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INQUIRY: the journal of health care organization, provision, and financing, latest issue

Topics include private health plans' entry into the Medicare market, maternity length-of-stay mandates, insurance for low-income adults without children, and the relationship between cost and hospital quality


ROCHESTER, NY (05/22/2012)(readMedia)-- INQUIRY journal Spring 2012 issue summaries:

The Effects of Market Structure and Payment Rate on the Entry of Private Health Plans into the Medicare Market by Austin B. Frakt, Steven D. Pizer, and Roger Feldman – This study examined firm-level entry models for the three main types of Medicare private health plans: coordinated care plans (CCPs) such as health maintenance organizations; private fee-for-service plans (PFFPs); and prescriptions drug plans (PDPs). Findings show that entry barriers -- for instance, the establishment of exclusive provider networks -- associated with CCP market concentration affect all three product types. Results indicate competition among products and suggest that cost and demand factors make market entry of certain product combinations more likely. The authors predict that the Affordable Care Act's proposed payment reductions for Medicare Advantage plans will decrease the presence of CCPs and PFFS plans and increase entry by PDPs. This is the first study to look at the effects of market structure across multiple products and to assess entry behavior from the firm's perspective.

The Impact of Maternity Length-of-Stay Mandates on the Labor Market and Insurance Coverage by Lindsay M. Sabik and Miriam J. Laugesen – This study found that state legislation mandating minimum maternity lengths of stay affected employer-sponsored health insurance coverage and possibly wages of employees at small firms, though it did not have a statistically significant impact on labor market outcomes overall among employees at firms of all size firms. At the smallest firms in states with the mandates, employees experienced a 6.2-percentage-point decline in the likelihood of having employer-sponsored insurance. The authors say the findings illustrate the need to consider how minimum benefit standards required under the health reform law will affect firms of different sizes.

Public and Private Health Insurance Premiums: How Do They Affect the Health Insurance Status of Low-Income Childless Adults? by Gery P. Guy Jr., E. Kathleen Adams, and Adam Atherly – Low-income childless adults are among the most likely Americans to be without health insurance. Using data from the 2000-2008 Current Population Survey, this analysis found higher public insurance premiums to be associated with a decreased probability of having public insurance and a greater likelihood of being uninsured, while higher private premiums were associated with a decreased probability of having private insurance. Eligibility for premium assistance programs and increased subsidies were associated with reduced probability of being uninsured. Though the magnitude of the effects were modest, the results are relevant to insurance expansions for childless adults under the Affordable Care Act.

The Relationship of Hospital Quality and Cost Per Case in Hawaii by Jack Ashby, Deborah Taira Juarez, John Berthiaume, Paul Sibley, and Richard S. Chung – This study found that low-cost hospitals in Hawaii had the highest quality, but the worst readmission performance. Results suggest that quality improvement was associated with a reduced rate of growth in costs, though the findings were not statistically significant. The authors concluded that, at least in Hawaii, high-quality hospital inpatient care does not have to cost more; however, the dynamics of the readmission rate differ substantially from other quality dimensions.

Dialogue: Compensation for Nonprofit Health Care Board Members: The Right Path or a Minefield? In this feature, health care executives candidly discuss the issues surrounding compensation for board members of nonprofit health care organizations. The panelists for this discussion were: Kenneth Ackerman, chairman of Integrated Healthcare Strategies in Minneapolis, Minn.; Douglas Clark, retired president and CEO of Excela Health (Pennsylvania); Michael Cascone, retired president and CEO of Blue Cross Blue Shield of Florida; and William Kreykes, former board chair of the Trinity Health System (Michigan) and retired president and CEO of the Lifespan Health System (Rhode Island). Bruce McPherson, president and CEO of the Alliance for Advancing Nonprofit Health Care in Washington, D.C., moderated the discussion.

The View from Here: Good News and Not-So-Good News by Alan C. Monheit – In this column, INQUIRY's editor delves beneath the surface of the so-called "good" news about the labor market and the slowdown in health care spending to point out the reality of serious economic problems.

INQUIRY, the journal of health care organization, provision, and financing, is in its 49th year. The nonprofit Excellus Health Plan, Inc., publishes INQUIRY; the journal maintains a freelance editorial staff and is run as an independent, peer-reviewed, quarterly academic journal. Press releases and article abstracts are available on the INQUIRY website at www.inquiryjournal.org under "Current Issue Table of Contents."

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