than insurance companies. This paper estimates the unknown and latent farm-level crop yield distribution that is consistent with the indemnity frequency realized under the CDC programme implemented in Finland. The frequency of granted indemnity payments r...