PHP 0310 Lecture Notes - Lecture 5: Forego, Risk Pool, Co-Insurance
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4 Feb 2017
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Premium: amount you pay to purchase insurance: comes out of paycheck (if employer-based, monthly bill (if individual insurance) Deductible: amount an individual/family has to pay out of pocket each year before insurance takes effect: high deductible health plans, first dollar coverage: first dollar coverage. Co-pay: fixed amount that insured person has to pay at the time a service is provided ($) Co-insurance: a fraction of the cost of a service that insured person has to pay (%) Counterbalancing moral hazard: balance or tension. No insurance/poor insurance: little protection against financial losses. Too much/poorly structured insurance: unnecessary or wasteful utilization. Rand health insurance experiment (1980s: textbook p482 or http://www. rand. org/pubs/research_briefs/rb9174. html, study of the impact of cost sharing on utilization and health outcomes, patients and families randomized to different levels of cost sharing, followed 3-5 years. Levels of co-insurance: 0, 25, 50, 95: outcome: the higher the co-insurance %, the lower the utilization of services.
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