In the absence of a perfect risk adjustment scheme, cost sharing can reduce risk selection in community-rated health insurance markets. However, cost sharing also reduces incentives for efficiency. In this paper, we develop a model in which insurers determine the cost efficiency of health care. They have incentives for risk selection because there are two risk types which differ in their expect...

OBJECTIVE We sought to assess the relationship between patient cost sharing; medication adherence; and clinical, utilization, and economic outcomes. METHODOLOGY We conducted a literature review of articles and abstracts published from January 1974 to May 2008. Articles were identified using PubMed, Ovid, medline, Web of Science, and Google Scholar databases. The following terms were used in t...

OBJECTIVES This study aims to compare the organisation of primary care (PC) systems in Estonia, Latvia and Lithuania, focusing on the structure and process of service delivery, and to discuss the suitability of the PHAMEU instrument for international comparison of PC systems. METHODS The data were collected in the framework of PHAMEU project during 2009-2010. The selected indicators were used...

OBJECTIVE To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes. METHODS Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from...

Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. Existing plans have been structured in a variety of ways, and these variations could influence the effectiveness of VBID plans. We evaluated seventy-six plans introduced by a large pharmacy benefit manager during 2007-10. We found that after we adjusted for the other features and baseline ...

OBJECTIVE To calculate the abandonment rate of oral oncolytic medications and identify factors that may affect likelihood of abandonment. STUDY DESIGN Cross-sectional cohort study using administrative claims data. METHODS We analyzed a nationally representative pharmacy claims database and identified 10,508 patients with Medicare and commercial insurance for whom oral oncolytic therapy was ...

Rural-urban differences in the supply of nursing home services are hypothesized to be jointly affected by competitive and regulatory forces, government pohcies, and the cost structure. Study findings indicate that rural services are slightly less accessible and lower in quality. A translog cost share function reveals no difference in the operating cost structure of rural and urban homes. Cost s...

Common sense suggests that networks are not random mazes of purposeless connections, but that these connections are organized so that networks can perform their functions well. One function common to many networks is targeted transport or navigation. Here, using game theory, we show that minimalistic networks designed to maximize the navigation efficiency at minimal cost share basic structural ...

BACKGROUND Rates of nonadherence to aromatase inhibitors (AIs) among Medicare beneficiaries with hormone receptor-positive early breast cancer are high. Out-of-pocket drug costs appear to be an important contributor to this and may be addressed by eliminating copayments and other forms of patient cost sharing. The authors estimated the incremental cost-effectiveness of providing Medicare benefi...