JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. University of Wisconsin Press andThe Board of Regents of the University of Wisconsin System are collaborating with JSTOR to digitize, preserve and extend access to The Journal of Human Resources. ABSTRACTWe estimate the demand for health plans by employees in 17 Minneapolis firms. The data set has approximately 900 employees who chose a single-coverage health plan and 2,100 employees who chose family coverage. A nested logit model is empirically shown to be the right approach for modeling health plan choice, with freedom to choose your own doctor being the variable that distinguishes health plan nests. Our estimates show that employees are very sensitive to the out-of-pocket premium for each plan, controlling for other plan characteristics. These results are important both for public policy and for employers who offer multiple health plans. I. IntroductionEmployment-based health insurance is the dominant method of financing health care in the United States, with recent estimates indicating that two-thirds of the nonelderly population is covered by a health plan related to the employment of a family member. Many retired workers are also covered through health insurance policies related to their former employment. This content downloaded from 169.229.32.137 on Thu, 8 May 2014 22:41:11 PM All use subject to JSTOR Terms and Conditions The Journal of Human ResourcesWith health care prices continuing to rise faster than the general rate of inflation, it is not surprising that employers have experienced large increases in their health insurance costs. The percent of gross payroll spent for health insurance increased by as much as 50 percent from 1976 to 1983. Employers are taking steps to bring these cost increases under control. Many are increasing the employees' level of cost-sharing for health plan premiums.Employment-based health insurance has not escaped the attention of public policy analysts, some of whom have made it a central feature of "competitive" health care proposals. These proposals would encourage or require employers to offer a choice of health care plans, with the employer's contribution fixed at a level less than or equal to the premium of the lowest-cost plan. Implicit in the competitive proposals is the assumption that employees choose their health plan based, at least in part, on the premium cost that they pay out of their own pocket. However, surprisingly few studies have attempted to estimate the sensitivity of health plan choice to out-ofpocket premium differences. A close examination of these studies shows them to be flawed in various degrees. The purpose of this study is to present methodologically sound and policy-relevant estimates of the demand for employme...

We compared the stage at which cancer is diagnosed and survival rates between African Americans and whites, for thirty-four solid tumors, using the population-based Surveillance Epidemiology and End Results (SEER) database. Whites were diagnosed at earlier stages than African Americans for thirty-one of the thirty-four tumor sites. Whites were significantly more likely than blacks to survive five years for twenty-six tumor sites; no cancer site had significantly superior survival among African Americans. These differences cannot be explained by screening behavior or risk factors; they point instead to the need for broad-based strategies to remedy racial inequality in cancer survival.

Antitrust advocates believe that horizontal consolidation in hospital markets can reduce competition and increase prices while merger advocates believe it can benefit consumers by reducing service duplication. This study analyzed the market conditions, operating characteristics, and costs and prices of approximately 3500 short-term general hospitals (including 112 within-market-area mergers) from 1986 to 1994 to investigate the effects of market concentration, hospital mergers, and managed care penetration. The results show: a shift away from non-price competition toward price competition in health care markets; that this shift was fueled by increased market penetration by price-sensitive buyers; that horizontal hospital mergers produced average cost savings of approximately 5%, which were generally passed on to consumers as lower prices; that cost savings were generally greater for mergers of similar-size hospitals, with a higher degree of duplicative services, and with lower pre-merger occupancy rates; and some evidence that post-merger price reductions were smaller in less-competitive markets.Hospital Mergers, Antitrust, Competition, Market Concentration, Economies Of Scale,

Plan characteristics significantly impact beneficiaries' decisions to enroll in Medicare M+C plans and individuals sort themselves systematically into plans based on individual characteristics.

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Objective. To compare medical care costs and utilization in a consumer-driven health plan (CDHP) to other health insurance plans. Study Design. We examine claims and employee demographic data from one large employer that adopted a CDHP in 2001. A quasi-experimental pre-post design is used to assign employees to three cohorts: (1) enrolled in a health maintenance organization Principal Findings. By 2002, the CDHP cohort experienced lower total expenditures than the PPO cohort but higher expenditures than the HMO cohort. Physician visits and pharmaceutical use and costs were lower in the CDHP cohort compared to the other groups. Hospital costs and admission rates for CDHP enrollees, as well as total physician expenditures, were significantly higher than for enrollees in the HMO and PPO plans.Conclusions. An early evaluation of CDHP expenditures and utilization reveals that the new health plan is a viable alternative to existing health plan designs. Enrollees in the CDHP have lower total expenditures than PPO enrollees, but higher utilization of resource-intensive hospital admissions after an initially favorable selection.Key Words. Health insurance, consumer-driven health plans, administrative data, managed careConsumer-driven health plans (CDHPs) have moved beyond the concept stage and are now health benefit options available to employees in many large companies. Mainstream insurers, such as Aetna, UnitedHealth Group, and Wellpoint have introduced their own CDHPs to compete with products offered by start-up companies such as Definity, Luminos, and others. Health policy analysts have expressed concerns that CDHPs could create adverse selection problems and have unintended impacts on service use. These concerns are motivated by analyses of plan designs and philosophical beliefs, 1189 but have been largely uninformed by empirical research. In this research project, we used a claims dataset to compare the medical service use and expenditures of employees who were enrolled in a CDHP in 2001 and 2002 to employees enrolled in a health maintenance organization (HMO) and a preferred provider organization (PPO). Our analysis addressed the following questions:1. What was the impact of the CDHP on payments to providers (i.e., total expenses)? 2. What was the impact of the CDHP on employee out-of-pocket expenses for medical care? 3. Was service use different for CDHP enrollees compared with enrollees in the other health plans? 4. Was the illness burden different in the CDHP versus other plans, and how did it change over time? 5. Were the CDHP effects different in the first year of enrollment, compared with the second year? BACKGROUND

General medical patients from an east London teaching hospital were recruited into intervention and comparison groups. Those recruited into the intervention group were given a copy of a letter listing their drugs prescribed at discharge and asked to give it to their regular community pharmacist when they went to obtain their prescribed drugs following hospital discharge. A comparison group returned home without a letter for their community pharmacist. Recruited patients were visited in their own homes once their community supply of drugs had been obtained. The frequency of all discrepancies between the prescribed drugs were compared for both groups. A consensus panel judged the importance of the discrepancies observed. The numbers deemed as clinically significant were compared for both groups, as the effect of the intervention. The 501 patients followed up (264 in the intervention group and 237 in the comparison group) were prescribed 2,736 drugs. The number of unintentional discrepancies observed was lower for the intervention group (32.2 per cent, 454/1,408) than for the : omparison group (52.7 per cent, 700/1,328) (chi-squared 117.38, P

Only the highest-volume hospitals showed an inpatient mortality benefit for Medicare patients with intertrochanteric hip fractures. Unlike the situation with elective arthroplasty procedures, our findings do not indicate a need to direct patients with routine hip fractures exclusively to high-volume centers, although the higher mortality rates found in the lowest-volume hospitals warrant further investigation.