what is a dominated plan?
One that ends up costing the employer more in all fields (so higher premium, higher ded., etc) - people
make choices that may seem insensible, but its bc they are just misinformed
Who are the providers of health care?
Private health insurers (ESHI), federal government (Medicare/Medicaid), state government
(Medicaid/other)
What are some factors that go into program design?
Status quo bias (changing defaults, but using active choice)
loss framing/endowment effect - people feel losses more than gains
mental accounting: makes benefits more visible ($165 hotel room, but $10 gym and $20 spa, vs $195
hotel room, free gym and spa)
What dramatically increases participation (Dr. Volvo lecture)
Automatic enrollment: opt-out plans vs. opt-in plans
Talk about the research evidence for opt-out being successful in terms of colon cancer screenings
Mail fecal occult blood test information for color cancer screening - if you just didn't say 'no,' you were
still sent mail. great outcomes
Explain end of life care experiment
already implementing a default option for patients end of life care (a box was already pre-checked in
light grey in a form, but Pt could override).
Findings: the default option is HUGELY influential`, and only 2/93 people wanted to switch
issue of antibiotics, and how studies aimed to overcome it?
Antibiotics were being heavily overprescribed
1) compared unnecessary prescribing between clinicians —> comparing performance to essentially
evoke a competition aspect (worked)
2) forcing clinicians to give a reason why they prescribed - holds them accountable (worked)
3) suggest alternatives (no significant difference for improvement)
What percentage of people get their insurance through employers?
55%
What is TRICARE?
, Insurance for military members and families
Explain the 2 varieties of employee sponsored health insurance:
1) fully insured: employer pays premium to insurer which pays for claims from pool of premiums
collected from those it insures (like doctors/hospitals paid by HI company) - insurer takes the risk and
charges money to take it on - only ~35% do this plan
**state governed
2) self insured/funded: 65% employer assumes the risk. Everything for the employee looks the same, but
employer pays all claims. Employer pays an administrative service company a fee to manage their
program
*federal law exempts self-funded plans from most state insurance laws (including reserve requirements,
mandated benefits, premium taxes)
**federal governed
Downsides to ESHI
selects out low-income and sicker populations
How was ESHI established? What historical event did they draw from?
WWII — soldiers were offered health benefits instead of wages — drew from that idea that "company"
provides health insurance
what are the impacts of firm size?
1) risk! — if an employee gets sick in a small firm, it will take more of a toll ($); if a large firm, you have
enough resources to minimize the effect
2) under the ACA, firms > 50 employees MUST offer HI
what is the standard enrollment health plan
PPO
True or false: small firms have less generous coverage across ALL plan types
True
What is the hybrid-like option for EHSI?
Level funded:
- technically self-funded, but with extensive stoploss coverage (mitigates risk from catastrophic claims)
- oftentimes small firms like this because they want self-funded benefits (If sold to employer with < 50
employees, they won't be subject to ACA's rating and benefit standards)
- employer makes a set "level" monthly payment to administrator (kinda like a premium)
- administrator uses this $ to fund a reserve acc for claims, admin costs, stoploss coverage premiums
- not subject to state insurance regulations
- big jump in popularity these days (explain the adverse selection implication)
One that ends up costing the employer more in all fields (so higher premium, higher ded., etc) - people
make choices that may seem insensible, but its bc they are just misinformed
Who are the providers of health care?
Private health insurers (ESHI), federal government (Medicare/Medicaid), state government
(Medicaid/other)
What are some factors that go into program design?
Status quo bias (changing defaults, but using active choice)
loss framing/endowment effect - people feel losses more than gains
mental accounting: makes benefits more visible ($165 hotel room, but $10 gym and $20 spa, vs $195
hotel room, free gym and spa)
What dramatically increases participation (Dr. Volvo lecture)
Automatic enrollment: opt-out plans vs. opt-in plans
Talk about the research evidence for opt-out being successful in terms of colon cancer screenings
Mail fecal occult blood test information for color cancer screening - if you just didn't say 'no,' you were
still sent mail. great outcomes
Explain end of life care experiment
already implementing a default option for patients end of life care (a box was already pre-checked in
light grey in a form, but Pt could override).
Findings: the default option is HUGELY influential`, and only 2/93 people wanted to switch
issue of antibiotics, and how studies aimed to overcome it?
Antibiotics were being heavily overprescribed
1) compared unnecessary prescribing between clinicians —> comparing performance to essentially
evoke a competition aspect (worked)
2) forcing clinicians to give a reason why they prescribed - holds them accountable (worked)
3) suggest alternatives (no significant difference for improvement)
What percentage of people get their insurance through employers?
55%
What is TRICARE?
, Insurance for military members and families
Explain the 2 varieties of employee sponsored health insurance:
1) fully insured: employer pays premium to insurer which pays for claims from pool of premiums
collected from those it insures (like doctors/hospitals paid by HI company) - insurer takes the risk and
charges money to take it on - only ~35% do this plan
**state governed
2) self insured/funded: 65% employer assumes the risk. Everything for the employee looks the same, but
employer pays all claims. Employer pays an administrative service company a fee to manage their
program
*federal law exempts self-funded plans from most state insurance laws (including reserve requirements,
mandated benefits, premium taxes)
**federal governed
Downsides to ESHI
selects out low-income and sicker populations
How was ESHI established? What historical event did they draw from?
WWII — soldiers were offered health benefits instead of wages — drew from that idea that "company"
provides health insurance
what are the impacts of firm size?
1) risk! — if an employee gets sick in a small firm, it will take more of a toll ($); if a large firm, you have
enough resources to minimize the effect
2) under the ACA, firms > 50 employees MUST offer HI
what is the standard enrollment health plan
PPO
True or false: small firms have less generous coverage across ALL plan types
True
What is the hybrid-like option for EHSI?
Level funded:
- technically self-funded, but with extensive stoploss coverage (mitigates risk from catastrophic claims)
- oftentimes small firms like this because they want self-funded benefits (If sold to employer with < 50
employees, they won't be subject to ACA's rating and benefit standards)
- employer makes a set "level" monthly payment to administrator (kinda like a premium)
- administrator uses this $ to fund a reserve acc for claims, admin costs, stoploss coverage premiums
- not subject to state insurance regulations
- big jump in popularity these days (explain the adverse selection implication)
