To gain insights into the impact of Medicaid Expansion under the Affordable Care Act, this study assesses the enrollment, utilization, and financial performance measures of California Medicaid focused health insurers. The study compares these quarterly measures, during the expansion period of 2014 to the same quarterly measures in 2013 and 2012. During 2014, Medicaid focused insurers expanded e...

ing from the likely increase in saving and wealth, the implications of growth in institutions, notably life insurers and pension funds, for financing patterns arise from differences in behaviour from the personal sector, which would otherwise hold assets directly. As we showed in Tables 7-9, portfolios of long-term institutions vary widely, but in most cases, they hold a greater proportion of c...

BACKGROUND With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be used to classify patients into dynamic long-term spending patterns. OBJECTIV...

2005 Hurricane Katrina: The extended flooding reminded insurers that storm surge is possibly the most serious threat posed by hurricanes both in terms of human life (WMO, 2007) and in terms of damages (Knutson, et al., 2010). Moreover, the important role engineering (levee design) plays in these situations was highlighted. Casinos floating on barges were swept inland by the surge. These aspects...

To achieve the aims of the Affordable Care Act, state and federal regulators must construct an effective system of risk adjustment, one that protects health insurers that attract a disproportionate share of patients with poor health risks. This brief, which summarizes a Commonwealth Fund–supported conference of leading risk adjustment experts, explores the challenges regulators will face, consi...

The health care industry cannot sidestep these changes. As a result, “pay-for-performance” initiatives by insurers and employers that offer some form of financial incentive to either physicians or hospitals for delivering the “right kind of care” are quickly spreading throughout the country. These initiatives, however, have not yet been applied to hospitals and physicians working together becau...

Health insurers face financial risks when they assume liability for the difference between difference between premium revenues and their estimates of future claims costs for a group. Market reform proposals vastly increase the amount of risk health plans of all types will face. A case study is used to show how insurers bidding in an alliance environment must either commit contingency reserves t...

s: This paper attempts to understand the outcomes when each party of the insurance contracts simultaneously has superior information to the other. We decompose the risk of a policyholder into a general risk and a specific risk. We assume that policyholders have superior information about specific risks while insurers have superior information about general risks. When each risk can be either hi...

These factors are important to consider when appraising the strength of research evidence. Although all studies have limitations, applied designs that address many of the factors described here can provide stronger evidence of the effectiveness of occupational therapy intervention. This appraisal process is critical not only to build the profession's body of evidence but also to ensure that our...