PURPOSE Low- and middle-income countries are increasingly pursuing health financing reforms aimed at achieving universal health coverage. As these countries rapidly expand access to care, overburdened health systems may fail to deliver high-quality care, resulting in poor health outcomes. Public insurers responsible for financing coverage expansions have the financial leverage to influence the ...

CONTEXT There is concern in both the medical community and the general public about mechanisms of medical decision making and the interplay of physician and insurer decisions in determining access to care. OBJECTIVE To examine the medical process influencing access to growth hormone (GH) therapy for childhood short stature by comparing coverage policies of US insurers with the treatment recom...

This paper explores the efficiency of UK specialist and composite insurers transacting general insurance business. The concept of efficiency concerns an insurer’s ability to produce a given set of outputs (such as premiums and investment income) via the use of inputs such as administrative and sales staff and financial capital. An insurer is said to be technically efficient if it cannot reduce ...

In this study we investigate the function of risk management in financial institutions‟ investment decisions in asset-backed securities (ABS) prior to the 2008 financial crisis, and the interaction of this function with financial regulations. We employ U.S. insurance companies as a laboratory, which provides detailed security-level information on ABS investment. We find that strong risk managem...

Few oncologic entities are more deserving of national scrutiny than low-risk prostate cancer. Prostate cancer is among the top 5 most costly cancers, with $11.9 billion spent annually in the United States (1). Recent publications have drawn attention to financially driven practices and questionable referral patterns (2, 3). The Congressional Budget Office estimates that half the increase in hea...

We develop the first integrated analytical framework to study contract and pricing strategies in the pharmaceutical industry. We demonstrate how this framework can be used to analyze optimal contract and pricing decisions for insurers and manufacturers, including recent pricing practices such as manufacturer’s coupons and risk-sharing contracts. We discuss the implications of these decisions fo...